ecg presentation

BASICSBASICS

OF OF

E C GE C G INTERPRETATIONINTERPRETATION

NORMAL E C GNORMAL E C G RATE: 60 – 100/ mts MECHANISM: SINUS (P wave precedes QRS) RHYTHM: REGULAR HEART RATE: 300/ NO OF LARGE BOXES BETWEEN TWO

SUCCESSIVE QRS COMPLEXES OR 1500/ NO OF SMALL SQUARES BETWEEN TWO

SUCCESSIVE QRS COMPLEXES

E C G: NORMAL WAVES AND E C G: NORMAL WAVES AND INTERVALSINTERVALS

P WAVE:ATRIAL DEP QRS COMPLEX:

VENTRICULAR DEP T WAVE:

VENTRICULAR REP U WAVE PR INTERVAL QT INTERVAL

E C G: DURATION OF NORMAL E C G: DURATION OF NORMAL WAVES AND INTERVALSWAVES AND INTERVALS

P WAVE:<0.12s WIDTH / HEIGHT

PR INTERVAL:0.12s TO 0.2s

QRS COMPLEX:<0.12s QT INTERVAL:0.35-0.43s VAT :<0.04s

E C G: DURATION OF NORMAL E C G: DURATION OF NORMAL WAVES AND INTERVALSWAVES AND INTERVALS

Q-T INTERVALQ-T INTERVAL Measured In A Lead With Initial q Wave. Measured From Beginning Of q Wave To

End Of T Wave. Shortens With Tachycardia And Lengthens

With Bradycardia. Q-T Interval Is Corrected For Rate Of 60,

Using Bazett’s Formula.

E C G: AXISE C G: AXIS

DEFDEF : DIRECTION OF MAXIMUM DEP FRONT

NORMAL AXIS: -30 to +110 LEFT AXIS: -30 to -90 RIGHT AXIS: +110 to -1 NORTH WEST AXIS: -90 to -180

HOW TO LOOK FOR AXIS?HOW TO LOOK FOR AXIS? METHOD 1:METHOD 1: SELECT A LEAD WITH MAXIMUM QRS , AXIS

WILL BE TOWARDS THIS LEAD. METHOD 2:METHOD 2: SELECT A LEAD WITH EQUIPHASIC QRS,

AXIS WILL BE AT 90º TO THIS LEAD. METHOD 3:METHOD 3: IF TWO LEADS HAVE QRS OF SAME HEIGHT, AXIS WILL BE BETWEEN TWO SUCH LEADS.

E C G : CHAMBER E C G : CHAMBER ENLARGEMENTENLARGEMENT

E C G: CHAMBER E C G: CHAMBER ENLARGEMENTENLARGEMENT

RT ATRIAL ENLARGEMENTRT ATRIAL ENLARGEMENT::`P`pulmonale –P wave height>2.5mm LT ATRIAL ENLARGEMENTLT ATRIAL ENLARGEMENT::`P`mitrale -P wave width >2.5mm Notched P wave BIATRIAL ENLARGEMENTBIATRIAL ENLARGEMENT::

Biphasic P wave in V1

Morris indexMorris index : :P wave depth >2 mm and duration >0.04 s of terminal deflection, suggests LT atrial enlargement

E C G: CHAMBER E C G: CHAMBER ENLARGEMENTENLARGEMENT

ATRIAL ENLARGEMENTATRIAL ENLARGEMENT

E C G: CHAMBER E C G: CHAMBER ENLARGEMENTENLARGEMENT

ATRIAL ENLARGEMENTATRIAL ENLARGEMENT

E C G: CHAMBER E C G: CHAMBER ENLARGEMENTENLARGEMENT

RT VENTRICULAR ENLARGEMENT:RT VENTRICULAR ENLARGEMENT: R wave >7mm in V1 , R/S ratio in V1>1

