That's a great question! I usually spend a few minutes talking about this specific point when I teach this topic in person, but I guess I inadvertently left it out here! The term "SVT,"is actually a bit problematic. Semantically, it would seem to include all tachyarrhythmias other than VT (including sinus tach), but no one uses it in this way. Most PMDs, most subspecialists, most nurses, and some hospitalists use "SVT" to encompass a-fib, a-flutter, atrial tach, AVNRT, and AVRT (among other rarer rhythms). On the other hand, almost all cardiologists, most critical care docs, and most anesthesiologists use "SVT" to encompass a-tach, AVNRT, and AVRT (i.e. leaving out fib and flutter). The reason they do this is that this latter group of rhythms act decidedly differently than fib and flutter, don't require anticoagualation, are relatively difficult to discern from one another (unlike fib and flutter), and usually warrant cardiology referral if recurrent. In other words, the clinical and practical similarities between a-tach, AVRNT, and AVRT are much greater than between those rhythms and fib/flutter. My personal recommendation is to use the term "SVT" as cardiologists do (and how I use it in the video), but to understand that other clinicians may use the term more broadly, which isn't necessarily wrong.

@@StrongMed those are fair points-thank you for the explanation! =D

@@StrongMed also once more for good measure-thank you so much for taking the time out of your busy schedule to make videos like these! I'm a student currently rotating through medicine and these videos have been nothing short of a blessing for my friends and me. 🙏

@@MayuraVyamsaka You're very welcome!

Thanks for your kind words. I'm very glad you've found the videos to be helpful!

mitotianiMartin Good luck with that! A nice thing about recording these videos instead of presenting them in person is that I can go back and record a section again if I can't get the words out.

Thanks for your interest! Unfortunately, the advanced EKG videos aren't up yet because I haven't created them yet! (I post videos as I create them.) I will likely be posting one advanced EKG video every 1-2 weeks over the summer and into the fall until they are completed, interspersed with other topics.

+Moises Lima You're absolutely correct that the RR interval in a-flutter is usually an integral multiple of x, where x is usually ~200ms. However, when we talk about the "regularity" of the rhythm, we categorize it based on the consistency of the RR interval. If the RR interval is always the same, it's "regular". If it varies according to a predictable pattern, it's "regularly irregular". And if it varies according to an unpredictable pattern, it's "irregularly irregular". In some cases of a-flutter with variable block, we may know that the next RR interval will be a multiple of x, but we don't know what multiple it will be until it happens, and therefore, it's classified as "irregularly irregular". There are other instances of a-flutter with variable block with a consistently repeating pattern (usually 4:1 block alternating with 2:1 block - as seen around 12:20),, in which case it would be referred to as a "regularly irregular" tachycardia.

This is exactly what I was thinking at this point as well and I'm sure I wouldn't know how to differentiate them either. I'd love to have an explanation for this

pynzie Sorry, they have been created or posted yet. Hopefully I will get to them over the summer.

Megh o Roddur, thanks for the feedback, and thanks for watching! I'd love to do a series on echo. Unfortunately, a major obstacle is that echocardiography falls much further away from my usual scope of clinical practice than EKGs (and other topics already posted), and thus, I would lack sufficient authority to make a high quality and trustworthy series at this time. Also, the barriers to recording, transferring, and displaying patient echos on KZfaq (e.g. software compatibility, privacy issues, and actual ownership of the echos) are much greater than with EKGs. I hope to post videos on echos someday (after I've had time to learn more myself), but sadly, it won't be in the near future.

Eric's Medical Lectures I would like to ask you to make videos on clinical pharmacology as well. Thank you very much in advance. Very useful!

P. Aliyev Phramacology is definitely on my list of topics to cover. Unfortunately, the list of requests from viewers has grown long, so I can't make any guarantees of when it will get posted, but I promise it will at some point. Thanks for watching!

>Is the P wave in atrial tachy abnormal unlike in sinus tachy where the P wave should be of normal morphology ? Yes. Also, even if the P wave during the arrhythmia looks normal in morphology and axis (i.e. upright in II, downgoing in aVR), you should also make sure that it looks identical to the P wave of the patient when at a normal rate (if a recent baseline ECG is available). Atrial tach can occur from a ectopic focus very close to the sinus node, leading to an ECG which looks like sinus tach when examined in isolation, but only becomes noticeable as something more abnormal when the comparison is made.

Kal. Jr It's not so much a mistake as it is suboptimal terminology/convention. There are 6 flutter waves for every 2 QRS complexes (some are less visible than others as they are occurring simultaneously with QRS complexes). It's typically described as 2:1 alternating with 4:1, though in reality, it is more like 2.5:1 alternating with 3.5:1. The reason for the inconsistent flutter wave to QRS relationship is probably because of a Wenckebach type phenomenon occurring in the AV node. Although it would seem that this pattern is super specific and very rare, in reality, it's not all that uncommon, and may be the most common form of "a-flutter with variable block".