Antiarrhythmics (Lesson 6 - Digoxin, Adenosine, Atropine, Isoproterenol, and Ivabradine)

[@kreilexijudaya24]

u'll know when a person is intelligent the way one discusses something. he is one of 'em

[@adafung8789]

Thank you so much for your wonderful lectures: always precisely clear and easy to understand.

[@Sh0a1bSaj1d]

Thankyou for all the videos , they were all so very helpful for me to understand everything!

[@SenthilKumar-wp6jl]

Eagerly awaiting your last video of the series sir. The ones thus far have been top notch. Thanks a ton :)

[@StrongMed]

Will be posted in 12 hours.

[@Gorillarevolta]

6:15 - pardon my ignorance but how can you tell if there is complete heart block with AFib if you can't see P waves? Is it to do with irregular qrs complexes? Thanks

[@StrongMed]

This is a common question! We actually have an example of a-fib with complete heart block built into our medical school clinical reasoning curriculum, and it trips people up every year. In a-fib, there are multiple competing waves of depolarization traveling through the atria which bombard the AV node at irregular intervals. Sometimes the AV node is still refractory, and sometimes it is not, but the net consequence is an irregularly irregular pattern to the ventricular depolarization and QRS complexes. So when you see an EKG with fibrillation waves of a-fib but regular QRS complexes, those QRS complexes cannot be the result of a-fib being conducted through the AV node. Instead, the signal that leads to those QRS complexes must originate from somewhere below the atria. So if the QRS complexes are regular and narrow in a person with a-fib, the person has complete AV block and a junctional escape rhythm. And if the QRS complexes are regular and wide in a person with a-fib, the person has AV block and a ventricular escape rhythm. It's a little easier to conceptualize if you keep in mind that what the atria is doing and what the AV node is doing are independent of one another. This is a little more advanced, but one could also have a-fib simultaneous with ventricular tachycardia, but in that case, the rate is usually fast enough and the ST/T abnormal enough that the presence of the fibrillation waves of a-fib cannot be detected from a conventional EKG.

[@Gorillarevolta]

@@StrongMed thanks for the in depth answer. I appreciate it

[@nkandumusakanya4098]

I can't thank you enough for the knowledge you share. I really enjoy your talks

[@khadijahanis]

may God bless your soul for making it easy for us to understand

[@sunving]

Thank you Dr Strong! You are a wonderful teacher. Ivabradine might be slow to pick up or adopt by General practitioners or even internist. May be like a new first line to treat hear failure with reduce ejection fraction , was not wildly adopted. I think :)

[@alisonchandler1358]

Really looking forward to your next video !! these have been great!!

[@mdmojammelhoquemohim1378]

Dear sir, thank you so much. May I get the link of "mechanism of arrhythmias"?

[@michaelmcintyre6414]

Thank you, One question. Should digoxin be given with hyper parathyroidism? My blood calcium is 11.1. Thanks again

[@StrongMed]

I'm sorry, but I cannot provide specific, individualized medical advice here, and recommend you ask your own physician. However, in general, hypercalcemia (high calcium) caries a theoretical increased risk of developing digoxin toxicity.

[@michaelmcintyre6414]

@@StrongMed Thank you, I understand. ECG has Osborne waves, short ST, and widened QRS. And they are calling non compliant because I don’t want to take digoxin. I’m starting to think, the digoxin might have killed off my myocytes. Parathyroid surgery soon, I hope. Thanks again, regards to all

[@rustyzi345]

Firefighting videos have heavy metal intro music and EMS and medical videos have classical music and jazz intros. You see the difference in culture.

[@StrongMed]

I actually alternate between classical and metal: kzbin.info/www/bejne/pWO9gZqGZa2Kia8

[@sunving]

thank you very much Dr Strong

[@samliu8908]

Fantastic thank you for summary

[@divyac67]

Very nice

[@shif442]

great when will the seventh lesson will be uploaded and what will be the next series of videos?

[@StrongMed]

7th lesson will be posted in the next couple of days - just need to record the narration. Upcoming videos over the rest of the summer will include a final one on appraisal of clinical trials, kidney failure, abdominal X-rays, and 1-2 "advice" videos. A few maybes include another on EKGs, SOAP notes/presentations, and cognitive bias.

[@shif442]

Strong Medicine great i think fullfilling the wonderful ecg library would be most helpful for everybody thank you very much

[@StrongMed]

I would love to finish up the ECG series, but at this point, my limiting factor with more ECG videos is finding good examples. Since I've exhausted all of the common and left-than-common diagnoses, I'm mostly left with the rare stuff which I need to wait around for.

[@shif442]

Strong Medicine life on the fast lane or ecgacademy.com

[@StrongMed]

You mean, which of those two do I like as an additional resource on ECGs? LITFL is great. I think of LITFL's ECG material as more of an atlas/encylcopedia, whereas my videos function more as a video textbook. In other words, if you have a specific diagnosis you want to learn more about, then LITFL is perfect. Whereas if you just want to learn more about a broader topic in general, that's what my ECG videos are best suited for. I don't know much about ECGAcademy, and the guy behind it might be an awesome instructor, but I'm not a fan of any med ed site that charges for information/resources that are available elsewhere for free.

[@draslam921]

Superb

[@albarone87]

Thank you, thank you😊

[@ahmedmaher8400]

Excellent

[@Елена-щ5п5д]

Thank you

[@ШавкатжонШухратович]

Thanks explain well

[@KingTiger10588]

omg thank you soo much!!!

[@bhishma99]

Awesome!!

[@muhammadfawad4094]

Why hypomagnesemia increases digoxin toxicity?

[@WhyNot-si4pj]

Possibly due to the intracellular role of magnesium as a cofactor of the phosphokinase enzyme in (Na/K- ATPase) pump ; which makes the pump kind of (magnesium - dependent) in order to release the energy required for Na/k countertransport upgradiently . As digoxin's mechanism of action works through antagonizing the (Na/K- ATPase) pump , hypomagnesemia would augment digoxin's toxicity ! God knows best !

[@wingcastles]

Why digioxin is DIGOXIN

[@nimrahali3796]

Extremely helpful! THANK YOU SO MUCH. I wanted to request to kindly record videos on "Drugs used in heart failure" and "Abdominal X-rays" if possible. Thanks Again GOD BLESS YOU.

[@StrongMed]

I'm planning on covering abdominal X-rays later this summer. Treatment of heart failure is on my list, but a bit further down. Realistically, probably not until next spring.

[@umairahmad4711]

Interesting for a 15 year old

[@umairahmad4711]

For my self