ST Elevation and ST Depression EXPLAINED

[@warmflash7]

OMG....I have never heard anyone explain the biophysical basis for ST depression and elevation so clearly and simply! Some of us learn better by learning the mechanism of things, but that not how things are taught generally in medical education, where instead it’s often “this is what you beed to know. Dont worry about why, unless you become an electrophysiologist.” Thank you!

[@CA-mk4hp]

God bless this mustached man helping me understand how to do my essay.

[@khan6004]

😂😂😂

[@hassinayazid99]

Amen! Lol

[@nicolecarswell4113]

I had to come to the comments to write how amazing Dr. Mustache is to actually get me to UNDERSTAND the why's behind this. This video was beyond helpful.

[@happyvibes722]

🤣🤣🤣🤣 you make me laugh by moustache

[@siliconesal]

Moustachioed - lovely word !

[@شذىنضال-ق7ه]

I spent 3 years in my medical school journey trying to understand this proplem and you explained it in 16 minute and i really fully understood it thanks a lot and god bless you

[@lukasx543]

I guess you didn't Google it once in 3 years.

[@gfivefour]

​@@lukasx543 I'm sure they did but couldn't find anything/anyone that explained it well enough. it was the same for me so I get what they're saying.... I've looked at so many things but no one explained it as well as these docs did.

[@katelynreilly5394]

this may be the single best video I have ever watched

[@akshayvarahamurthy8743]

Thank you 🙏

[@jaquelinemanuel5716]

Your lecture is SOOOO GREAT! I know what ST elevation and ST depression look like in an ECG but I did not know what that really means but now I know. Thank you.

[@sarangjadhav7298]

one of the best explanation for st elevation and depression in a very simple way .

[@healthyhabitsfitnessforwom7595]

This is exactly what happens to me personally during my Vasospasms. I have numerous EKGs that show this exact process even when I have slight pain. Thank you for this explanation.

[@markwilliams2620]

Dr.....you have answered a question I have had asked everyone about for 9 months. Thank you! Insomniatic Monitor Tech

[@marleemurray6584]

After taking two anatomy courses and multiple exercise physiology courses you've just cleared up all confusion I've had about this topic in 15 minutes. Thank you so much.

[@desertdweller129]

Changed my perspective while looking at STEMI and NSTEMI . Thank you for the explanation .

[@breakinggreatness1010]

This was so good. All teachers should have this ability to teach, communicate and make difficult subjects easy for others to understand. Keep it up!

[@DV-bj9wi]

I just have been sent this video in the 5th week of my CVS block and man this was such a helpful and eye opening lecutre. Thank you so much for putting this much effort into making these videos so great. Your way of explaning and creative use of the board is outstanding! Keep doing what you do, you deserve 100 times the amount of subscribers you have! Thank you once again and I wish you all the success in the future.

[@kittylitterish80]

Amazing!! So glad that you guys do these videos. Couldn't find this info, presented in a comprehensible way anywhere else.

[@ryan_churchill]

Thank you so much! I've been so confused about this for weeks and just shared the link with my medical cohort!

[@DrMattDrMike]

Thanks Ryan! 😊 🙏

[@aestheticvibes7524]

@@DrMattDrMike sir please help, i am 20 years old,i have anxiety issue and did 5 ecg last year and came back normal but today i did ecg and during the test i was anxious and heart was beating fast and when the test was done the report said Borderline condition in 1.early repolarization and 2.sT T abnormalities..i dont know what it is and is it false report....please sir

[@evanhalpern3909]

I'm having a serious case of mustache envy at the moment. I feel the sudden need to overcompensate. Good video by the way. Very informative.

[@MSK-s7w]

Thank you for your great presentation. I think every cardiology fellows should watch your video.

[@Jrodrig1138]

When I tell you my mind is blown right now. I was never taught it this way and assumed it was just elevated because of something happening during repolarization. Until today when I decided to understand what is happening in the heart and ecg during elevation and depression. Thank you!!!!!!!

[@jaydenbeaini4761]

Best 16mins I have spent in a long time... finally makes so much sense!!

[@paulbieber7103]

I’m worried that I’m becoming addicted to your videos. Brilliant explanation. Thank you.

[@fedorfomin5759]

Hm, very logical and straightforward explanation. The only thing that is now missing for me, how this 'baseline shift' restores after repolarisation. If we have damaged cells in early depolarisation before the next QRS cycle, we should see some changes on the T-P segment

[@nickdoan4895]

Agree. Please explain. Sir.

