Download - ECG’s Jake Turner. What is an ECG? A recording of the electrical activity within the heart
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ECG’s
Jake Turner
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What is an ECG?
• A recording of the electrical activity within the heart.
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What you need to know
• Basic pathologies that can be picked up on ECG
• How to calculate heart rate• Shockable rhythms• How to localise a pathology from an ECG• Basic arrhythmias
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ECG basics
• Check that this ECG is for the patient in front of you! (Name, DOB, patient number etc)
• Check which lead the rhythm strip is (usually lead II)
• At the bottom left is the 'paper speed' (25 mm/s on the horizontal axis) and the sensitivity of the ECG (10mm/mV).
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ECG strips
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Localising a pathology on ECG
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Coronary arteries
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How to calculate heart rate
• Method 1: We always print off 10 second ECG strips, so count the number of QRS complexes, multiply this by 6 and you have the heart rate!
• Method 2: Count the number of large squares between each QRS complex, then divide 300 by this number (this method cannot be used for an irregular rhythm).
• NOTE: To calculate the heart rate using method 1 you must use the rhythm strip!
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Arrhythmias on ECG
• Ventricular or atrial• Too fast, too slow or irregular• Sinus rhythm, regularly regular– Normal, tachycardic or bradycardic
• Sinus rhythm, regularly irregular– P-P interval varies by more than 10%.
• Irregularly irregular– Atrial fibrillation (VF is effectively pulseless)
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Sinus rhythm
• This just means that every QRS complex is preceded by a P wave!
• Note: It does not necessarily mean that every P wave is followed by a QRS complex.
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How to tell if a rhythm is regular?
• Check if the ECG printout tells you!• Paper strip method
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How to read an ECG (the official version)
• Step 1: Rhythm• Step 2: Rate• Step 3: Conduction (PQ,QRS,QT)• Step 4: Heart axis• Step 5: P wave morphology• Step 6: QRS morphology• Step 7: ST morphology• Step 7+1: Compare the current ECG with a
previous one
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What we need to read from an ECG
• Step 1: What jumps out at you? (VF, VT, irregularly irregular, gross morphological problems, ST elevation indicative of an NSTEMI etc)
• Step 2: Rhythm• Step 3: Rate• Step 4: Conduction (is there conduction?)• Step 5: General morphology (is everything about the right
size?)• Step 6: Compare the current ECG with a previous one (this
is less likely to come up in an OSCE, but could do in an exam)
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Normal ECG• Rhythm: sinus• Rate: 60-100 bpm• PQ interval 120-200ms• QRS width 60-100ms• Heart axis: between -30 and +90 degrees
• The maximal height of the P wave is 2.5 mm in leads II and / or III• The p wave is positive in II and AVF, and biphasic in V1• The p wave duration is usually shorter than 0.12 seconds (3 small squares)
• No pathological Q waves• No left or right ventricular hypertrophy• Normal R wave propagation. (R waves increase in amplitude from V1-V5)
• No ST elevation or depression• T waves should be concordant with the QRS complex• The ECG should not have changed from the previous ECG
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Normal ECG
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Quiz time!
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What didn’t I cover?
• Heart blocks• The effects of ion disturbances• QRS complex abnormalities• Bundle branch blocks• Cardiac hypertrophy• Genetic conditions• Treatments• Axis deviation
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Any Questions?
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ECG denotations.• The letters "Q", "R" and "S" are used to
describe the QRS complex• Q: the first negative deflection after the p-
wave. If the first deflection is not negative, the Q is absent.
• R: the positive deflection• S: the negative deflection after the R-wave• Small print letters (q, r, s) are used to describe deflections of small
amplitude. For example: qRS = small q, tall R, deep S.• R`: is used to describe a second R-wave.
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Revision sites
• http://en.ecgpedia.org/wiki/Main_Page
• http://en.ecgpedia.org/wiki/Basics• http://www.medicine-on-line.com/html/ecg/e
0001en_files/14.htm• http://www.nottingham.ac.uk/nursing/practic
e/resources/cardiology/index.php
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Specific revision pages
• For bundle branch blocks: http://www.medicine-on-line.com/html/ecg/e0001en_files/13.htm
• For right and left hypertrophy: http://www.medicine-on-line.com/html/ecg/e0001en_files/12.htm