R in V1+ S in V6 >11mm

LT VENTRICULAR ENLARGEMENT:LT VENTRICULAR ENLARGEMENT:

R in V6= R in V5 ; R in V6>20mm

S in V1>30mm ; R in V6+ S in V1>35mm

Romhilt -Estes Score >5

E C G: CHAMBERE C G: CHAMBER ENLARGEMENTENLARGEMENT

VENTRICULAR ENLARGEMENTVENTRICULAR ENLARGEMENT

E C G: CHAMBERE C G: CHAMBER ENLARGEMENTENLARGEMENT

RT & LT VENTRICULAR ENLARGEMENTRT & LT VENTRICULAR ENLARGEMENT

E C G : HEART E C G : HEART BLOCKSBLOCKS

E C G:HEART BLOCKSE C G:HEART BLOCKS

TYPES: TYPES: S A BLOCK A V BLOCK:1º A V BLOCK

2º A V BLOCK

(Wenckebach,Mobitz ,2:1 block )

3ºA V BLOCK( complete block) BUNDLE BRANCH BLOCK ( Rt and Lt ) FASCICULAR BLOCK (Rt and Lt )

E C G: HEART BLOCKSE C G: HEART BLOCKS

A V BLOCK: 1A V BLOCK: 1ººHEART BLOCKHEART BLOCK

E C G: HEART BLOCKSE C G: HEART BLOCKS

A VA V BLOCK:2BLOCK:2ººHEART BLOCKHEART BLOCK

( Wenckebach Type)

E C G: HEART BLOCKSE C G: HEART BLOCKS

A V BLOCK: 2A V BLOCK: 2ººHEART BLOCKHEART BLOCK

(Mobitz Type)

E C G:HEART BLOCKSE C G:HEART BLOCKS

A V BLOCK:2A V BLOCK:2ººHEART BLOCKHEART BLOCK

(2:1Block)

E C G: HEART BLOCKSE C G: HEART BLOCKS

A V BLOCK: 3A V BLOCK: 3ººHEART BLOCKHEART BLOCK

(Complete Heart Block)

E C G: HEART BLOCKSE C G: HEART BLOCKS

RT BUNDLE BRANCH BLOCKRT BUNDLE BRANCH BLOCK

E C G: HEART BLOCKSE C G: HEART BLOCKSRT BUNDLE BRANCH BLOCKRT BUNDLE BRANCH BLOCK

E C G: HEART BLOCKSE C G: HEART BLOCKS

LT BUNDLELT BUNDLE BRANCH BLOCKBRANCH BLOCK

E C G: HEART BLOCKSE C G: HEART BLOCKSLT BUNDLE BRANCH BLOCKLT BUNDLE BRANCH BLOCK

E C G:E C G: HEART BLOCKSHEART BLOCKS

RT & LT BUNDLE BRANCH BLOCKRT & LT BUNDLE BRANCH BLOCK

E C G : ISCHEMIC E C G : ISCHEMIC HEART DISEASEHEART DISEASE

E C G: ISCHEMIC HEART E C G: ISCHEMIC HEART DISEASEDISEASE

TYPES OF CHANGES:TYPES OF CHANGES: ISCHEMIA

INJURY

NECROSIS

E C G: ISCHEMIC HEART E C G: ISCHEMIC HEART DISEASEDISEASE

E C G: ISCHEMIC HEART E C G: ISCHEMIC HEART DISEASEDISEASE

LEAD GROUPSLEAD GROUPS Anterior: V1- V6

Septal: V3 – V4

Lateral: I, aVL, V5 , V6

High Lateral: I, aVL Inferior: II, III, aVF Posterior: Mirror Image

In V1 , V2

I H D: ISCHEMIAI H D: ISCHEMIA ANGINAANGINA

I H D: MI(SUB ENDOCARDIAL)I H D: MI(SUB ENDOCARDIAL)

I H D: MI( INFERIOR )I H D: MI( INFERIOR )

