Download - How to read 12 lead ECG
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How to read ECGPG corner
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Mr do not Miss
Lead reversal and ECG artefacts
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Technology does not understood science of ECG
Do not believe in COMPUTERIZED ECG INTERPRETATIONS
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At least 14 observationsbefore answering
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Standardization
Usual 1 mV = 10 mm In special cases ECG may be intentionally recorded at
one-half standardization (1 mV =5mm) or two times normal standardization (1 mV = 20 mm). However, overlooking this change in gain may lead to the mistaken diagnosis of low or high voltage.
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Rhythm
Sinus rhythm bradycardia or tachycardia SR with APBs or VPBs SR with AV block
Nonsinus:PSVT), Afib or flutter, VT and AV junctional escape
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Sinus rhythm
Discrete P waves that are always positive (upright) in lead II (and negative in aVR
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Heart Rate
Normally, the ventricular (QRS) rate and atrial (P) rates are the same (1:1 AV conduction)
Tachycardia >100
Bradycardia <60
Irregular Regularly irregular :Wenchebach’s Irregularly irregular :Fib
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PR Interval
The normal PR interval (measured from the beginning of the P wave to the beginning of the QRS complex) is 0.12 to 0.2 sec
First-degree AV block
A short PR interval with sinus rhythm and with a wide QRS complex and a delta wave is seen in the Wolff-Parkinson-White (WPW) pattern
A short PR interval with retrograde P waves (negative in lead II) generally indicates an ectopic (atrial or AV junctional) pacemaker.
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P wave
Normal not exceed 2.5 mm in amplitude and is less than 3 mm (120 ms) wide in all leads
Tall, peaked P waves may be a sign of right atrial overload (P pulmonale)
Wide (and sometimes notched P) waves are seen with left atrial abnormality.
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QRS Interval
0.1 sec (100 ms) or less, measured by eye
110 ms if measured by computer
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QT/QTc Interval
Shortened :hyperkalaemia and digitalis effect
Prolonged:hypocalcemia or hypokalemia, drug effects (quinidine, procainamide, amiodarone, or sotalol), or myocardial ischemia
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QRS Voltage
Stick to criteria for Normal /LVH/RVH
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QRS Axis Frontal plane
Normal: −30° to +100°
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R wave progression
Inspect leads V1 to V6
Normal increase in R/S ratio occurs as you move across the chest
Poor: (small or absent R waves in leads V1 to V3) AWMI
The term reversed R wave progression Tall R waves in lead V1 that progressively decrease in
amplitude:RVH, posterior (or posterolateral) infarction, and dextrocardia
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Q,T,U Document changes
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U Wave U Waves Look for prominent U waves. These waves,
usually most apparent in chest leads V2-V4, may be a sign of hypokalemia or drug effect or toxicity (e.g., ami-odarone ami-odarone, dofetilide, quinidine, or sotalol).
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Normal frontal loop:1.q in II/III/aVF2.No q in I/AVL
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Counter clock loop in frontal plane:1.q in AVL2.No q in II/III/AVF
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(1) standardization—10 mm/mV; 25 mm/sec(2) rhythm—normal sinus (3) heart rate—75 beats/min (4) PR interval—0.16 sec (5) P waves—normal size (6) QRS width—0.08 sec (normal) (7) QT interval—0.4 sec (slightly prolonged for rate) (8) QRS voltage—normal(9) QRS axis—about 30° (biphasic QRS complex in lead II with positive QRS complex in lead I) (10) R wave progression:early precordial transition with relatively tall R wave in lead V2 (11) abnormal Q waves—leads II, III, and aVF (12) ST segments: elevated in leads II, III, aVF, V4, V5, and V6 slightly depressed in leads V1 and V2 (13) T waves—inverted in leads II, III, aVF, and V3 through V6 (14) U waves—not prominent. Impression: This ECG is consistent with an inferolateral (or infero-posterolateral) wall myocardial infarction of indeterminate age, possibly recent or evolving. Comment: The relatively tall R wave in lead V2 could reflect loss of lateral potentials or actual posterior wall involvement
EXAMPLE
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Calcium and 12 Lead ECG
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What ECG findings may be present in pulmonary embolus?
Sinus tachycardia (the most common ECG finding)
Right atrial enlargement (P pulmonale)—tall P waves in the inferior leads
Right axis deviation
T wave inversions in leads V1-V2
Incomplete right bundle branch block (IRBBB)
S1Q3T3 pattern—an S wave in lead I, a Q wave in lead III, and an inverted T wave in lead III. Although this is only occasionally seen with pulmonary embolus, it is quite suggestive that a pulmonary embolus has occurred.
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I can only give you hint because I know less