2026-04-28_09_19_45
May 14, 2026 19:21
· 1:13:45
· English
· Whisper Turbo
· 2 സ്പീക്കറുകള്
ഈ തീയതിയുടെ കാലാവധി ഇന്നു് തീരുന്നു.
സ്ഥിരമായുള്ള സ്റ്റോറേജ് അപ്ഗ്രേഡ് ചെയ്യുക →
കാണിക്കല് മാത്രം.
1:42
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Speaker 1 (2026-04-28_09_19_45)
My name is Melan Sebsi and I should be with you in the last
1:47
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Speaker 1 (2026-04-28_09_19_45)
part of the day.
1:47
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Speaker 1 (2026-04-28_09_19_45)
Associate Professor Křivan just told you that you will divide it into
1:52
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Speaker 1 (2026-04-28_09_19_45)
two groups.
1:53
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Speaker 1 (2026-04-28_09_19_45)
So one group will go with him somewhere and for second group
1:57
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Speaker 1 (2026-04-28_09_19_45)
I will bring the patient here.
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Speaker 1 (2026-04-28_09_19_45)
But in virtual manner,
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Speaker 1 (2026-04-28_09_19_45)
so not physically.
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Speaker 1 (2026-04-28_09_19_45)
So if somebody would like to prefer stay here without real
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Speaker 1 (2026-04-28_09_19_45)
patient, I have some ACG,
2:10
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Speaker 1 (2026-04-28_09_19_45)
I have some lab test,
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Speaker 1 (2026-04-28_09_19_45)
I have documentation for each
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Speaker 1 (2026-04-28_09_19_45)
patient and I will go through them.
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Speaker 1 (2026-04-28_09_19_45)
Okay?
2:22
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Speaker 2 (2026-04-28_09_19_45)
1,
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Speaker 2 (2026-04-28_09_19_45)
2, 3, 4,
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Speaker 1 (2026-04-28_09_19_45)
5, 6, 7,
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Speaker 1 (2026-04-28_09_19_45)
9.
2:27
S…
Speaker 1 (2026-04-28_09_19_45)
So two more people please here,
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Speaker 2 (2026-04-28_09_19_45)
stay here.
2:30
S…
Speaker 1 (2026-04-28_09_19_45)
So I
2:42
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Speaker 1 (2026-04-28_09_19_45)
prepared three patients,
2:43
S…
Speaker 1 (2026-04-28_09_19_45)
so it's possible that you will divide it into three groups.
2:45
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Speaker 1 (2026-04-28_09_19_45)
So
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Speaker 1 (2026-04-28_09_19_45)
each
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S…
Speaker 1 (2026-04-28_09_19_45)
three patients are our
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Speaker 1 (2026-04-28_09_19_45)
patients from our department with real ACG.
3:05
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Speaker 1 (2026-04-28_09_19_45)
We will get the documentation of the patient.
3:10
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Speaker 1 (2026-04-28_09_19_45)
Somewhere on the top we will find the number.
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Speaker 1 (2026-04-28_09_19_45)
of the page and usually it's chronological but
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Speaker 1 (2026-04-28_09_19_45)
sometimes not so please go through it and
3:23
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Speaker 1 (2026-04-28_09_19_45)
what we will do just read briefly what
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Speaker 1 (2026-04-28_09_19_45)
was the problem for the patient unfortunately is it
3:31
S…
Speaker 1 (2026-04-28_09_19_45)
in check but I hope that you will have something like Google Translator or
3:36
S…
Speaker 1 (2026-04-28_09_19_45)
please ask if something will be not familiar
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Speaker 2 (2026-04-28_09_19_45)
for you
3:44
S…
Speaker 1 (2026-04-28_09_19_45)
So go please through the patients.
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Speaker 1 (2026-04-28_09_19_45)
First question is why the patient is here.
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Speaker 1 (2026-04-28_09_19_45)
Second question,
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Speaker 1 (2026-04-28_09_19_45)
lab results,
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Speaker 1 (2026-04-28_09_19_45)
PCG,
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Speaker 1 (2026-04-28_09_19_45)
etc.
3:54
S…
Speaker 1 (2026-04-28_09_19_45)
For diagnostic thinking and for what
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Speaker 1 (2026-04-28_09_19_45)
to do with it.
4:00
S…
Speaker 1 (2026-04-28_09_19_45)
So some therapeutic options.
4:03
S…
Speaker 1 (2026-04-28_09_19_45)
The idea is that you will see some real documentation
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S…
Speaker 1 (2026-04-28_09_19_45)
and ask if something is
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Speaker 1 (2026-04-28_09_19_45)
not...
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Speaker 1 (2026-04-28_09_19_45)
clear for you so this will take something
4:19
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Speaker 1 (2026-04-28_09_19_45)
like 30 minutes and in the last part somebody
4:25
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Speaker 1 (2026-04-28_09_19_45)
from your group will come here and will present this patient for others so you
4:29
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Speaker 1 (2026-04-28_09_19_45)
will say that this patient with some such complaints
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S…
Speaker 1 (2026-04-28_09_19_45)
ACG and the ACG will show for the
4:37
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Speaker 1 (2026-04-28_09_19_45)
rest of the group so it will be something like interactive sorry
4:53
S…
Speaker 1 (2026-04-28_09_19_45)
Here is some coffee. It looks fresh.
5:01
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Speaker 1 (2026-04-28_09_19_45)
It's free,
5:02
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Speaker 1 (2026-04-28_09_19_45)
I have mine,
5:02
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Speaker 1 (2026-04-28_09_19_45)
so please take it.
5:13
S…
Speaker 1 (2026-04-28_09_19_45)
So,
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Speaker 1 (2026-04-28_09_19_45)
my asking is,
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Speaker 1 (2026-04-28_09_19_45)
then it's better,
7:28
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Speaker 1 (2026-04-28_09_19_45)
so two possibilities.