I H D:MI(ANTERIOR)I H D:MI(ANTERIOR)

E C G : E C G : EXTRASYSTOLESEXTRASYSTOLES

ECTOPICS : ECTOPICS : SUPRAVENTRICULARSUPRAVENTRICULAR

ECTOPICS:VENTRICULARECTOPICS:VENTRICULAR

E C G: E C G: TACHYARRHYTHMIATACHYARRHYTHMIA

SS

E C G:TACHY ARRHYTHMIASE C G:TACHY ARRHYTHMIAS

TYPESTYPES BASED ON ORIGIN: Supra Ventricular Tachycardia, Ventricular Tachycardia BASED ON MORPHOLOGY: Narrow QRS Tachycardia, Broad QRS Tachycardia BASED ON RHYTHM: Regular Tachycardia , Irregular Tachycardia BASED ON MECHANISM: Reentry, Non Reentry, Pre excitation

E C G:TACHY ARRHYTHMIASE C G:TACHY ARRHYTHMIAS

E C G:TACHY ARRHYTHMIASE C G:TACHY ARRHYTHMIAS

A : AV Nodal Reentry

B : AV Reentry

C : Atrial Tachycardia

E C G: TACHY ARRHYTHMIASE C G: TACHY ARRHYTHMIASJUNCTIONAL TACHYCARDIAJUNCTIONAL TACHYCARDIA

E C G:TACHY ARRHYTHMIASE C G:TACHY ARRHYTHMIAS

ATRIAL FIBRILLATIONATRIAL FIBRILLATION

E C G: TACHY ARRHYTHMIASE C G: TACHY ARRHYTHMIASATRIAL FLUTTERATRIAL FLUTTER

E C G: TACHY ARRHYTHMIASE C G: TACHY ARRHYTHMIAS

MULTIFOCAL ATRIAL TACHYCARDIAMULTIFOCAL ATRIAL TACHYCARDIA

E C G:TACHY ARRHYTHMIASE C G:TACHY ARRHYTHMIASVENTRICULAR VENTRICULAR

TACHYCARDIATACHYCARDIA NEGATIVE QRS IN V1-V6 AV DISSOCIATION QR COMPLEXES IN V4-V6

LT / NORTH WEST AXIS CAPTURE BEATS NARROW R WITH

SLURRED DELAYED S QRS > 0.12s

E C G:TACHY ARRHYTHMIASE C G:TACHY ARRHYTHMIASVENTRICULAR TACHYCARDIAVENTRICULAR TACHYCARDIA

E C G:TACHY ARRHYTHMIASE C G:TACHY ARRHYTHMIAS

TORSADES DE POINTESTORSADES DE POINTES

E C G:TACHY ARRHYTHMIASE C G:TACHY ARRHYTHMIAS VENTRICULAR FIBRILLATIONVENTRICULAR FIBRILLATION

E C G: BRADY E C G: BRADY ARRYHTHMIASARRYHTHMIAS

E C G:BRADY ARRYHTHMIASE C G:BRADY ARRYHTHMIAS

JUNCTIONAL(A V NODAL) RHYTHMJUNCTIONAL(A V NODAL) RHYTHM

E C G:BRADY ARRHYTHMIASE C G:BRADY ARRHYTHMIAS

IDIOVENTRICULAR RHYTHMIDIOVENTRICULAR RHYTHM

E C G : OTHER E C G : OTHER COMMON CHANGESCOMMON CHANGES

PERICARDITISPERICARDITIS

PERICARDIAL EFFUSIONPERICARDIAL EFFUSION

HYPERTENSIVE HEART HYPERTENSIVE HEART DISEASEDISEASE

PULMONARY EMBOLISMPULMONARY EMBOLISM

E C G:KE C G:K++ABNORMALITYABNORMALITY

HYPOKALEMIAHYPOKALEMIA

HYPERKALEMIAHYPERKALEMIA