[@Dr.bhushanbhole]

Refractory phase

[@jasonchan275]

Spent half an hour om this video and now I understand it. Thanks so much!

[@lunaeve711]

My professors need to watch your channels to learn how to teach. You explain so well. I love you so much!😘😘😘

[@jordanpope9096]

I have been trying to understand this concept across 2 degrees and have just now made sense of it thanks to this video. Thank you so much!

[@twinklelight1362]

Wow now In understood why is it St elevation and depression! Thank you so much for this highly- educational video! 👏👏👏❤️❤️❤️

[@pouyanrazminia2996]

One of the best explanations for ST changes following ischemia! Thank you so much!

[@lionnelberinyuy8438]

Very helpful. I'm a beginner in ECG reading and interpretation but I must confess that I have learnt a lot from this video. Thank you sir

[@Demon1987AS]

Wow. So simple! A question I’ve had for years finally answered. Thank you!

[@ltfextreme6506]

I can’t comprehend how this channel is soo underrated!

[@kaleemwhitmore7877]

Thanks you Dr . You is the ONLY person gave me this clear understanding in ecg and subtle understanding of axis deviation. Thanks one love

[@israchan4474]

I ALWAYS wanted to know this but never found anyone explaining it. tysm!!!

[@A.Hemashreeanand]

Your explaining very well!!! sir ..hats off sir👑...🙏🙏💐really a great great teacher...I had ever seen....🔥

[@pilaringham3031]

WOW best explenation ever, not found in most books. THANKS now I can continue learning the resto of cardiology :)))))))

[@Santy_4799]

I was quite upset as none of the books provide an explanation for this phenomenon. Thank you for your wonderful presentation.

[@rebeccawan3088]

YES. So many resources only tell you what the ECG indicates but not WHY or the pathophysiology behind.

[@rebeccawan3088]

And my med school only have one lecture on ECG with NO teaching about cardiac pathology. We have to learn everything ourselves. Online resources like this is a god savior.

[@Santy_4799]

@@rebeccawan3088 Yup, same here in India

[@rashifarsya]

I know right! Lol!

[@Promiseland2024]

Oh how i wish you were my nursing instructor. You explained that so well! Thank you so much 💓

[@SebnemEgriboyun]

I'm a medical student and I was struggling to understand this, thank you so much!

[@nj2552]

AH! I love learning something like this that just fits in with everything else I've learned and just fills the gap as to why it is. Great clip!!!

[@Juliana.Nyarko]

Oh my days, where have you been all my life thank you so much for your video I’m already understanding how myocardial infraction works.

[@PabloSanchez-ih8eo]

Great explanation Dr. Mike! Have been looking everywhere as to why subendocardial ischemia leads to initial elevation of the isoelectric point..

[@normaesquivel6575]

Even though it takes effort to understand cardio, I like listening to you, and that makes it easier! Thank you 💗

[@aditirawat4560]

This is just mind blowing how u explained it. Just the best 👑

[@dharvisondhi6931]

This is awesome!!!!.Never understood this concept before....Thanks a load Dr. Mike

[@rg8276]

This one video explanation was enough for me to subscribe!

[@HabibKhan-kz1tx]

God bless this energetic man.

[@DrMattDrMike]

You too!

[@johannliesner6659]

BRILLIANT EXPLANATION, thank you!!

[@jspriver]

Not bad dude. No bad at all. As an old medic 12 leads were not a thing in the field and I never learned them. This has cleared things up a ton thanks

[@robinsonn94]

If potassium leaves the cells due to the decrease in ATP and it not being able to prevent the K+ channels from opening, wouldn’t the cells become more negative? I get what you’re saying with how it would slow the concentration gradient, but we would still have less K+ in the cell from the open channels releasing it into the ECF? Or are you saying the increased K+ release from the ischemic cells would cause a decrease conc. Gradient for the healthy myocardial cells to release potassium, causing this increase in threshold?

[@nu.wa.n]

yeah that part didn't really make sense. I guess a constant leaking of Potassium is required to maintain a resting potential of -90mV. Also, i think a lack of ATP means the Sodium-Potassium atpase that usually brings in potassium is also not functioning accordingly. it's a complex situation where the resting potential is more positive than in a healthy cell.

