craig ernst, mhs, pa-c. rate rhythm axis hypertrophy infarct st-t changes (injury/ischemia) ...

The ECGCraig Ernst, MHS, PA-C

Rate Rhythm Axis Hypertrophy Infarct ST-T Changes (injury/ischemia) Intervals

◦ PR◦ QRS◦ QT

A Systematic Approach

Quick Estimate◦“300, 150, 100, 75, 60, 50”

Alternative Methods◦6 second strip and multiply by 10

Or

◦1500/# mm between R-R

Rate

What is the rate?

What is the rate?

P before each QRS?QRS follows each P?Regular or Irregular?

Rhythm

What is the Rhythm?

What is the Rhythm?

What is the Rhythm?

Leads I and AVF◦Upright in both = normal axis◦Up in I and down in AVF = LAD◦Down in I and up in AVF = RAD◦Down in both = Extreme RAD

Axis

What is the Axis?

What is the Axis?

What is the Axis?

S in V1 + R in V5 = greater than or equal to 35 mm

R in AVL greater than 11 mm

Hypertrophy (LVH)

Q wave of greater than .04 sec (one small block)

Q wave 1/3 the amplitude or more of the QRS complex

Infarct

Old Infarct? Where?

Location of Infarct

Injury◦ST elevation

Ischemia◦ST depression or T wave inversions

Location◦Same as for MI

ST-T Changes

What is going on?

PR duration: less than 0.12 or greater than 0.20

QRS duration: greater than 0.12QT duration: greater than 0.44

◦Should not be greater than half the R-R interval

Intervals

RhythmsBlocks◦1st degree◦2nd degreeMobitz IMobitz II

◦3rd degree

Name that Block

Name that Block

Name that block

Ectopy◦PVC

◦PAC

Rhythms

Rhythms

Tachycardias◦Sinus◦MAT◦PSVT◦A-fib◦A-flutter◦VT

What is the Tachycardia?

What is the Tachycardia?

What is the Tachycardia?

What is the Tachycardia?

What is the Tachycardia?

What is the Tachycardia?

What is the Tachycardia?

What is the Tachycardia?

Potassium Calcium Drugs

◦ B-blockers◦ Calcium channel blockers◦ Digitalis

Effects of Drugs and Electrolytes

Case