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Hello, good evening everyone. And thank you so much for joining us. Um I'm Jo Li. I'm a consultant cardiologist, specializing in out congenital heart disease in Oxford. And I'm also the women in cardiology leave for the British Cardiovascular Society. And I'm delighted to introduce my coa doctor Joy Baso. Hi, everyone. I'm, I'm a consultant cardiologist at Wickham Hospital State Band of Hospital and also at the Hammersmith. I'm doing heart failure and inherited cardiac conditions and I'm also the one of the Thames Valley um women in cardiology reps. Thanks to amazing. And we're going to introduce our wonderful speaker in a second, but I'll just do the sort of brief housekeeping things there. So, just a big welcome. And we did this program last year. And the idea was to provide you medical students, foundation, doctors, resident doctors with high quality practical teaching to help you survive and thrive on the wards and also to showcase the careers of some amazing women in cardiology and hope that they might inspire you to consider a career in this wonderful specialty also. Um So, so unfortunately, we can't interact speaking, but please do ask questions through the chat and make comments, anything you're not clear about because Jenny loves it to be interactive and then Joy or myself might type replies or we'll kind of bunch questions or, and check in with Jenny at various points. So please ask lots of questions and if things aren't clear or anything, we can go back or whatever. Um There will be the feedback form, I'll put in the chat link at the end and then when you fill that in, you will automatically get sent a certificate of attendance afterwards. And Jenny has kindly agreed for the video recording to be made available afterwards also via medal. Um So that's the housekeeping bit. And so it gives me then great pleasure to introduce my friend and colleague, Jenny Rainer. Um Jenny is an honorary consultant, cardiologist specializing in heart failure and cardiometabolic disease at Oxford University Hospitals NHS Foundation Trust. And she's also a senior clinical research fellow and ad field supervisor at the University of Oxford Center for Magnetic Clinical Magnetic Resonance Imaging. And Jay is really extraordinary because she's not only a brilliant clinician who is on the front line in A&E on the ward in clinic, seeing these patients and looking after their heart failure, but she's also a brilliant scientist, a brilliant educator and also a brilliant mother to three incredible Children who you'll hopefully hear about at the end. Um And so we were in for a treat last year. This was described in the feedback as the best ECG teaching ever. Um So we're delighted to have her back. She's gonna teach us, then we'll do Q and A and then we're gonna ask her to tell us a little bit about her career at the end. Thank you, Jenny. Over to you. Thank you Jo I think, wait to set me up to fail. Um Right. We've been having a little bit of trouble sharing slide. So hopefully this is gonna work imminently um because it, I wouldn't, I don't think I could talk about EC GS without sharing any Ec GS. So hopefully, can you see that? Yes, Jenny winning. Really brilliant. Ok, good. Right. Thanks for that Joe and welcome everyone. This is really exciting. It's such a nice opportunity to um talk to a bit of a, a wider audience. Um Usually I get people trapped in a small stuffy room in Oxford somewhere. So it's really nice to, to speak to lots of you. I wish I could see you and speak to you properly. But unfortunately, um this is the best way, so do drop messages in the chat. Um I will be, we'll be looking at lots of Ec Gs. So if um if you have a particular question, we may not be able to answer all of them. But um if there are kind of themes that come up, er we'll, we'll go over them um in due course. So we're gonna talk about EC GS today and next week. So it's a lot of, er, me talking to you about EC GS. But, um, hopefully I'll make it a bit more exciting than it sounds. I just wanted to remind everyone how very cool the ECG is what we take for granted really is we put lots of stickers on a patient on their arms and legs and chest and it tells us about the amazing electrical activity inside the heart muscle. And I can't think of another test that tells you that much information from what is really quite a simple thing. So, um, can you see my second slide? I won't do this for every slide. I just want to make sure they're moving. I can see it, Jenny. But if anyone can put in the chat just to confirm that you guys can see it also just put in the chat. Yes. Can see in here that would make me feel more relaxed. Great. All right. Thank you. And you and the right. I can't, I can't list all your notes. But anyway, thank you very much. Um, so cool. I'm just reminding you the top bit that you can see. Hopefully my pointer might work. Oh, well, at some point, you