Shadowing Practice: ST Elevation and Depression on an EKG Rhythm Strip - Learn English Speaking with Video
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In this video, we'll take a look at ST segment changes.
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How do we identify and measure ST elevation and depression?
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And what does it mean for our patient?
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The ST segment is the space between the QRS and the T wave.
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It should be resting comfortably on the baseline, but in some strips you may see it above or below the baseline.
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When you're checking location of the ST segment, sometimes it seems a little variable.
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But what we're basing this measurement on is where the J -point is.
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That's the junction between the QRS and the ST segment.
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It's where we stopped measuring the QRS complex.
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So start by identifying where the baseline is.
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Where does your PR segment rest?
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And where does your diastolic phase between the T -wave and the P -wave come to rest?
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That's your baseline.
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Now, is the J -point on, below, or above the baseline.
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The threshold for this is one millimeter or more elevated or depressed,
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so one small box above or below the baseline is considered significant and warrants noting on the interpretation.
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Take your calipers.
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Place one point on the baseline and one point on the J -point.
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You're measuring vertically for this, so take that measurement to a nice clear area where you can count the small boxes.
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Vertically, each box represents one millimeter, so count the boxes and note ST elevation or depression
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if you have at least one full small box or one millimeter of change from the baseline.
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For this strip we have elevation.
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The J point is three small boxes above the baseline.
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So it's a three millimeter ST elevation.
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For this strip we have depression.
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The J point is two small boxes below the baseline.
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So it's a two millimeter ST depression.
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A lot of elevation and depression is chronic, and is indicative of some level of ischemic damage.
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You can get a lot more specific with that
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if you do a 12 -lead and look at how the ST changes appear on a number of different leads,
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but on a 3 and 5 -lead monitor, we'll just say they indicate ischemia.
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There are a couple of findings that are a bit more concerning, though.
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If you see acute elevation, meaning it wasn't there before, and after the J -point you see a convex curve,
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meaning after the j -point the tracing goes back up before returning to the baseline.
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It ends up taking on a shape known commonly as a tombstone.
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When you see tombstones, think heart attack.
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The tombstone shape won't always show in every lead.
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Depending on where the infarct is, the tombstone will show itself in the associated leads, and others may show nothing.
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Here's an example of a 12 -lead EKG.
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If we were looking at lead 2, we would have seen a tombstone shape appear for our patient.
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But if we were looking at lead 1, it's only showing a minor depression.
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Some other leads, like 3 or AVF, are showing the tombstone, but the rest are showing depression or sometimes no change at all.
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This EKG may be indicative of an inferior wall MI,
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which can be figured out based on which leads are showing the elevation changes and which are not.
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That being Having said, we'll only be viewing leads 1, 2, 3, AVR, AVL, AVF and V1 on our 5 -lead setup.
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And primarily, we'll be looking at lead 2.
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So we can't see every infarct with a 5 -lead setup.
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But when you do see it, check your patient for symptoms and activate the emergency response.
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If the patient is showing symptoms, even if the 5 -lead isn't showing any elevation, activate the emergency response.
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The 12 -lead may reveal what we couldn't see with the 5.
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Another acute change you may see is when after the J -point, the ST segment curves down into a concave curve.
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It can be indicative of pericarditis.
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This ST change is usually widespread across many leads.
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Pericarditis is inflammation of the pericardial sac surrounding the heart.
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Symptoms include sharp chest pains, much like infarction.
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So again, if you see this ST change on your strip, check your patient for symptoms and activate the emergency response.
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Woordenschat en spreektips bij deze les
Deze spreekles is gebaseerd op de video “ST Elevation and Depression on an EKG Rhythm Strip”. Deze woorden komen het vaakst terug: lead, baseline, elevation, depression, tombstone. Deze video bevat 56 zinnen en 693 woorden om na te spreken. Het gesproken deel duurt 4:15. De spreker praat in een natuurlijk tempo van ongeveer 163 woorden per minuut, dicht bij een alledaags gesprek. Slechts 77% van de woorden hoort bij de 3.000 meest gebruikte Engelse woorden, dus de woordenschat is pittig.