7:30
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Speaker 1 (2026-04-28_09_19_45)
First, I don't know what I would like to do,
7:32
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Speaker 1 (2026-04-28_09_19_45)
so we'll choose somebody and they will propose this and this and this.
7:35
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Speaker 1 (2026-04-28_09_19_45)
Second,
7:36
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Speaker 1 (2026-04-28_09_19_45)
I'm interested in arithmia,
7:38
S…
Speaker 1 (2026-04-28_09_19_45)
so I will find somebody from arithmiac group.
7:41
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Speaker 1 (2026-04-28_09_19_45)
Yeah,
7:44
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Speaker 1 (2026-04-28_09_19_45)
I don't know.
7:45
S…
Speaker 1 (2026-04-28_09_19_45)
Okay,
7:50
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Speaker 1 (2026-04-28_09_19_45)
so...
7:50
S…
Speaker 1 (2026-04-28_09_19_45)
You are here,
7:51
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Speaker 1 (2026-04-28_09_19_45)
this is first week,
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Speaker 1 (2026-04-28_09_19_45)
last week,
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Speaker 1 (2026-04-28_09_19_45)
next week or second.
7:55
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Speaker 1 (2026-04-28_09_19_45)
After it,
7:56
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Speaker 1 (2026-04-28_09_19_45)
I propose on Thursday to just think if it will be,
8:00
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Speaker 1 (2026-04-28_09_19_45)
what will be for you interesting.
8:02
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Speaker 1 (2026-04-28_09_19_45)
Yes.
8:03
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Speaker 1 (2026-04-28_09_19_45)
I can wrote your email,
8:05
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Speaker 1 (2026-04-28_09_19_45)
so you can write me or assist the provisor Ksivanis for you,
8:09
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Speaker 1 (2026-04-28_09_19_45)
advise somebody
8:13
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Speaker 1 (2026-04-28_09_19_45)
or I said,
8:15
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Speaker 1 (2026-04-28_09_19_45)
okay, I do,
8:16
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Speaker 1 (2026-04-28_09_19_45)
I think,
8:17
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Speaker 1 (2026-04-28_09_19_45)
I work on this and this.
8:19
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Speaker 1 (2026-04-28_09_19_45)
So maybe will this be interesting for you.
8:28
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Speaker 1 (2026-04-28_09_19_45)
And this project you will do this year or?
8:31
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Speaker 1 (2026-04-28_09_19_45)
So you need to
8:35
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Speaker 1 (2026-04-28_09_19_45)
end it after June.
8:37
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Speaker 1 (2026-04-28_09_19_45)
So you have something like tomorrow.
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Speaker 1 (2026-04-28_09_19_45)
Just
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Speaker 1 (2026-04-28_09_19_45)
to
8:49
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Speaker 1 (2026-04-28_09_19_45)
be sure that will somebody help you because usually
8:55
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Speaker 1 (2026-04-28_09_19_45)
we are...
8:56
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Speaker 1 (2026-04-28_09_19_45)
busy and have a lot of things to do so sometimes we skip something like
9:00
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Speaker 1 (2026-04-28_09_19_45)
medical students so just after it you find
9:05
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Speaker 1 (2026-04-28_09_19_45)
somebody so just pushing the group quite a short time so okay
9:09
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Speaker 1 (2026-04-28_09_19_45)
just write an email
10:01
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Speaker 1 (2026-04-28_09_19_45)
So, you have Martina Kotačová.
10:05
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Speaker 1 (2026-04-28_09_19_45)
Okay.
10:05
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Speaker 1 (2026-04-28_09_19_45)
The first thing,
10:07
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Speaker 1 (2026-04-28_09_19_45)
what was the problem of the patient?
10:08
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Speaker 2 (2026-04-28_09_19_45)
She's having so far of chest veins that are intermittent and
10:12
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Speaker 2 (2026-04-28_09_19_45)
she feels fine with breast,
10:14
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Speaker 2 (2026-04-28_09_19_45)
but she's having chest veins to palpitations.
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Speaker 1 (2026-04-28_09_19_45)
Okay.
10:16
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Speaker 1 (2026-04-28_09_19_45)
Palpitations,
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Speaker 1 (2026-04-28_09_19_45)
I think, were more intensive than chest veins.
10:21
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Speaker 1 (2026-04-28_09_19_45)
First palpitations.
10:23
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Speaker 1 (2026-04-28_09_19_45)
What do you know about this woman?
10:25
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Speaker 2 (2026-04-28_09_19_45)
Well,
10:26
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Speaker 2 (2026-04-28_09_19_45)
she has, well,
10:27
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Speaker 2 (2026-04-28_09_19_45)
on physical examination,
10:28
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Speaker 2 (2026-04-28_09_19_45)
she has barely any pathologies.
10:31
S…
Speaker 1 (2026-04-28_09_19_45)
Okay.
10:32
S…
Speaker 1 (2026-04-28_09_19_45)
The first is age.
10:34
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Speaker 1 (2026-04-28_09_19_45)
I don't know if you are familiar with our personal
10:38
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Speaker 1 (2026-04-28_09_19_45)
number.
10:39
S…
Speaker 1 (2026-04-28_09_19_45)
So the first two...
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Speaker 2 (2026-04-28_09_19_45)
She was born in 49.
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Speaker 1 (2026-04-28_09_19_45)
No,
10:42
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Speaker 1 (2026-04-28_09_19_45)
no. The first two are year.
10:45
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Speaker 1 (2026-04-28_09_19_45)
So she's born 1981.
10:49
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Speaker 1 (2026-04-28_09_19_45)
and it's something like 2000 something,
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Speaker 1 (2026-04-28_09_19_45)
so quite young woman.
10:53
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Speaker 1 (2026-04-28_09_19_45)
It's interesting,
10:55
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Speaker 1 (2026-04-28_09_19_45)
very important.
