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Hi, everyone. If you're there waiting, um we'll hopefully stop up bypass time. All right. So it's just gone. Um five past on my clock. So we'll make a start. Uh Hi, everyone. My name is Khadija and um there is Joanne here. Uh And yeah, welcome to teachings things. And if you don't mind going to the next slide, thank you. Um If you're new here, this is what we do. We do weekly tutorials open to everybody um regardless of your sort of uh grade or where you are in med school or life. Uh We focus on core presentations and teaching diagnostic techniques. Um It's all taught by medical students aimed for medical students, but it's also reviewed by doctors to ensure accuracy. Um And we can keep you updated by upcoming events through our emails and our group chats. So, yes, keep in touch. Um So this is sort of like we'll do this in two sections. Uh We've got some learning objectives here, basically by the end of this session, we're hoping to give a crash course on um all things to do with cardiac arrhythmias, but splitting it up into understanding the basics and the foundations um having a structure to how you think about arrhythmias in your head. Uh then going on to identify like common clinical vignettes and that sort of thing. Um And then also being able to apply like your A LS uh guidelines for managing arrhythmias, which is something that comes up super often uh in your UK MLA. Um So yeah, we've got a nice small group. So hopefully, uh please don't be shy really open to lots of questions and stuff in the polls. We'll be keeping an eye on that. Um And please just drop any comments if you want us to go through things a little bit, a little bit more depth. So start us all off. Nice and easy. Um We've got some options here, but which of these is your dominant pacemaker? We'll just start the poll. So I was trying to find that. Come on guys, it's not that much for us. So please do not be shy. We'll wait till we have three people. I find that's, that's a good thing. Thank you, do. So we'll move on. Um So yeah, you guys all got it right. It is the essay node. Um I thank you. All right. So when we're looking at these sorts of things, I'm always like, I was a big person um who was always just a bit like why does all this matter? Why does like all of the biochem and that sort of thing matter Um And basically, it's only actually when I did these sides, I realized the importance of going back to your basic principles to help you understand when more complex things go on. So having a really good knowledge of what normal looks like and what a normal cardiac rhythm cycle is and how it all works can help build on your understanding for what happens if something goes wrong and what it can look like. So if you find that you're really struggling with arrhythmias or really struggling with certain aspects of ECG S sort of recommend to go back to thinking about why each of those features of an ECG exist normally and then working forward. Um Well, I suppose almost working backwards to then figure out like what, what you see in front of you and what could have caused what you see in front of you if that makes sense. Um So yes, I know this can get a bit dry, but hopefully bear with me beautiful. So now we're just talking about um the cardiac cycle in general. Uh So can anyone tell me what the first um like what happens? What's the first part of the cardiac cycle in the chat? So what happens first for your heart to beat anyone? Awesome atrial uh depolarization. And how does that start? What's the first thing that happens? You kind of um oh sorry. I don't know if I was exposed. Uh The first question was a hint to that. So what happens first for the atria to depolarize? OK. So if you go click one, thank you. Um So the first thing that happens is your SA node, which you were identified um was your uh gets excited, essentially was all going. Um Yeah, so your SA node gets excited and it causes sort of AAA like burst of electrical activity uh that causes your atria to contract and that's why you have your nice P wave because that's your sort of movement of your muscle fibers. Um Anyone tell me about the next thing that happens. All right. So then the next thing that sort of uh goes on is that, so you've got your SA node excited that then triggers your A V node which is kind of on the middle. Um And this lying around the atrial septa. Um And that delivers a slow action potential. And the reason it tries to deliver that slowly is that you allow the ventricles to sort of fill. So if you think if that action is really quick and everything happened, happened really quickly. Um Oh Yeah, wonderful. Uh Someone's already put it in the chat, which is great. Uh So you've got your SA node that then triggers your A V node, which then delivers a slow action potential down if you go on the next bit um that travels down the bundle of his, which is sort of the bits sort of in the middle of your ventricle se. Um Oh yeah, thank you. Um And then that sort of splits off on either side of your heart to go through your right and left bundle branches. Um Obviously, that's like the main flow of electrical activity, but to get into all the muscle fibers, et cetera, that's where you have the bikin fibers. Um And those depolarizations are super fast because that's when your ventricles really contract and in this um sort of like flow from uh so you've got your atrial depolarization which causes your P wave and then you've got your ventricular sort of um contraction which causes your QR S complex and it's really sharp and quick because your um fibers have really fast depolarizations. Um Yes. And, and then you've got, and then you've got your T wave, which is your ventricle repolarization. And that's when it relaxes and when it relaxes, it also has. Um Yeah, that's also like showed as a, a display of electrical activity. Now, can anyone tell me uh why you can't see your atrial repolarization? Wonderful. Yes. So it all um happened. It's all like hidden in your QR S. So if you think of it as a nice like almost like a flow diagram in your head, your sa nodes get triggered that then triggers your AP node which goes down the bundle of hi and give and sort of um conducts down your body