ECG interpretation, arrhythmias

Most likely old new to many of you but interesting for newly or relatively newly afflicted like me.

Googled: Dr Najeeb and listened to ECG Interpretation 1-8 & Cardiac Arrhythmias - Aterial & Ventrical Fibrilation

It took a few hours but answered sooo many questions to make the time worthwhile. His train of thought is very easy to follow. But i realize that non technically/interested people might find it useless.

The most difficult part is making the required diet/life-style changes to get relief or possibly some degree of healing - as long as the cause isn't genetic?

Looks like a good series if you want to learn the basics of ECG interpretation.

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Joe
The most difficult part is making the required diet/life-style changes to get relief or possibly some degree of healing - as long as the cause isn't genetic?

The cause is probably genetic for all of us. Consider this: The vast majority of the population has all the same lifestyle issues we do and yet the vast majority of the population doesn't have afib. Also, the afib world is full of super health-conscious, fit people, and yet they have afib anyway.

I think you can make things better with lifestyle changes, and you can even achieve some degree of control with more extensive measures, but ultimately you come down to a choice between drugs and ablation.

Joe - There have been previous posts on the topic of genetic influences for Afib. I’ve listed a couple of the links to those.

Keep in mind that it’s the expression of the gene that can be changed or influenced and that goes to the lifestyle factors we've discussed...called the field of Epigenetics. The progressive doctors who are using this method to change the risks of various health issues are typically not given the credit they deserve, but there is a lot of evidence for those who are having great success. It's often said this diverts megabucks from BigPharma so it discredited whenever possible. I am not aware of any doctors doing this for Afib but those afibbers who change lifestyle habits aggressively and stave off their initial AF onset from further progression AF such as GeorgeN, Dean, Fran, Erling and many of the people in CR 61 have found a way to change the genetic expression through Epigenetics.

It's certainly worth trying because there are so many additional health improvements as well.


[www.afibbers.org]

[www.afibbers.org]

[www.afibbers.org]

Jackie

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Carey

The cause is probably genetic for all of us. Consider this: The vast majority of the population has all the same lifestyle issues we do and yet the vast majority of the population doesn't have afib. Also, the afib world is full of super health-conscious, fit people, and yet they have afib anyway.

Thanks for saying to this. Being new to the problem I'm really struggling with the self blame... The "If you just lost the weight, you wouldn't have this problem" thought (I've always had weight issues)....
Or the " that's what you get for slacking on the exercise this last year" (I let new job stress erode my fitness plans)....
Or "the bread, it must be all the bread I eat" (BF makes wonderful bread!)....
Or " maybe I should have worried about my BP more when it was borderline" (my doctor wasn't worried)

But even knowing that I really don't do anything "more wrong" than most, and that I probably make more healthy choices than most... I'm still feeling overcome with self guilt.



Edited 1 time(s). Last edit at 07/11/2018 01:20AM by bolimasa.

You are the practical man, Carey. If all 'alternatives' fail ablation is the only option - agreed. I do think that the Professional heart specialists are to focused on drugs first. This is possibly a result of their training background, business model and also complying with treatment protocols to protect themselves?

Thank you Jackie for the links - great refreshers to read.

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bolimasa
But even knowing that I really don't do anything "more wrong" than most, and that I probably make more healthy choices than most... I'm still feeling overcome with self guilt.

One of my big pet peeves is EPs and other alleged experts who like to write articles blaming people for their afib. (A specific, well-known EP comes to mind but I'll forego mentioning his name.)

Sure, you can improve your odds of avoiding afib with healthy lifestyles choices, and sure, you can improve afib symptoms with lifestyle changes, but the reality is that most of us got dealt the card at birth and it doesn't take much deviation from a "perfect" lifestyle to end up in afib if you got that card. There's absolutely no reason anyone should feel self guilt because of their afib and the people who make money writing articles that suggest otherwise just piss me right the hell off.

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Carey
One of my big pet peeves is EPs and other alleged experts who like to write articles blaming people for their afib. (A specific, well-known EP comes to mind but I'll forego mentioning his name.)