10:55
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Speaker 1 (2026-04-28_09_19_45)
Okay,
10:56
S…
Speaker 1 (2026-04-28_09_19_45)
so first two letters or numbers are year,
10:59
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Speaker 1 (2026-04-28_09_19_45)
then month,
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Speaker 1 (2026-04-28_09_19_45)
month for woman with five,
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Speaker 1 (2026-04-28_09_19_45)
I think so you will distinguish between man and woman,
11:06
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Speaker 1 (2026-04-28_09_19_45)
and the 28th day of birth,
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Speaker 1 (2026-04-28_09_19_45)
and this is just number to it.
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Speaker 1 (2026-04-28_09_19_45)
So, quite young woman,
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Speaker 1 (2026-04-28_09_19_45)
palpitation,
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Speaker 1 (2026-04-28_09_19_45)
some chest pain.
11:17
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Speaker 1 (2026-04-28_09_19_45)
Okay.
11:18
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Speaker 1 (2026-04-28_09_19_45)
ACG.
11:18
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Speaker 2 (2026-04-28_09_19_45)
On the ACG we have...
11:21
S…
Speaker 1 (2026-04-28_09_19_45)
Look on the ACG,
11:22
S…
Speaker 1 (2026-04-28_09_19_45)
which is here.
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Speaker 2 (2026-04-28_09_19_45)
There
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Speaker 1 (2026-04-28_09_19_45)
are three there.
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Speaker 2 (2026-04-28_09_19_45)
On
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S…
Speaker 1 (2026-04-28_09_19_45)
the ACG you have somewhere the date,
11:42
S…
Speaker 1 (2026-04-28_09_19_45)
so just take care if it was...
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Speaker 2 (2026-04-28_09_19_45)
Okay,
11:51
S…
Speaker 1 (2026-04-28_09_19_45)
so
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S…
Speaker 1 (2026-04-28_09_19_45)
go through the ACG and discuss it.
12:06
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Speaker 1 (2026-04-28_09_19_45)
What do you have?
12:07
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Speaker 1 (2026-04-28_09_19_45)
You have Mr.
12:08
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Speaker 1 (2026-04-28_09_19_45)
Psioda.
12:08
S…
Speaker 1 (2026-04-28_09_19_45)
Okay, first.
12:09
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Speaker 1 (2026-04-28_09_19_45)
What was the complaint of this patient?
12:11
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Speaker 1 (2026-04-28_09_19_45)
The problems that bring them?
12:14
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Speaker 2 (2026-04-28_09_19_45)
The chest pain and the pain relating to the shoulder.
12:17
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Speaker 1 (2026-04-28_09_19_45)
Okay.
12:18
S…
Speaker 1 (2026-04-28_09_19_45)
And sweating.
12:19
S…
Speaker 1 (2026-04-28_09_19_45)
You can say that it was typical pain,
12:23
S…
Speaker 1 (2026-04-28_09_19_45)
something like vagina.
12:24
S…
Speaker 1 (2026-04-28_09_19_45)
What do you know about the patient from personal history,
12:27
S…
Speaker 1 (2026-04-28_09_19_45)
etc., etc.?
12:29
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Speaker 2 (2026-04-28_09_19_45)
Okay,
12:33
S…
Speaker 1 (2026-04-28_09_19_45)
no oncological history.
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Speaker 2 (2026-04-28_09_19_45)
No other clinic.
12:37
S…
Speaker 1 (2026-04-28_09_19_45)
Okay, we speak today about chest pain and the cardiology if you
12:41
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Speaker 1 (2026-04-28_09_19_45)
heard chest pain it lets you to myocardial infarction or ischemic heart disease.
12:45
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Speaker 1 (2026-04-28_09_19_45)
Are there some risk factors for ischemic heart disease which
12:50
S…
Speaker 1 (2026-04-28_09_19_45)
you will look for in the patient so you
12:54
S…
Speaker 1 (2026-04-28_09_19_45)
would like to see if the patient is smoker,
12:57
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Speaker 1 (2026-04-28_09_19_45)
obese,
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Speaker 1 (2026-04-28_09_19_45)
familiar history of myocardial infarction.
13:02
S…
Speaker 1 (2026-04-28_09_19_45)
There is a family story without nothing.
13:05
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Speaker 1 (2026-04-28_09_19_45)
Smoking,
13:06
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Speaker 1 (2026-04-28_09_19_45)
I'm not sure if he was a smoker or not.
13:08
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Speaker 2 (2026-04-28_09_19_45)
Okay,
13:14
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Speaker 1 (2026-04-28_09_19_45)
obesity and diabetes.
13:25
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Speaker 1 (2026-04-28_09_19_45)
Exactly.
13:26
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Speaker 1 (2026-04-28_09_19_45)
So it's 100 kilos,
13:28
S…
Speaker 1 (2026-04-28_09_19_45)
178 centimeters.
13:29
S…
Speaker 1 (2026-04-28_09_19_45)
So, it's slightly obvious.
13:31
S…
Speaker 1 (2026-04-28_09_19_45)
Okay.
13:31
S…
Speaker 1 (2026-04-28_09_19_45)
Some risk factor for ischemic heart disease are present.
13:34
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Speaker 2 (2026-04-28_09_19_45)
Exactly.
13:34
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Speaker 1 (2026-04-28_09_19_45)
I don't know if you are familiar with
13:39
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Speaker 1 (2026-04-28_09_19_45)
our personal numbers.
13:41
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Speaker 1 (2026-04-28_09_19_45)
This is this one.
13:42
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Speaker 1 (2026-04-28_09_19_45)
It started with the year of born.
13:44
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Speaker 1 (2026-04-28_09_19_45)
So, 85.
13:44
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Speaker 1 (2026-04-28_09_19_45)
It's 1985.
13:46
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Speaker 1 (2026-04-28_09_19_45)
Okay?
13:47
S…
Speaker 1 (2026-04-28_09_19_45)
Okay.
13:49
S…
Speaker 1 (2026-04-28_09_19_45)
First,
13:50
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Speaker 1 (2026-04-28_09_19_45)
which examination we took?