[@Baraa.K.Mohammad]

I think it's all about putting in mind these two factors: the temporality and the bigger scope (i.e. this being an scene inside a tissue rather than just a single cell), think of it as there are two groups of cells those which have already been severely damaged and those who are getting affected by what's happening to the former group of cells... the cells which have ATP deficit are throwing Potassium out, this leads to bigger Potassium concentration outside in comparison to what it's supposed to be, but also you have other cells which still have ATP and have normal channels that allow Potassium to leak out, these cells can NOT make Potassium go outside because there's already so much outside (from the cells that have already been damaged) and thus their resting membrane is less negative as a result of so much (+ve) Potassium inside, this will make these cells "more depolarized" than the rest of the myocytes! The temporality factor which I mean is simply to remember that every ECG reading is concerned with particular phase of the Ischemic process, ie these changes have a period of time where they take place in, which is obvious as you know that early on in Ischemic process the ECG might be normal and that the ECG of a myocardium undergoing ischemia changes overtime AS IT'S undergoing this ischemic event.... I think about it that way, I don't know if it makes sense but for me that's how I can keep this concept straight!

[@dr.shadmbbsdphmasco]

Nope Remember this concept Cells at RMP or at rest means +ve outside and -ve inside if an action potential means then -ve Out and +ve in

[@dr.shadmbbsdphmasco]

@@nu.wa.n actually due to the electrochemical driving force for K+ will drive it out of the cell in small percent even at rest its temporary and inorder to compensate for that only Sodium potassium pump functions here its lost so More potassium leaked before during to the opening of K+ channels due to lack of ATP since the K+ conc outside became more positive so the concentration gradient has decreased so less K+ leaks out which makes it more positive inside and outside too

[@saadyasir10]

Didn't know Fuse from apex had an education Channel Been struggling with this for so long.... Love this ❤❤❤

[@Juliana.Nyarko]

You are literally so alive thank you so so much

[@zahraasalim2739]

Wow, I finally understand it! This is a really wonderful explanation. Thank you so much.

[@jessebassett5865]

thank you so much this finally started to make sense after weeks of trying to get my head around it thank you again

[@brianchen8809]

you save my license test, how lucky i am can come across this video. thanks way more a lot

[@christapenman4240]

Thank you for such a great video. I've been searching for this very explanation down to the cellular level of STEMI and NSTEMI

[@herbaboa]

Such an elegant moustachy understanding of a very efficiently explained concept so confusinggly everywhere else

[@AT-yj8gl]

No dr Mike you do not understand I have been looking for this explanation for the past 3 days day and night and it has been driving me crazy. Like thank you so freaking much my Australian professor

[@chorvang9670]

Dr. Mike, what a wonderful presentation. Thank you sooooo much!!! Please, can you do a video on how to read an EKG and 12-lead EKG printouts?

[@sycho_saya]

in a nutshell >> its the shift of isoelectric point, either high(in ST depression) or low (in ST elevation) makes it appear as ST elevation/Depression. ST elevation- subendocardial ischemia ST depression- transmural ischemia/infarct thank you man, thats pretty simple, lots of love...❤

[@Irisjohnnylee]

Doing clinical exercise physiology and revising some basic concepts for indications of terminating exercise testing. This is such a good simple explanation thank you!!

[@zakirzak1494]

Another great video... thank you 🙏 Your videos make things easier to understand

[@nicolecarswell4113]

Thank you thank you! This was beyond helpful it helped bridge the gap between what it means when I see it and what is actually occuring to make it that way. Can't say thanks enough

[@eyaayadi9053]

i had no idea! I was looking for this video for a while and I m glad that I found it! thank you so much

[@Yamudu369]

you are god sir...thank u for clearing concept n making it easy

[@siyabendunus6443]

Tank u so much! Great video, great teacher. Was a pleasure to listen to ur passionate explanation!

[@Baraa.K.Mohammad]

Thanks for the explanation! This is a very good video to explain this concept and I liked it all until 13:22 which was very anticlimactic for me to be honest. The "it doesn't care about this part" is just a huge gap that's not less confusing than the fact that the Ischemic part is actually uplifting the Baseline... (i.e. why doesn't it "the electric events and readings" care about these cells right now and yet they cared about them in depolarization?!)

[@AhmedOsamaZayed]

did you find a better explanation?

[@Baraa.K.Mohammad]

@@AhmedOsamaZayed Nope... I hope you were luckier than me and did find something during these 4 months... lol!

[@Baraa.K.Mohammad]

@@AhmedOsamaZayed Nope... I hope you were luckier than me and did find something during these 4 months... lol!

[@Hossam_1993]

I saw two videos of him without mustache now I am watching this, this is so hilarious if you are not used to see him with mustache.

[@code3toepain]

This is a fantastic video. Great job Doc

[@johnikadougan8585]

I finally understand this! Thank you.