Well known for an internet soapbox moreso than actual outcomes.

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wolfpack
Well known for an internet soapbox moreso than actual outcomes.

Exactly.

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Joe
Most likely old new to many of you but interesting for newly or relatively newly afflicted like me.

Googled: Dr Najeeb and listened to ECG Interpretation 1-8 & Cardiac Arrhythmias - Aterial & Ventrical Fibrilation

It took a few hours but answered sooo many questions to make the time worthwhile. His train of thought is very easy to follow. But i realize that non technically/interested people might find it useless.

The most difficult part is making the required diet/life-style changes to get relief or possibly some degree of healing - as long as the cause isn't genetic?

I'll have to read this... I just bought a small heart rate monitor and have been busily trying to figure out to interpret the traces...
Definitely not so easy...
It will tell me I have an arrhythmia, but I'm not convinced that is always Afib. When I'm off (most the time it seems), my rhythm seems be "irregularly irregular" (which I understand to be a hallmark of aFib) and sometimes I see vibrating oscillations that I think indicate afib, but many times I'm irregular but don't have oscillations, plus I often see the P wave which I thought was supposed to disappear when you are in aFib.

Can you be irregular but only see other signs of AFib in a couple of beats in a 30 second trace? I am certainly curious how to read these things, even though I'm sure it doesn't really matter cuz I'm kind of screwed either way!

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bolimasa
I'll have to read this... I just bought a small heart rate monitor and have been busily trying to figure out to interpret the traces...
Definitely not so easy...
It will tell me I have an arrhythmia, but I'm not convinced that is always Afib. When I'm off (most the time it seems), my rhythm seems be "irregularly irregular" (which I understand to be a hallmark of aFib) and sometimes I see vibrating oscillations that I think indicate afib, but many times I'm irregular but don't have oscillations, plus I often see the P wave which I thought was supposed to disappear when you are in aFib.

Can you be irregular but only see other signs of AFib in a couple of beats in a 30 second trace? I am certainly curious how to read these things, even though I'm sure it doesn't really matter cuz I'm kind of screwed either way!

Learning to interpret ECGs isn't something you can do on the fly. You can pick up some basics, but you're never going to get competent at it from casual internet browsing. If you really want to learn, sign up for a course. I'm sure there are online courses available, and maybe even a local community college has one.

To answer some of your questions....

Yes, irregularly irregular is the hallmark of afib. A normal rhythm is never irregular, so if you're seeing an irregular rhythm it's not a normal rhythm. The oscillations you mention could be artifact. Without seeing what you're seeing I couldn't hazard a guess.

It's true that you won't see P waves during afib, but seeing them at all with most consumer devices is difficult, at best. There are techniques to get better readings with devices like the Kardia, but you didn't mention what you bought so I have no idea how it works.

A 30-second trace is 3 times longer than a standard ECG, so yes, it's plenty long enough to see afib if it's there.

What device did you buy?

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Carey

What device did you buy?

I bought an Emay. An acquaintance of mine suggested it, and I liked the idea that it was a stand alone unit, and came with software so you can look at and keep track of traces on the computer. It is also advertised as recognizing 12 different types of events, which I thought might be good. so now my nerdy self is trying to figure out how to interpret. I get the impression more people like the Kardio monitor, though I don't know if there is a reason for that.

The thing I'm not sure I like is that it tells me I'm in arrhythmia, but what I don't know is if arrhythmia always afib.
Sometimes I think it is quite clearly afib, other times the trace looks a lot like my 'normal' trace but irregular.
I'd show you copies of traces... but I don't see a spot to upload pictures here.

Not sure this matters for any practical purpose... as it all means I'm screwed up, but, I'm curious.

Interpreting ECG tracings isn't easy, I agree. Small handheld devices are convenient, but there are numerous artifacts. The obvious (arrhythmias) is usually clearly displayed and it's the main purpose of those devices.
Some of them can be used with wires. You just stick two or three electrodes on your torso and connect the wires. It's trickier, but the tracings are far better (when the electrodes are placed as they have to be), with clear P waves if they exist.
I showed tracings from my Heal Force Prince to my EP, and he was impressed with their quality.