13:53
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Speaker 1 (2026-04-28_09_19_45)
This is the admission to another hospital.
13:57
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Speaker 1 (2026-04-28_09_19_45)
It's in Znojmo,
13:58
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Speaker 1 (2026-04-28_09_19_45)
so it's a small hospital,
13:59
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Speaker 1 (2026-04-28_09_19_45)
80 km from here.
14:01
S…
Speaker 1 (2026-04-28_09_19_45)
So this is the complex of the patient and this is the...
14:04
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Speaker 2 (2026-04-28_09_19_45)
Okay.
14:08
S…
Speaker 1 (2026-04-28_09_19_45)
Okay.
14:09
S…
Speaker 1 (2026-04-28_09_19_45)
So
14:15
S…
Speaker 1 (2026-04-28_09_19_45)
we have two,
14:15
S…
Speaker 1 (2026-04-28_09_19_45)
three,
14:17
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Speaker 1 (2026-04-28_09_19_45)
and the AVF.
14:18
S…
Speaker 1 (2026-04-28_09_19_45)
Which of the packet is it is?
14:21
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Speaker 2 (2026-04-28_09_19_45)
Invaluable.
14:29
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Speaker 1 (2026-04-28_09_19_45)
Okay,
14:30
S…
Speaker 1 (2026-04-28_09_19_45)
if you have elevation in the inferior part,
14:33
S…
Speaker 1 (2026-04-28_09_19_45)
and this is our first diagnosis,
14:36
S…
Speaker 1 (2026-04-28_09_19_45)
so myocardial infarction with ST segment elevation.
14:39
S…
Speaker 1 (2026-04-28_09_19_45)
Inferior part is elevation.
14:42
S…
Speaker 1 (2026-04-28_09_19_45)
You can find sometimes in opposite part
14:46
S…
Speaker 1 (2026-04-28_09_19_45)
of the heart ST segment depression,
14:48
S…
Speaker 1 (2026-04-28_09_19_45)
which is the opposite part of the heart in terms
14:52
S…
Speaker 1 (2026-04-28_09_19_45)
of inferior heart for elevation.
14:54
S…
Speaker 1 (2026-04-28_09_19_45)
So it's anterior heart,
14:56
S…
Speaker 1 (2026-04-28_09_19_45)
anterior part for depression.
15:00
S…
Speaker 1 (2026-04-28_09_19_45)
They are anterior depression and they are.
15:02
S…
Speaker 1 (2026-04-28_09_19_45)
So in lead V1 there is a 37 depression.
15:05
S…
Speaker 2 (2026-04-28_09_19_45)
Okay?
15:06
S…
Speaker 1 (2026-04-28_09_19_45)
This is a CG we will like for describing for the others,
15:10
S…
Speaker 1 (2026-04-28_09_19_45)
but you will know already who is there.
15:12
S…
Speaker 1 (2026-04-28_09_19_45)
So, continue.
15:13
S…
Speaker 2 (2026-04-28_09_19_45)
Okay,
15:23
S…
Speaker 1 (2026-04-28_09_19_45)
so you have the man with some chest pain,
15:26
S…
Speaker 1 (2026-04-28_09_19_45)
I think.
15:26
S…
Speaker 1 (2026-04-28_09_19_45)
What do you know about his
15:31
S…
Speaker 1 (2026-04-28_09_19_45)
complaints, his person?
15:47
S…
Speaker 2 (2026-04-28_09_19_45)
No vomitation.
15:49
S…
Speaker 2 (2026-04-28_09_19_45)
No vomitation.
15:52
S…
Speaker 1 (2026-04-28_09_19_45)
Okay,
15:53
S…
Speaker 1 (2026-04-28_09_19_45)
so chest pain.
16:06
S…
Speaker 2 (2026-04-28_09_19_45)
ECG.
16:06
S…
Speaker 1 (2026-04-28_09_19_45)
Okay.
16:07
S…
Speaker 2 (2026-04-28_09_19_45)
First ECG,
16:09
S…
Speaker 1 (2026-04-28_09_19_45)
can you look on it and describe what you see there?
16:12
S…
Speaker 2 (2026-04-28_09_19_45)
I
16:22
S…
Speaker 2 (2026-04-28_09_19_45)
see it as the elevations.
16:23
S…
Speaker 1 (2026-04-28_09_19_45)
I do not agree.
16:25
S…
Speaker 2 (2026-04-28_09_19_45)
What's your colleagues?
16:28
S…
Speaker 2 (2026-04-28_09_19_45)
Kind of.
16:30
S…
Speaker 2 (2026-04-28_09_19_45)
I'm also sure about that.
16:31
S…
Speaker 2 (2026-04-28_09_19_45)
That's how I agree.
16:32
S…
Speaker 1 (2026-04-28_09_19_45)
You are right that the ST segment usually
16:37
S…
Speaker 1 (2026-04-28_09_19_45)
should be like this line and it's more like this.
16:41
S…
Speaker 1 (2026-04-28_09_19_45)
So typical elevation,
16:44
S…
Speaker 1 (2026-04-28_09_19_45)
it's like this one.
16:45
S…
Speaker 2 (2026-04-28_09_19_45)
The
16:56
S…
Speaker 1 (2026-04-28_09_19_45)
things you have,
16:57
S…
Speaker 2 (2026-04-28_09_19_45)
so this is,
16:59
S…
Speaker 1 (2026-04-28_09_19_45)
you have something all over G point
17:03
S…
Speaker 1 (2026-04-28_09_19_45)
and some kind of ST.
17:08
S…
Speaker 2 (2026-04-28_09_19_45)
It's not elevation.
17:09
S…
Speaker 1 (2026-04-28_09_19_45)
I will describe it as an ascending shape
17:13
S…
Speaker 1 (2026-04-28_09_19_45)
of ST segment.
