Rate and Rhythm | Atrial Fibrillation and Atrial Flutter

Ninja Nerds,
Join us for our Electrocardiogram (ECG) playlist. During this lecture we will continue on rate and rhythm and discuss atrial fibrillation and atrial flutter. Download the template below to follow along and learn how to calculate rate, interpret rhythm, and observe for any abnormalities within this real 12-lead ECG strip.

ECG strip: Jason Winter @ ECG Educator

DOWNLOAD the Atrial Fibrillation and Atrial Flutter templates to learn while you watch!

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[alyssadeguzman]

Your videos are ever so useful! Just wish you could make the pointer more visible. Sometimes it's difficult to keep track of where you are pointing 😅

[beatriceportento]

If anyone is wondering how he got 300 for the atrial rate for A-fib, the pointer is by V1. 7:25 - 7:33

[estherlively]

Honestly, I am currently in PA school right now in our Cardio module learning about EKG through ZOOM due to COVID-19, these videos are literally SAVING me from a lot of headaches because I did not understand what our professor was talking about. THANK YOU for making learning EKG fun and totally understandable. I WILL CONTINUE to donate and support your gofundme page since I will be on this page for other modules as well. It looks like these EKG videos are pretty new, and it couldn't' have come at a better time. THANK YOU SO MUCH and continue to post during these trying times. They say doctors save lives, well you save our lives or any future health care by sharing your amazing knowledge with us

[stephendurling]

These videos have first helped me to get introduced to a particular topic, and incredibly these same videos further my basic understanding into a more broad and thus useful tool to care for patients. Two Ninja thumbs up!

[sruthik]

After so much of hunting finally found this ninja nerd science ... its really really useful .. ur patience ur diagrams, thank u sooo much pls don’t stop ur good work

[kazeckr]

difficult to follow where you're pointing at
wish the cursor could be bigger and you can zoom in the particular place during your explaining

But really thank you!!!!

[siavasilopoulos]

Thank you so much for the video I’m studying for my ACSM CES exam and I need the review the last time I learned a EKG was 7 years ago. This is refreshing

[georgepaul]

It's awesome to finally see this series

[BakrAli]

1. Rate: normal, tachycardia, bradycardia
2. Rhythm
- R-R interval: regular, irregular (almost always a fib, multifocal atrial tachycardia, ectopic rhythm like some aberrant conduction like PAC PVC)
- P wave: sinus (II +, aVR -)[if inverted: lead misplaced, dextrocardia, ectopic rhythm], ectopic (atrial ectopic rate > 60 abnormal p wave or retrograde), junctional (AV node rate 40-60 might be retrograde p wave too cause might be SA node damage), idioventricular (Purkinje fibers rate 20-40 looks like PVC also it might be accelerated to a rate of 60), if irregular and no distinguishable p wave look for fibrillatory waves in V1 or II then it's a fib. If not sure about II look at III avf, saw tooth abnormal p wave is atrial flutter F wave
- P -> QRS: AV association, heart block, AV dissociation (if no p wave then it is dissociation), Ratio of p to qrs 3:1 (dissociation) or 1:1 (association)
- QRS: narrow, wide (VT, junctional rhythm, aberrant conduction down the bundle branch system)


Remember rate means ventricular rate

Rate
60 100 normal
100 150 tachycardia
150 250 SVT
250 350 flutter (Atrial or ventricular)
350 450 fibrillation (Atrial or ventricular)
Ventricular flutter almost always progresses to ventricular fibrillation


Irregular rhythm narrow QRS and fibrillatory waves in II V1 no p wave = a fib
A fib has rate of 350 450, we ar talking about atrial rate here


P wave like Saw tooth = flutter
Ratio of p to qrs 3:1 or 1:1
Most common ratio is 2:1

Typical a flutter = Saw tooth is upward in V1 and downward in II III avf

[nathaliaschramm]

You could make videos analyzing X-rays. To interpret them is very difficult sometimes too.

[Hebayousef]

Your ECG videos are the BEST, thank you 🙏🏻

[thefenerbahcesk]

I have a final about this next week. Thanks for being there as always.

[momolulu]

so far your videos...are one of the best...helping a lot students...to understand the pathophys of many subjects...

[filipafalcao]

i already searched for so many ecg videos and these are definitely THE BEST! Thank you so much :)

[MaroonGoone]

Dang it can be so hard to see where he is writing/pointing i.e. at 7:21

[donnanewkirk]

It would be awesome if you could project those EKG's on the whiteboard so we could follow you easier. I'm a VERY visual person and watching you draw things is SO helpful!

[dennypaul]

Great Lecture! My only comment is that when you are showing a point on the graph that is small it is sometimes difficult to see where you are.

[gcflupis]

Very clear explanations!!! Thanks a lot 🙏🏻🙏🏻🙏🏻

[Zetsuke]

I learned so much this is the best way to teach this honestly

[reggiepalmer]

Great to know because I have been suffering with this for 20 years😖