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.

How do we identify and measure ST elevation and depression?

And what does it mean for our patient?

The ST segment is the space between the QRS and the T wave.

It should be resting comfortably on the baseline, but in some strips you may see it above or below the baseline.

When you're checking location of the ST segment, sometimes it seems a little variable.

But what we're basing this measurement on is where the J -point is.

That's the junction between the QRS and the ST segment.

It's where we stopped measuring the QRS complex.

So start by identifying where the baseline is.

Where does your PR segment rest?

And where does your diastolic phase between the T -wave and the P -wave come to rest?

That's your baseline.

Now, is the J -point on, below, or above the baseline.

The threshold for this is one millimeter or more elevated or depressed,

so one small box above or below the baseline is considered significant and warrants noting on the interpretation.

Take your calipers.

Place one point on the baseline and one point on the J -point.

You're measuring vertically for this, so take that measurement to a nice clear area where you can count the small boxes.

Vertically, each box represents one millimeter, so count the boxes and note ST elevation or depression

if you have at least one full small box or one millimeter of change from the baseline.

For this strip we have elevation.

The J point is three small boxes above the baseline.

So it's a three millimeter ST elevation.

For this strip we have depression.

The J point is two small boxes below the baseline.

So it's a two millimeter ST depression.

A lot of elevation and depression is chronic, and is indicative of some level of ischemic damage.

You can get a lot more specific with that

if you do a 12 -lead and look at how the ST changes appear on a number of different leads,

but on a 3 and 5 -lead monitor, we'll just say they indicate ischemia.

There are a couple of findings that are a bit more concerning, though.

If you see acute elevation, meaning it wasn't there before, and after the J -point you see a convex curve,

meaning after the j -point the tracing goes back up before returning to the baseline.

It ends up taking on a shape known commonly as a tombstone.

When you see tombstones, think heart attack.

The tombstone shape won't always show in every lead.

Depending on where the infarct is, the tombstone will show itself in the associated leads, and others may show nothing.

Here's an example of a 12 -lead EKG.

If we were looking at lead 2, we would have seen a tombstone shape appear for our patient.

But if we were looking at lead 1, it's only showing a minor depression.

Some other leads, like 3 or AVF, are showing the tombstone, but the rest are showing depression or sometimes no change at all.

This EKG may be indicative of an inferior wall MI,

which can be figured out based on which leads are showing the elevation changes and which are not.

That being Having said, we'll only be viewing leads 1, 2, 3, AVR, AVL, AVF and V1 on our 5 -lead setup.

And primarily, we'll be looking at lead 2.

So we can't see every infarct with a 5 -lead setup.

But when you do see it, check your patient for symptoms and activate the emergency response.

If the patient is showing symptoms, even if the 5 -lead isn't showing any elevation, activate the emergency response.

The 12 -lead may reveal what we couldn't see with the 5.

Another acute change you may see is when after the J -point, the ST segment curves down into a concave curve.

It can be indicative of pericarditis.

This ST change is usually widespread across many leads.

Pericarditis is inflammation of the pericardial sac surrounding the heart.

Symptoms include sharp chest pains, much like infarction.

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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Vocabulary and speaking notes for this lesson

This speaking lesson is built on the video “ST Elevation and Depression on an EKG Rhythm Strip”. The speaker keeps coming back to these words: lead, baseline, elevation, depression, tombstone. This video has 56 sentences and 693 words to shadow. The speech runs for 4:15. The speaker talks at a natural 163 words per minute, close to everyday conversation. Only 77% of the words are among the 3,000 most common in English, so the vocabulary is demanding.

Key vocabulary in this video

15 words from the video worth learning, with pronunciation and meaning:

Word	Pronunciation	Meaning
baseline noun	/ˈbeɪslaɪn/	A line that is a base for measurement or for construction.
elevation noun	/ˌɛlɪˈveɪʃn̩/	The act of raising from a lower place, condition, or quality to a higher; said of material things, persons, the mind, the voice, etc.
segment noun	/ˈsɛɡmɛnt/	A length of some object.
strip verb	/ˈstɹɪp/	To remove or take away, often in strips or stripes.
symptom noun	/ˈsɪm(p)təm/	A perceived change in some function, sensation or appearance of a person that indicates a disease or disorder, such as fever, headache or rash; strictly, a…
curve noun	/kɚv/	A bend, such as in a road.
activate verb	/ˈæktɪˌveɪt/	To encourage development or induce increased activity; to stimulate.
indicative adjective	/ɪnˈdɪk.ə.tɪv/	Serving as a sign, indication or suggestion of something.
measurement noun	/ˈmɛʒ.ə.mənt/	The act of measuring.
acute adjective	/əˈkjut/	Brief, quick, short.
primarily adverb	/ˈpɹaɪ.mə.ɹə.li/	Of a primary or central nature, first and foremost.
sharp adjective	/ʃɑɹp/	Terminating in a point or edge, especially one that can cut or pierce easily; not dull, obtuse, or rounded.
reveal verb	/ɹɪˈviːl/	To uncover; to show and display that which was hidden.
associate noun	/əˈsoʊʃi.ət/	A person united with another or others in an act, enterprise, or business; a partner or employee.
commonly adverb	/ˈkɑmənli/	As a rule; frequently; usually.

Phrasal verbs you will hear

Word	Meaning
end up verb	To bring to a conclusion.
figure out verb	To come to understand; to discover or find a solution; to deduce.

Pronunciation to watch

The speaker uses 12 contractions and reduced forms, such as we'll, you're, can't. Say them the short way, as you hear them.

The “sh” and “zh” sounds: elevation /ˌɛlɪˈveɪʃn̩/, measurement /ˈmɛʒ.ə.mənt/, sharp /ʃɑɹp/, associate /əˈsoʊʃi.ət/, interpretation /ɪnˌtɜːpɹəˈteɪʃən/
Long words — get the stress right: indicative /ɪnˈdɪk.ə.tɪv/, primarily /ˈpɹaɪ.mə.ɹə.li/, associate /əˈsoʊʃi.ət/, interpretation /ɪnˌtɜːpɹəˈteɪʃən/, inferior /ɪnˈfɪɹ.i.ɚ/

How to practise with this video

Listen to the whole video once without speaking and note the words you do not know.
Start at 0.75× speed, shadow it sentence by sentence, then go back to normal speed once it feels easy.
Record yourself and compare with the original, paying attention to words like baseline, elevation, segment.

What is the Shadowing Technique?

Shadowing is a science-backed language learning technique originally developed for professional interpreter training and popularized by polyglot Dr. Alexander Arguelles. The method is simple but powerful: you listen to native English audio and immediately repeat it out loud — like a shadow following the speaker with just a 1–2 second delay. Unlike passive listening or grammar drills, shadowing forces your brain and mouth muscles to simultaneously process and reproduce real speech patterns. Research shows it significantly improves pronunciation accuracy, intonation, rhythm, connected speech, listening comprehension, and speaking fluency — making it one of the most effective methods for IELTS Speaking preparation and real-world English communication.

Shadowing technique: read the full step-by-step guide →

Shadowing Practice: ST Elevation and Depression on an EKG Rhythm Strip - Learn English Speaking with Video

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