17:15
S…
Speaker 1 (2026-04-28_09_19_45)
So if you have elevation,
17:17
S…
Speaker 1 (2026-04-28_09_19_45)
so you need to have elevated G point.
17:21
S…
Speaker 1 (2026-04-28_09_19_45)
So this is when the ST segment starts.
17:25
S…
Speaker 1 (2026-04-28_09_19_45)
And this is so typical,
17:26
S…
Speaker 1 (2026-04-28_09_19_45)
this one.
17:28
S…
Speaker 1 (2026-04-28_09_19_45)
But yes,
17:29
S…
Speaker 1 (2026-04-28_09_19_45)
I agree it's not completely normal.
17:32
S…
Speaker 1 (2026-04-28_09_19_45)
But I will not say that there are typical changes for ST
17:36
S…
Speaker 1 (2026-04-28_09_19_45)
segment elevation.
17:39
S…
Speaker 1 (2026-04-28_09_19_45)
So if I will describe the CCG,
17:41
S…
Speaker 1 (2026-04-28_09_19_45)
I will say at the first line this is normal.
17:45
S…
Speaker 1 (2026-04-28_09_19_45)
So no special signs
17:49
S…
Speaker 1 (2026-04-28_09_19_45)
of acute myocardial infarction.
17:51
S…
Speaker 1 (2026-04-28_09_19_45)
What you will do in such case?
17:53
S…
Speaker 1 (2026-04-28_09_19_45)
We did not spoke about some risk factors for
17:58
S…
Speaker 1 (2026-04-28_09_19_45)
coronary event for this patient.
18:00
S…
Speaker 1 (2026-04-28_09_19_45)
I don't know how old is he?
18:02
S…
Speaker 1 (2026-04-28_09_19_45)
52.
18:03
S…
Speaker 2 (2026-04-28_09_19_45)
So it's...
18:11
S…
Speaker 2 (2026-04-28_09_19_45)
29,
18:12
S…
Speaker 2 (2026-04-28_09_19_45)
25 years old?
18:14
S…
Speaker 1 (2026-04-28_09_19_45)
50 years old?
18:16
S…
Speaker 1 (2026-04-28_09_19_45)
Okay, so something like intermediate.
18:18
S…
Speaker 1 (2026-04-28_09_19_45)
Usually the ischemic disease starts in the older
18:22
S…
Speaker 1 (2026-04-28_09_19_45)
age.
18:22
S…
Speaker 1 (2026-04-28_09_19_45)
What are the risk factors for coronary disease?
18:26
S…
Speaker 2 (2026-04-28_09_19_45)
Smoking?
18:28
S…
Speaker 1 (2026-04-28_09_19_45)
Diabetes?
18:29
S…
Speaker 1 (2026-04-28_09_19_45)
Ademia and
18:33
S…
Speaker 1 (2026-04-28_09_19_45)
hypertension.
18:34
S…
Speaker 1 (2026-04-28_09_19_45)
Does he have something from it?
18:36
S…
Speaker 1 (2026-04-28_09_19_45)
Okay,
18:38
S…
Speaker 1 (2026-04-28_09_19_45)
first point.
18:39
S…
Speaker 1 (2026-04-28_09_19_45)
Obesity?
18:54
S…
Speaker 2 (2026-04-28_09_19_45)
What do you do?
18:58
S…
Speaker 1 (2026-04-28_09_19_45)
Ask the patient,
18:59
S…
Speaker 1 (2026-04-28_09_19_45)
in this case you will go through personal amnesis,
19:02
S…
Speaker 1 (2026-04-28_09_19_45)
it's like O -Sob -Ni -O -R,
19:04
S…
Speaker 1 (2026-04-28_09_19_45)
so there should be written if there is hypertension.
19:06
S…
Speaker 2 (2026-04-28_09_19_45)
So he is not treated with any other comorbidities.
19:10
S…
Speaker 1 (2026-04-28_09_19_45)
Okay, then I will look in the pharmacological history.
19:14
S…
Speaker 1 (2026-04-28_09_19_45)
Sometimes there is written something that you can expect hypertension,
19:18
S…
Speaker 1 (2026-04-28_09_19_45)
for example.
19:30
S…
Speaker 1 (2026-04-28_09_19_45)
So his first thinking was that the chest pain is not because of heart,
19:34
S…
Speaker 1 (2026-04-28_09_19_45)
but because of backbone.
19:35
S…
Speaker 1 (2026-04-28_09_19_45)
That's why he took some painkillers,
19:39
S…
Speaker 1 (2026-04-28_09_19_45)
etc.
19:39
S…
Speaker 1 (2026-04-28_09_19_45)
Okay,
19:40
S…
Speaker 1 (2026-04-28_09_19_45)
first STG,
19:41
S…
Speaker 1 (2026-04-28_09_19_45)
let's say,
19:42
S…
Speaker 1 (2026-04-28_09_19_45)
not 100 % normal,
19:44
S…
Speaker 1 (2026-04-28_09_19_45)
but not typical for ischemic heart disease.
19:46
S…
Speaker 1 (2026-04-28_09_19_45)
What next you can do for such patients?
19:51
S…
Speaker 1 (2026-04-28_09_19_45)
Biochem lab?
19:51
S…
Speaker 1 (2026-04-28_09_19_45)
Okay.
19:52
S…
Speaker 2 (2026-04-28_09_19_45)
Drop on.
19:53
S…
Speaker 1 (2026-04-28_09_19_45)
Exactly.
19:53
S…
Speaker 1 (2026-04-28_09_19_45)
So it was positive,
19:55
S…
Speaker 1 (2026-04-28_09_19_45)
but I don't think so.
19:57
S…
Speaker 1 (2026-04-28_09_19_45)
But positivity,
19:59
S…
Speaker 1 (2026-04-28_09_19_45)
it was something like...
20:00
S…
Speaker 2 (2026-04-28_09_19_45)
Slightly higher,
20:00
S…
Speaker 2 (2026-04-28_09_19_45)
I think.
