I’m a cardiac physiology student, the teachers just say what is seen on the ecg, but don’t explain the mechanisms. Thank you so much for explaining this with enough detail, but in a simple, clear and easy to understand way.
الله يسعدك ادي صرلي بدور ع شرح لافهم هالموضوع، شو هالابداع رائع ما شاء الله❤️ Amazing, i have never ever understood it before, u have just explained it too smoothly, professionally and make it really easy, may Allah bless you ❤️ Plzz need more videos for other topics
ويسعدك 😊 My pleasure to help! In Shaa Allah, I'm planning on making a video about somewhat advanced ECGs like Sgarbossa criteria, Wide QRS tachycardias in practice (Brugada algorithm)...etc. But I don't know when 😅.
Amazing explanation.Just Excellent.I was finding for proper explanation of ecg changes in hyperklemia and hypokalemia so long ,but did not find anything like your vdo.May God bless you .Hope you to make more and more vdos and enlightesn us.
Hey, a awesome way to explain such a complex topic.thank you. Just a doubt,in hypokalemia,potassium is low inside and outside the cell,if that is the case the normal intracellular pot levels are 40 times more than extracellular ,even if it gets low ,still there is a good gradient ,but then why is potassium exiting slowly ?
My pleasure to help ^_^ The way i understood it: that it doesn't flow out "slowly" by an absolute sense, but rather relative to the speed it usually flows with which leads to a lower T-wave amplitude in mild hypokalemia. Only in severe hypokalemia it becomes very slow that it's undetectable by our leads meaning "flat" T. But you're correct in the concept that there IS still a gradient even with lower K. ..... Additionally: some types of hypokalemia reflect actual store depletion (meaning lower intracellular levels) which can be seen better on ECGs, while others are just a shift EC --> IC leading to no ECG changes ;)
Dr, so many textbooks talks about how hyperkalemia causes increase in RMP due to potassium struggling to move out during repolarisaion. This makes me wonder how repolarisation is rapid in hyperkalemia since its difficult for potasium to move out.
As far as I know, potassium doesn't really struggle to move out, but rather opposite. That's because when we talk about hyperkalemia we mean increase in both intracellular & extracellular K+. We know that K+ in blood is around 4mmol and in cells around 100mmol, so when hyperkalemia occurs then the extracellular concentration becomes 6-7 AND intracellular becomes 150-175 (increases by ratio/folds). That's why the intracellular increase is much more than in blood which makes it so easy as gradient between 150 (in) and 6 (out). I hope I could get my idea across. Sorry for sooo late reply 😅
there is a big blunder in this....atrial waves (p) on ecg are not the nodal depolarization but the depol of atrial muscle (that is similar to ventricular muscle graph)
doc...see how in this the atrial muscle graph is not similar to sa nodal graph is what i mean but while explaining you explains p wave with sa nodal graph which is incorrect........now i might sound like a prick here with this but your explanation for rest of the ecg was awesome ...best one out there ....helped me a ton
@@roadrunner651 You're right. I mixed up the action potential for SA node with that for atrial depolarization. They're not the same. Thanks for correction 👍👍
By your logic shouldn't the QT segment be Shortened in Hyperkalemia? Since Repolarisation occurs faster? Also the Repolarisation is the efflux of potassium ions and not the action of the sodium-potassium pump... I believe this to be the source of the error
It prolongs also by different mechanisms than hypokalemia. (Keeping in mind that QT = QRS + ST + T duration). Despite the repolarization being stronger and faster: 1. Due to QRS prolongation. (Difficult for Na to flow into cells). 2. The amount of potassium ions is bigger therefore it takes longer for restoration till resting potential (via Na/K ATPas which is limited to 3 by 2 ions) to occur.
@@PathophyswithMac I had always assumed that the T wave is only the potassium going out of the cells. Does it also include the action of Na/K pumps? This is why I am getting confused
@@siddhanthravichandran3245 Correct. T-wave is only potassium efflux, but if we're talking about all QT time then as I said it has many components which can lengthen it. Na/K ATPase can be seen as the TP duration (or T-QRS).
No. QTc should be longer actually. Unless it's a very mild hyperkalemia where the ECG isn't affected that much and the patient has short QT since before.
