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Introduction toECG
Dr. Rashed J. Al-Hamdan M.D. FRCP( C )
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Introduction to ECG
ECG is short for ElectroCardioGram.
The idea of ECG is to measure a surface
electrical potential of the electrical activitiesoccurring in the heart.
This entails fitting leads to look at the
currents from every possible angle. This emphasizes the need for standardizing
the leads positions to be able to compare
different ECGs.
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An old ECG Machine
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Conduction System
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Normal ECG
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Action Potential and ECG
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Basic ECG Leads
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Basic ECG Leads
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Chest Leads
V1: 4th space, Rt para-
sternal line.
V2: 4th space Lt para-
sternal line. V3: Between V2 and V3.
V4: 5th Space Mid-
clavicular line.
V5: 5th space Anterior
axillary line.
V6: 5th space Midaxillary
line.
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Electro-Mechanical Coupling
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Standard Limb Leads
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Standard Limb Leads
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Waves and Intervals
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Axis Determination
The depolarization wave spreads in different
directions through the ventricle.
The term axis usually refers to the meandirection of the QRS wave in the frontal
plane unless otherwise specified.
This means that we are examining the QRSaxis only in the standard limb leads.
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Axis Determination The way to determine the electrical axis is made easy
by remembering few rules in ECG.
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Axis Determination
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Axis Determination
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Axis Determination
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Common Mistakes
One of the commonest mistakes to be done
by nurses and doctors is leads
misplacement.
The most common ones are
1- Right ArmLeft Arm leads misplacement.
2- Arm
Leg leads misplacement.3- Reversal of 2 leads of the anterior chest
leads V1V3.
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Common Mistakes: Rt - Lt Arm
Leads Misplacement
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Common Mistakes: Rt - Lt Arm
Leads Misplacement
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Common Mistakes: Leg - Arm
Leads Misplacement
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Common Mistakes: V1V2
Leads Misplacement
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Spot The Differences
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What is that ???
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What is that ???
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Atrial and Ventricular Tachycardia
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Atrial Flutter
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Atrial Flutter
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Atrial Flutter
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Atrial Flutter
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Flutter With High AV Block
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Atrial Fibrillation
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Fine Atrial Fibrillation
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P S V T
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A V N R T - Sinus Rhythm
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A V N R T - Attack
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Ventricular Tachycardia
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Ventricular Tachycardia
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W P W
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Orthodromic WPW
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Antidromic WPW
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WPW with AFib
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WPW with AFib
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Atrio-Ventricular Block
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1st Degree AV Block
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Mobitz Type I
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Mobitz Type II
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3rd Degree AV Block
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Bundle Branch Blocks
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Right B B B
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Left B B B
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Torsade de Pointes
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Torsade de Pointes
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Hyperkalemia
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Hyperkalemia
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Hypokalemia
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Hypokalemia
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S T E M I
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S T E M I
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S T E M I
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S T E M I
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S T E M I
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S T E M I
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STEMI with LBBB
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Single Chamber Pacemaker
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Dual Chamber Pacemaker
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I C D
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Dangerous Patterns
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Dangerous Patterns
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Dangerous Patterns
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Dangerous Patterns
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Dangerous Patterns
D P
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Dangerous Patterns