20:01
S…
Speaker 1 (2026-04-28_09_19_45)
Okay,
20:04
S…
Speaker 2 (2026-04-28_09_19_45)
you will find it somewhere here
20:08
S…
Speaker 2 (2026-04-28_09_19_45)
in the lab results,
20:09
S…
Speaker 2 (2026-04-28_09_19_45)
it will be troponin first than the last.
20:11
S…
Speaker 1 (2026-04-28_09_19_45)
Let's say it
20:15
S…
Speaker 2 (2026-04-28_09_19_45)
is something like 10 nanogram per liter.
20:19
S…
Speaker 2 (2026-04-28_09_19_45)
So it's slightly positive,
20:21
S…
Speaker 1 (2026-04-28_09_19_45)
but not too big.
20:22
S…
Speaker 2 (2026-04-28_09_19_45)
If you have a big myocardial infection,
20:24
S…
Speaker 2 (2026-04-28_09_19_45)
such elevation will have a thousand,
20:27
S…
Speaker 2 (2026-04-28_09_19_45)
let's say.
20:28
S…
Speaker 2 (2026-04-28_09_19_45)
What next?
20:33
S…
Speaker 1 (2026-04-28_09_19_45)
Like, we saw that they did
20:37
S…
Speaker 1 (2026-04-28_09_19_45)
the angio.
20:40
S…
Speaker 1 (2026-04-28_09_19_45)
Okay,
20:41
S…
Speaker 1 (2026-04-28_09_19_45)
but the angios.
20:42
S…
Speaker 2 (2026-04-28_09_19_45)
I'm not sure if it
20:47
S…
Speaker 2 (2026-04-28_09_19_45)
will be enough just chest pain and
20:51
S…
Speaker 2 (2026-04-28_09_19_45)
slightly positive troponin for angio.
20:53
S…
Speaker 2 (2026-04-28_09_19_45)
Angio is some kind of invasive.
20:58
S…
Speaker 2 (2026-04-28_09_19_45)
diagnosis test okay we came up
21:02
S…
Speaker 2 (2026-04-28_09_19_45)
to the NGO but before I would like to be more sure or
21:07
S…
Speaker 2 (2026-04-28_09_19_45)
have more suspicion for coronary artery disease you
21:11
S…
Speaker 2 (2026-04-28_09_19_45)
would like to say something
21:17
S…
Speaker 2 (2026-04-28_09_19_45)
ECO, exactly.
21:18
S…
Speaker 2 (2026-04-28_09_19_45)
ECO was normal.
21:19
S…
Speaker 1 (2026-04-28_09_19_45)
You will find it.
21:20
S…
Speaker 1 (2026-04-28_09_19_45)
It was normal.
21:21
S…
Speaker 2 (2026-04-28_09_19_45)
What I use sometimes is repetitive use of ACG.
21:25
S…
Speaker 2 (2026-04-28_09_19_45)
So that's why you have the second ACG.
21:27
S…
Speaker 2 (2026-04-28_09_19_45)
So if there is acute coronary syndrome,
21:29
S…
Speaker 2 (2026-04-28_09_19_45)
I will expect some changes.
21:32
S…
Speaker 2 (2026-04-28_09_19_45)
So usually you look for ST segment elevation or depression.
21:36
S…
Speaker 2 (2026-04-28_09_19_45)
The second ACG,
21:37
S…
Speaker 2 (2026-04-28_09_19_45)
I think it's normal.
21:39
S…
Speaker 1 (2026-04-28_09_19_45)
Again.
21:42
S…
Speaker 2 (2026-04-28_09_19_45)
What you can repeat is troponin again.
21:44
S…
Speaker 2 (2026-04-28_09_19_45)
So if you measure troponin in one hour or in three
21:48
S…
Speaker 2 (2026-04-28_09_19_45)
hours, and there is difference,
21:50
S…
Speaker 2 (2026-04-28_09_19_45)
then you have some point for acute coronary
21:55
S…
Speaker 1 (2026-04-28_09_19_45)
syndrome.
21:55
S…
Speaker 2 (2026-04-28_09_19_45)
That was the point of this patient.
21:58
S…
Speaker 2 (2026-04-28_09_19_45)
So first troponin was positive,
22:01
S…
Speaker 2 (2026-04-28_09_19_45)
but not too much.
22:03
S…
Speaker 2 (2026-04-28_09_19_45)
ECU was negative,
22:04
S…
Speaker 2 (2026-04-28_09_19_45)
ACG was negative,
22:06
S…
Speaker 2 (2026-04-28_09_19_45)
but the second troponin was quite high,
22:09
S…
Speaker 2 (2026-04-28_09_19_45)
something like five times or six times.
22:11
S…
Speaker 2 (2026-04-28_09_19_45)
That's why angiob.
22:12
S…
Speaker 1 (2026-04-28_09_19_45)
Okay.
22:13
S…
Speaker 1 (2026-04-28_09_19_45)
What was the angiob?
22:16
S…
Speaker 1 (2026-04-28_09_19_45)
We
22:21
S…
Speaker 1 (2026-04-28_09_19_45)
think that it's a Ramos marginal and also
22:27
S…
Speaker 1 (2026-04-28_09_19_45)
90 % of the proximal ACD,
22:31
S…
Speaker 1 (2026-04-28_09_19_45)
which we...
22:33
S…
Speaker 2 (2026-04-28_09_19_45)
Right coronary artery.
22:34
S…
Speaker 2 (2026-04-28_09_19_45)
So,
22:36
S…
Speaker 2 (2026-04-28_09_19_45)
and this was interesting for me.
22:37
S…
Speaker 2 (2026-04-28_09_19_45)
So we have the patients with typical chest pain,
22:39
S…
Speaker 2 (2026-04-28_09_19_45)
okay, but no ACG changes almost,
22:42
S…
Speaker 2 (2026-04-28_09_19_45)
and very,
22:42
S…
Speaker 2 (2026-04-28_09_19_45)
very slightly increased troponin with too severe stenosis.