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bolimasa
I'd show you copies of traces... but I don't see a spot to upload pictures here./quote]

You post photos here by posting them to a photo hosting site, copying a link to the photo on that site, and then inserting that link into a post here using the "Insert image URL" button (in the middle of the row of buttons when you post, looks like a little picture of mountains). There are many photo hosting sites, but I like to use postimages.org.

As an example, below is a screen shot of me composing this post:

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Carey

You post photos here by posting them to a photo hosting site

Yeah I noticed that, was just being lazy... but since I have a minute while my cells spin...
I'm at work and don't remember my photo share account passwords, so I put the on an unused blog page:
Here's the link
If you click them you can see them better.



Edited 1 time(s). Last edit at 07/13/2018 03:43PM by bolimasa.

The first trace is clearly AF.

The second trace looks like NSR "peppered" with PACs.

The third trace is NSR. I'm estimating your HR at around 65 bpm. QT interval is good (some AARs can prolong that, which is bad).

As always, don't substitute my opinion for real medical advice.

Thanks.
That is kind of what I thought.
If that is correct, I'm a little disappointed in monitor because in the second scenario it just tells my I'm in arrhythmia, and I'd like to know is if I am in afib. Would the Kardio monitor differentiate between the two? Or is that why they have the subscription service to have your traces read?

The Kardia wouldn't tell you any more than that. I agree with wolfpack's interpretation. The 1st image is afib, the second is NSR with some PACs, and the third is NSR. A Kardia would probably just say "unclassified" on #2. The very clearly identifiable P waves in #2 should tell you it's not afib.

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bolimasa
I'm at work and don't remember my photo share account passwords, so I put the on an unused blog page:

What I like about postimages.org is it's free and it doesn't even require a login. Anybody can post photos there with a couple clicks of the mouse.

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Carey
The Kardia wouldn't tell you any more than that. I agree with wolfpack's interpretation. The 1st image is afib, the second is NSR with some PACs, and the third is NSR. A Kardia would probably just say "unclassified" on #2. The very clearly identifiable P waves in #2 should tell you it's not afib.

Well, if the Kardia would give me essentially the same result I like my new monitor. Easy to use, simple software. You can label traces and easily search for them later.

I'm glad I'm probably righ-ish in my interpretation. I can see there is a ton to learn to understand this subject.

I'll have to check out postimages.... And here I thought I had an account everywhere
on the internet!

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bolimasa
Thanks.
That is kind of what I thought.
If that is correct, I'm a little disappointed in monitor because in the second scenario it just tells my I'm in arrhythmia, and I'd like to know is if I am in afib. Would the Kardio monitor differentiate between the two? Or is that why they have the subscription service to have your traces read?

One of the hallmarks of afib is the lack of a "p" wave (the bump before the QRS wave):


I'm guessing you are holding your device with an electrode in each hand? This does not give a presentation with a p wave that stands out, in most cases. Hence hard to see. My my AliveCor/Kardia, I put one electrode in my right hand and the other on the lower left part of my body - hip, knee & etc. This gives more of a "Lead II" presentation.

Your second image has more pronounced p waves, though still not distinct.

That's why it is important to know how to place leads and interpret the signals sent. Wonder how these new gadgets can replace V1 to V5 plus the neutral leads? They can't. For one, an R progression can't be seen.....

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Joe
That's why it is important to know how to place leads and interpret the signals sent. Wonder how these new gadgets can replace V1 to V5 plus the neutral leads? They can't. For one, an R progression can't be seen.....

Yeah, the consumer devices only provide a rhythm strip, although you can sort of squeeze out lead II with the technique George described. I'm betting that in the next few years we'll see devices with additional leads you paste to your chest that use bluetooth to communicate with a smartphone.