can tell me whether it, the pointer works or not. Um So the, um, you've got your P wave, then there's a QR S and then at wave and basically that's telling you about electrical activity in the heart. Um, in different stages of the cardiac cycle. So if you remember that the P wave is um the atrial activation. So that's from the sinoatrial node up near where the S VC comes into the right atrium. And that is the heart's own intrinsic pacemaker that does the job most of the time. Um And it activates the atria starting on the right hand side, moving across to the left and that's what you see with the P wave, then there's a little pause um the pr interval, er and then your QR S complex, which is basically activation of the ventricles. So the conducting system of the heart is amazing when it's working and that electricity whizzes down the um the bundle of his so that can connection down the septum between the two ventricles really, really fast and efficiently. And then it stimulates both the ventricles nicely at the same time. So that's your QR S complex. And then your T wave is basically everything just kind of chilling out and getting back to normal. So the repolarisation of your ventricles. So now we've got that, I'm gonna talk a little bit about cardiac access, not very much cos it's not very interesting. Um and also it can be really complicated, but I thought I would just touch on it to um to say that we've done it. Um So basically the direction of the QR S complex. So the, the pointy bit in the middle um tells you about the direction of the electrical activity in the heart muscle. And no, when, when the electrical activity is going towards the sticker, the lead, the QR S complex is positive and that's all you really need to remember. So usually the way your heart is pointed where most of the myocardium is um is the left ventricle and a little bit of the right ventricle, then the direction of activation heads generally in that direction and you get positive broadly positive in all your leads. And we tend to judge axis looking, um comparing perhaps lead one and lead two or lead three. I tend to look at one and aVF we'll come onto that. So that's a normal cardiac axis. And then if something goes wrong in um the electrical conduction of the heart, the axis can change. So basically the overall direction of electricity through your myocardium and hence the direction of your QR S complex can change. And which way your QR S complex goes in which leads tells you which way the electrical activity has swung. So in this example, we've got right axis deviation, instead of being over here between naught and 60 it's swung around to the right hand side and so your leads two and three, which look at that side of the heart are more up and your lead one on the other side of the heart is more down there are, I'm sure there are much more complicated ways of explaining this, but this is how I understand it and vice versa. So, if you've got something that's happened with your electrical conducting, um, and it's swung around to the left hand side. So you've got left axis deviation, it's going away from your two and three leads. So it's negative there and towards your lead one. So it's positive in that direction and that is pretty much all I'm gonna say about axis apart from a couple of exceptions and I apologize. Um I hope you can see this a little bit bigger than I can see it. Um It, you can maximize your screens, can't you? So this is I'm gonna do a total spoiler alert. A normal E CG. Um The best thing with E CG is it and any kind of um medical test, I think if you've got a result in front of you that you, um you've got lots of information being bombarded at you. If you can break it down into little bite size chunks and um useful information um in a system, then you don't miss anything and even if you don't really know what it means, you can make a bit of a guess at it. So things that we normally look at with ECG, I know if we went through the really boring things like is the machine turned on? Have you got the right patient, et cetera? Do check that you've got the right patient. Um So first things I look at are um rate and generally will go with fast, slow or normal. Um And there are various ways of calculating that, um, or you can eyeball it or the machine will tell you, but sometimes it's wrong. So it's best to just check it yourself. To me, this looks like a normal rate. Um And I'm looking at the rhythm strip which is this long bit at the, at the bottom, which is just lead two. In this case, they just print out a long bit rather than just three beats. Um And then what did I say? Rate? Yep. Normal rhythm. So, is it regular or irregular? And sometimes it's hard and sometimes you do need to do the old trick of getting the piece of paper and the pencil and marking it out and checking. But this does look broadly regular to me. Um And when I say regular, I sort of mean sinus rhythm, which is um,