22:46
S…
Speaker 1 (2026-04-28_09_19_45)
Okay,
22:47
S…
Speaker 2 (2026-04-28_09_19_45)
what's next?
22:48
S…
Speaker 1 (2026-04-28_09_19_45)
Look,
22:49
S…
Speaker 1 (2026-04-28_09_19_45)
look and read.
22:50
S…
Speaker 1 (2026-04-28_09_19_45)
So,
22:53
S…
Speaker 2 (2026-04-28_09_19_45)
ACG was with the D -segment elevation and depression.
22:57
S…
Speaker 2 (2026-04-28_09_19_45)
What was the next part?
23:03
S…
Speaker 2 (2026-04-28_09_19_45)
so you have the suspicion for myocardial infarction with ST signal elevation so
23:07
S…
Speaker 2 (2026-04-28_09_19_45)
you send such patients to some cat lab and we some
23:12
S…
Speaker 2 (2026-04-28_09_19_45)
of the patients from this normal camp to our cat lab so this is our admission
23:16
S…
Speaker 2 (2026-04-28_09_19_45)
admission paper nothing special there ACG
23:21
S…
Speaker 1 (2026-04-28_09_19_45)
okay still
23:25
S…
Speaker 2 (2026-04-28_09_19_45)
some depression okay and
23:31
S…
Speaker 2 (2026-04-28_09_19_45)
and there was coronary angiogram and what was there so this is echocardiography
23:36
S…
Speaker 2 (2026-04-28_09_19_45)
yes but
23:40
S…
Speaker 2 (2026-04-28_09_19_45)
what i would like to point on the echo there was hypokinesis on the inferior wall
23:44
S…
Speaker 2 (2026-04-28_09_19_45)
so it was in the right of the inferior
23:48
S…
Speaker 2 (2026-04-28_09_19_45)
wall infarction but what was interesting on angio there
23:52
S…
Speaker 2 (2026-04-28_09_19_45)
was no stenosis no thrombosis no problems
23:57
S…
Speaker 2 (2026-04-28_09_19_45)
on the coronary arteries did you read it
24:02
S…
Speaker 2 (2026-04-28_09_19_45)
More or just a beer?
24:04
S…
Speaker 1 (2026-04-28_09_19_45)
So now what
24:08
S…
Speaker 1 (2026-04-28_09_19_45)
was the problem?
24:08
S…
Speaker 1 (2026-04-28_09_19_45)
So if you
24:15
S…
Speaker 2 (2026-04-28_09_19_45)
have myocarditis,
24:16
S…
Speaker 2 (2026-04-28_09_19_45)
you can have changes on the ACG.
24:19
S…
Speaker 2 (2026-04-28_09_19_45)
you can have wall motion abnormalities on the echo,
24:23
S…
Speaker 2 (2026-04-28_09_19_45)
you will have positive troponin,
24:25
S…
Speaker 2 (2026-04-28_09_19_45)
but not because of coronary arteries,
24:27
S…
Speaker 2 (2026-04-28_09_19_45)
but because of myocarditis.
24:29
S…
Speaker 2 (2026-04-28_09_19_45)
If it is regional and here it is the inferior part,
24:33
S…
Speaker 2 (2026-04-28_09_19_45)
that's why where the change is just the inferior part is okay.
24:37
S…
Speaker 2 (2026-04-28_09_19_45)
Go through the treatment
24:41
S…
Speaker 2 (2026-04-28_09_19_45)
with myocarditis if you will find something.
24:49
S…
Speaker 2 (2026-04-28_09_19_45)
So, that is Kutrčová, who's next?
25:00
S…
Speaker 2 (2026-04-28_09_19_45)
This was around 8,
25:01
S…
Speaker 2 (2026-04-28_09_19_45)
then I think she got rested or got some medication.
25:03
S…
Speaker 1 (2026-04-28_09_19_45)
I think it was without special
25:07
S…
Speaker 1 (2026-04-28_09_19_45)
medication,
25:08
S…
Speaker 1 (2026-04-28_09_19_45)
just rest.
25:10
S…
Speaker 2 (2026-04-28_09_19_45)
So with this,
25:12
S…
Speaker 2 (2026-04-28_09_19_45)
before, it was a bit janky,
25:15
S…
Speaker 2 (2026-04-28_09_19_45)
we noticed that it was regular because the intervals are correct,
25:19
S…
Speaker 1 (2026-04-28_09_19_45)
although it's a bit weird.
25:20
S…
Speaker 1 (2026-04-28_09_19_45)
I agree,
25:22
S…
Speaker 1 (2026-04-28_09_19_45)
so...
25:25
S…
Speaker 1 (2026-04-28_09_19_45)
Technically, if you go through the whole ACG,
25:27
S…
Speaker 1 (2026-04-28_09_19_45)
you see that it's not regular,
25:30
S…
Speaker 1 (2026-04-28_09_19_45)
so you see some irregularity.
25:32
S…
Speaker 1 (2026-04-28_09_19_45)
But if you look at this part,
25:34
S…
Speaker 1 (2026-04-28_09_19_45)
you will find P wave,
25:35
S…
Speaker 1 (2026-04-28_09_19_45)
QRS complex,
25:36
S…
Speaker 1 (2026-04-28_09_19_45)
P QRS.
25:37
S…
Speaker 1 (2026-04-28_09_19_45)
So you can say that this is sinus written.
25:39
S…
Speaker 1 (2026-04-28_09_19_45)
The P wave you have concordant in all leads
25:44
S…
Speaker 1 (2026-04-28_09_19_45)
and the same in the V1 to V6.
25:46
S…
Speaker 1 (2026-04-28_09_19_45)
Okay, so part of it is sinus written.