[@tbrooke1234]

You are AMAZING. so many things coming together for me with your videos. Thank you Thank you Thank you

[@anp2920]

This man is the best in medical teaching in youtube!

[@yuriko189]

I have been looking everywhere for this explanation. Thank you so much for this video Dr. Mike. It cleared things up for me.

[@bishalmandal7754]

Thank you for this proper explanation!

[@bhavyathakker9488]

Need more teachers like you 👍👍👍

[@carnage3694]

Thank you I was looking for this concept

[@tomwinkler294]

I didn’t quite get why would a resting membrane potential of -50 lead to the fast acting sodium channels not opening up (they were supposed to open up at above -70 so they should be open). Also didn’t understand why would the repolarization happen earlier.

[@tenythomas5842]

the concept is very well explained . But I got a doubt about the early take-off from the isoelectric line, will you able to explain this a bit more please. because I never noticed this on an ECG.thank you.

[@nickdoan4895]

Yup, I am waiting for his explanation. And it would be nice if he draw, at least 3 cycles of ekg.

[@User-to7nb]

I opened this, heard Dr.Mike, and yelled "you imposter!" (inspired by the mustache) now here I am giggling instead of studying

[@supot707]

No. I think he is really smart and a muscular man.

[@jpdigerolamo]

So well explained while going thru my arrhythmia course. Thanks a lot!

[@saraadiba5861]

Amazing!please make more videos like this,basic is explained so nicely!

[@hinnypinny]

🤯 You're a fantastic teacher. Thank you!!!

[@jesslugsdin677]

This is great! Revising for ACEM primaries and your videos are perfect - thank you.

[@tiffanywilliams4781]

Amazing! I have a question. Why doesn’t the P wave appear far lower than isoelectric line if the sub endocardia ischemia is raising the line? Why does the P wave start on the same line as the raised isoelectric line? Shouldn’t it be in line with the ST depression as it isn’t being affected by the ischemia?

[@himaanshubhatt]

Dr Mike I have a question.If in place of assuming all about that k+ let's say the ischemic tissue doesn't get enough ATP.So the Na-K ATPase no longer works(which was initially helping the cardiac myocyte maintain its -90mV RMP).It further results in a loss of gradient for K+ to move out from the cell.So less K+ moves out making cells more positive.Am I going on the right track or am I missing something here ?

[@DrMattDrMike]

Absolutely.

[@himaanshubhatt]

Thank you this video was very informative.Cleared my concepts pretty well!

[@dr.shadmbbsdphmasco]

@@himaanshubhatt remember like this Ischaemic cells have greater or higher permeability to ions so even at rest too it's in depolarized state when rest are at RMP

[@MsYaotube]

this was AMAZING - better than my medical school. WOW!

[@tomtankengine0]

So THAT'S how it works! Great lecture!

[@peppapig934]

So is it spontaneous depolarization in absence of SAN impulse in NSTEMI? or do we still need SAN impulse before depolarization but it just happens faster and repolarizes faster?

[@SSelenaTY]

you guys are great. glad I accidently found out this channel, which help me understand many concepts

[@gfivefour]

thank you docs!!! you explained it the way that I understand stuff.

[@wit9815]

this vis is amazing, oh my god, best explanation ever, thank u so so so much

[@christyjane3451]

Thank you for this Doctor!🤗

[@jerseyjeeper1575]

That was an awesome example, thanks very much.

[@victoragommuo7967]

Thank you for such an amazing explanation ❤️❤️

[@rachael4775]

i was feeling pretty down about this but you explained it sooo well. thank you so much!

[@sharonpadilla4878]

Awesome! Thank you very much

[@sprucemoor5194]

By far the best Ive seen so far, but as a man with weak facial hair growth, that magnificent mustche is making it hard to focus. Cheers to the down under from the northern parts of Scandinavia!

[@medii4469]

Best explaination ever..thanks🙌

[@susanjones3323]

Excellent explanation. Thank you.

[@ogulcankaplan2360]

Great explanation but I wonder how you would explain reciprocal changes in a STEMI with this mechanism. That still confuses me

[@dr.shadmbbsdphmasco]

Vector direction only

[@chrishutchison621]

This was such a good way to explain shock

[@snazzydarcyreads]

Yes SIR! Thank you so much!

[@Namiiii1004]

This is so cool! very helpful, thanks!!

[@elisearmer8306]

What does it mean when it polarizes *slightly* then immediately depolarizes, then immediately repolarizes - two sort repolarization/depolarizations per heart-beat cycle with *each* of them being very slight.

[@nikunjkumarkanani9018]

Thank you sir for teaching me this concept😊