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Carey

Yeah, the consumer devices only provide a rhythm strip, although you can sort of squeeze out lead II with the technique George described.

Today, you can buy a Chinese Holter for $500US <[www.ebay.com] or a portable ECG with leads for $170 that can record 30 hours of single channel. <[www.ebay.com]

Years ago, I borrowed a Holter from a friend who used to post here. I played with it for a while but didn't think the hassle of using leads gave me enough incremental benefit. There were a couple of other posters back then with their own Holters.

I do periodically like to be able to monitor overnight, but a tachogram (beat to beat heart rate vs time) provides sufficient info for me. I can get that using a Polar chest strap and an iPhone app, then displaying the data in Polar software. I'm primarily looking for ectopic beat counts and also heart rate patterns that could indicate apneas. Afib is also obvious on the tachogram.

I also learned that my heart rate during sleep could go as low as the high 30's when I first monitored 14 years ago. Now, after detraining, it rarely goes below 45 or so.

With an EMS background I found it frustrating to be in weird rhythms but be unable to actually see an ECG to see what was going on with my heart without running to a doctor. So several years ago I bought a used 12-lead on eBay for $800. When I switched EPs, the new guy was thrilled at the inch-thick stack of ECGs I brought with me. He went through every single one of them and made notes, and he came to expect an ECG from me on every follow-up visit. Best investment I ever made. For example, it allowed me to see in January 2017 that the flutter I'd been dealing with for two years had changed and was now starting out as afib and then quickly organizing into flutter. That proved to me and my EP that I had reconnected, so it led me to seek an ablation with Natale.

But now, having been afib-free for almost a year, I'm considering selling it. I have a Kardia with a lifetime subscription if anything wonky appears again, so the 12-lead has sat unused in the corner since August 2017.

Carey,

If I had a different situation, like yours, I would certainly get my own 12 lead. I'm not saying it isn't valuable, just not for me in my situation.

I've not gotten into the this far enough yet.
What does lead 2 tell you?

The leads are essentially the angle at which you’re looking at the heart’s surface electrical activity. Lead 1 is arm-to-arm, so basically you’re looking at your heart from side-to-side. Lead 2 is looking from top right-to-left bottom, which is in most cases through the long vertical axis of the heart as it is positioned in the left of your chest. Since your right arm is closest to your right atrium and your left leg or thigh is closest to your left ventricle you get a picture of how the charge flows from the SA node through the AV node and into the Bundle of His. That’s probably why the P-wave is more evident in that presentation versus Lead 1.

All this is my electrical engineer’s understanding of electrophysiology. I must admit I’m trained in quantum physics - electronic current moving through conductors. This whole business here is ionic currents moving through tissue. Related, for sure, but not the same.

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bolimasa
I've not gotten into the this far enough yet.
What does lead 2 tell you?

What Wolfpack said.

However for your purpose, the reason for Lead II is a more prominent p wave. NSR should have regular R to R peak times/distances (on the recording) and a p wave. Though it can certainly get more complex than this, if the peak to peak times are irregular and there is no p wave, it is afib. Here is a quick and dirty ECG tutorial <[geekymedics.com]

Thanks... In my super brief reading I've found the axis biz confusing. It's on my list by to try to figure out... But only being into this since memorial day I'm still a little overwhealmed with all the research I feel I need to do, plus for my mental health I'm trying not to obsess about this 24-7.

I'd probably feel better if during my one cardiology can visit I got the impression some expert was critically looking at my data... I sure hope that changes.

One thing I'm concerned about how the discern tacchycardia from exercise.
I need to formulate questions before Tuesday morning.

Had my first blood thinner incident today... Now that was exciting, and bit messy.

The cardiac axis is the direction in which charge is flowing over the surface of the heart. Normally it's a bit "down and to the left". You need multiple leads to determine it. It can't be done with a Kardia or probably even the Emay. You find the lead (or the spot between two leads) in which the QRS complex is equiphasic, meaning there's just as much "up" spike as there is "down" spike. That point is 90 degrees to the cardiac axis.