25:53
S…
Speaker 2 (2026-04-28_09_19_45)
when you say regular does it not mean like all the intervals are the same even
25:58
S…
Speaker 1 (2026-04-28_09_19_45)
though it's pathological like obviously this is I'm
26:02
S…
Speaker 1 (2026-04-28_09_19_45)
not sure if I understand you correctly so the question is what is irregularity
26:06
S…
Speaker 1 (2026-04-28_09_19_45)
or yeah
26:08
S…
Speaker 1 (2026-04-28_09_19_45)
So you have RR interval and if they are regular or
26:12
S…
Speaker 1 (2026-04-28_09_19_45)
almost regular...
26:13
S…
Speaker 2 (2026-04-28_09_19_45)
You maintain the same interval.
26:14
S…
Speaker 1 (2026-04-28_09_19_45)
Exactly.
26:15
S…
Speaker 1 (2026-04-28_09_19_45)
But to be...
26:17
S…
Speaker 1 (2026-04-28_09_19_45)
There is respiratory sinus arrhythmia.
26:21
S…
Speaker 1 (2026-04-28_09_19_45)
So if you have normal patient with just breathing,
26:25
S…
Speaker 1 (2026-04-28_09_19_45)
you will have some small variation.
26:28
S…
Speaker 1 (2026-04-28_09_19_45)
But you have also always P -Voricularis complex,
26:31
S…
Speaker 1 (2026-04-28_09_19_45)
P -Voricularis complex.
26:32
S…
Speaker 1 (2026-04-28_09_19_45)
So the slightly variation of such...
26:36
S…
Speaker 1 (2026-04-28_09_19_45)
rr intervals we take as a normal if there is
26:40
S…
Speaker 1 (2026-04-28_09_19_45)
this is complete abnormal or if you have atrial fibrillation so the rr intervals
26:44
S…
Speaker 1 (2026-04-28_09_19_45)
varies that's why we sometimes describe then the heart rate in the
26:48
S…
Speaker 1 (2026-04-28_09_19_45)
atrial fibrillation something like from 60 to 70 beats per minute because it's really
26:53
S…
Speaker 1 (2026-04-28_09_19_45)
you can measure it in the rapid
26:58
S…
Speaker 1 (2026-04-28_09_19_45)
part or in the slower part so this i will describe as irregularly
27:02
S…
Speaker 1 (2026-04-28_09_19_45)
basic based on
27:06
S…
Speaker 1 (2026-04-28_09_19_45)
Sinus written together with some 1,
27:09
S…
Speaker 1 (2026-04-28_09_19_45)
2, 3.
27:10
S…
Speaker 1 (2026-04-28_09_19_45)
What are these complexes,
27:12
S…
Speaker 1 (2026-04-28_09_19_45)
for example?
27:13
S…
Speaker 2 (2026-04-28_09_19_45)
Do you mean these ones?
27:16
S…
Speaker 1 (2026-04-28_09_19_45)
Yes, so it's the same.
27:18
S…
Speaker 2 (2026-04-28_09_19_45)
These are pathologies,
27:22
S…
Speaker 2 (2026-04-28_09_19_45)
and I saw this as a depression.
27:24
S…
Speaker 1 (2026-04-28_09_19_45)
Okay,
27:26
S…
Speaker 1 (2026-04-28_09_19_45)
you are right,
27:27
S…
Speaker 1 (2026-04-28_09_19_45)
but this is sinus.
27:32
S…
Speaker 1 (2026-04-28_09_19_45)
I'm asking what is this complex,
27:35
S…
Speaker 1 (2026-04-28_09_19_45)
what type of the complex it is.
27:37
S…
Speaker 1 (2026-04-28_09_19_45)
So we say that this is sinus written,
27:39
S…
Speaker 1 (2026-04-28_09_19_45)
this is non -sinus.
27:41
S…
Speaker 1 (2026-04-28_09_19_45)
Okay,
27:43
S…
Speaker 1 (2026-04-28_09_19_45)
what it is?
27:44
S…
Speaker 1 (2026-04-28_09_19_45)
Ventricular premature beats.
27:47
S…
Speaker 1 (2026-04-28_09_19_45)
If
27:55
S…
Speaker 1 (2026-04-28_09_19_45)
you have AV block,
27:55
S…
Speaker 1 (2026-04-28_09_19_45)
you have P wave.
27:58
S…
Speaker 1 (2026-04-28_09_19_45)
And not for every P wave QRS complex.
28:02
S…
Speaker 1 (2026-04-28_09_19_45)
To be honest,
28:02
S…
Speaker 1 (2026-04-28_09_19_45)
AV block first grade is prolongation of the PR interval.
28:06
S…
Speaker 1 (2026-04-28_09_19_45)
Usually it's to 200,
28:07
S…
Speaker 1 (2026-04-28_09_19_45)
220.
28:08
S…
Speaker 1 (2026-04-28_09_19_45)
If you have 300 between P and QRS complex,
28:11
S…
Speaker 1 (2026-04-28_09_19_45)
you can call it AV block grade one.
28:13
S…
Speaker 1 (2026-04-28_09_19_45)
If there is more P waves than QRS complex,
28:17
S…
Speaker 1 (2026-04-28_09_19_45)
then you have AV block some grade.
28:20
S…
Speaker 1 (2026-04-28_09_19_45)
Completely not connected is AV block third grade.
28:24
S…
Speaker 1 (2026-04-28_09_19_45)
If there is some connection,
28:25
S…
Speaker 1 (2026-04-28_09_19_45)
second grade,
28:26
S…
Speaker 1 (2026-04-28_09_19_45)
etc.
28:27
S…
Speaker 1 (2026-04-28_09_19_45)
But if this complex,
28:30
S…
Speaker 1 (2026-04-28_09_19_45)
if you have complex on the SCG,
28:32
S…
Speaker 1 (2026-04-28_09_19_45)
it looks usually wider than sinus written and
28:37
S…
Speaker 1 (2026-04-28_09_19_45)
it's not regular,
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