Belangrijke woorden in deze video
15 woorden uit de video die het leren waard zijn, met uitspraak en betekenis:
| Woord | Uitspraak | Betekenis |
|---|---|---|
| segment zelfstandig naamwoord | /ˈsɛɡmɛnt/ | segment |
| strip werkwoord | /ˈstɹɪp/ | strippen |
| symptom zelfstandig naamwoord | /ˈsɪm(p)təm/ | symptoom |
| curve zelfstandig naamwoord | /kɚv/ | curve, kromming |
| activate werkwoord | /ˈæktɪˌveɪt/ | activeren, aanzetten |
| indicative bijvoeglijk naamwoord | /ɪnˈdɪk.ə.tɪv/ | indicatief |
| measurement zelfstandig naamwoord | /ˈmɛʒ.ə.mənt/ | meting |
| acute bijvoeglijk naamwoord | /əˈkjut/ | kort |
| sharp bijvoeglijk naamwoord | /ʃɑɹp/ | scherp, puntig |
| reveal werkwoord | /ɹɪˈviːl/ | onthullen, zich ontpoppen |
| monitor zelfstandig naamwoord | /ˈmɑ.nɪ.tɚ/ | toezichthouder |
| indicate werkwoord | /ˈɪndɪˌkeɪt/ | aanwijzen, aanduiden |
| interpretation zelfstandig naamwoord | /ɪnˌtɜːpɹəˈteɪʃən/ | interpretatie |
| chronic bijvoeglijk naamwoord | /ˈkɹɑ.nɪk/ | chronisch |
| depend werkwoord | /dɪˈpɛnd/ | afhangen |
Phrasal verbs die je zult horen
| Woord | Betekenis |
|---|---|
| end up werkwoord | belanden, terechtkomen |
| figure out werkwoord | uitvogelen, er achter komen |
Uitspraak om op te letten
De spreker gebruikt 12 samentrekkingen en verkorte vormen, zoals we'll, you're, can't. Spreek ze kort uit, zoals je ze hoort.
- De klanken “sh” en “zh”: elevation /ˌɛlɪˈveɪʃn̩/, measurement /ˈmɛʒ.ə.mənt/, sharp /ʃɑɹp/, associate /əˈsoʊʃi.ət/, interpretation /ɪnˌtɜːpɹəˈteɪʃən/
- Lange woorden — let op de klemtoon: indicative /ɪnˈdɪk.ə.tɪv/, primarily /ˈpɹaɪ.mə.ɹə.li/, associate /əˈsoʊʃi.ət/, interpretation /ɪnˌtɜːpɹəˈteɪʃən/, inferior /ɪnˈfɪɹ.i.ɚ/
Klanken die Nederlandstaligen lastig vinden:
- Stemhebbende eindmedeklinker — /b/, /d/, /g/, /z/, /v/ niet verscherpen: curve /kɚv/, indicative /ɪnˈdɪk.ə.tɪv/, depend /dɪˈpɛnd/, widespread /ˌwaɪdˈspɹɛd/, threshold /ˈθɹɛʃ(h)oʊld/
- /æ/ — opener dan de Nederlandse “e”: activate /ˈæktɪˌveɪt/, variable [ˈvæɹ.i.ə.bl̩], calipers /ˈkæl.ɪ.pɚz/
- /w/ — met ronde lippen: warrant /ˈwɔɹənt/, widespread /ˌwaɪdˈspɹɛd/
Zo oefen je met deze video
- Luister de hele video één keer zonder te spreken en noteer de woorden die je niet kent.
- Begin op 0,75× snelheid, spreek zin voor zin na en ga terug naar normale snelheid zodra het makkelijk gaat.
- Neem jezelf op en vergelijk met het origineel; let daarbij op woorden als segment, strip, symptom.
Wat is de Shadowing-techniek?
Shadowing is een wetenschappelijk onderbouwde taalleermethode die oorspronkelijk is ontwikkeld voor professionele tolkentraining en gepopulariseerd door polyglot Dr. Alexander Arguelles. De methode is eenvoudig maar krachtig: je luistert naar native Engelse audio en herhaalt het onmiddellijk hardop — als een schaduw die de spreker volgt met slechts 1–2 seconden vertraging. In tegenstelling tot passief luisteren of grammaticadrills, dwingt shadowing je hersenen en mondspieren om echte spraakpatronen tegelijkertijd te verwerken en te reproduceren. Onderzoek toont aan dat het de uitspraaknauwkeurigheid, intonatie, ritme, verbonden spraak, luisterbegrip en spreekvaardigheid aanzienlijk verbetert — waardoor het een van de meest effectieve methoden is voor IELTS Speaking-voorbereiding en echte Engelse communicatie.