ecg at a glance

7/25/2019 ECG at a glance

1/53

ECG at a glance


2/53

ACTION POTENTIALACTION POTENTIAL PolarizationPolarization

Intracellular is more negative thanIntracellular is more negative than

extracellularextracellular

DepolarizationDepolarization Intracellular becomes more positiveIntracellular becomes more positive

Infux o Na+Infux o Na+

epolarizationepolarization Intracellular restores to its resting potentialIntracellular restores to its resting potential

E!ux o "+E!ux o "+


3/53

ACTION POTENTIALACTION POTENTIAL


4/53

CARDIAC CELLSCARDIAC CELLS

PROPERTIESPROPERTIES

#utomaticit$#utomaticit$

Excitabilit$Excitabilit$

Con%uctivit$Con%uctivit$ Contractilit$Contractilit$


5/53

CONDUCTION SYSTEMCONDUCTION SYSTEM

&inoatrial No%e ' No%e(&inoatrial No%e ' No%e( h$thmic rate ) * , - bpmh$thmic rate ) * , - bpm

Interno%al Path.a$Interno%al Path.a$ #nterior/ mi%%le/ posterior path.a$s#nterior/ mi%%le/ posterior path.a$s

#trioventricular No%e '#0 No%e(#trioventricular No%e '#0 No%e(

egions ) atriono%al '#N(/ no%al 'N(/egions ) atriono%al '#N(/ no%al 'N(/no%al12is 'N2( no%al12is 'N2(

Dela$s the impulseDela$s the impulse


6/53


3un%le o 2is3un%le o 2is ate ) 4 , * bpmate ) 4 , * bpm

3un%le 3ranches3un%le 3ranches 533 6 33533 6 33

533 ) anterior/ posterior/ septal533 ) anterior/ posterior/ septal

asciclesascicles Pur7in8e 9ibersPur7in8e 9ibers ate ) : , 4 bpmate ) : , 4 bpm


7/53



8/53



9/53

LEADSLEADS

&tan%ar% 5imb 5ea%s&tan%ar% 5imb 5ea%s 5ea% I/ II/ III5ea% I/ II/ III

#ugmente% 5imb 5ea%s#ugmente% 5imb 5ea%s a05/ a0/ a09a05/ a0/ a09

Precor%ial 5ea%sPrecor%ial 5ea%s 0-/ 0:/ 0;/ 04/ 0


10/53

LEADSLEADS


11/53

LEADSLEADS

5E#D&5E#D& 0IE= >9 2E#?0IE= >9 2E#?

I/ a05I/ a05 5ateral5ateral

II/ III/ a09II/ III/ a09 IneriorInerior0-/ 0:0-/ 0: &eptal&eptal

0;/ 040;/ 04 #nterior#nterior

0


12/53

ECG WAVEFORMSECG WAVEFORMS


13/53

ECG WAVEFORMSECG WAVEFORMS P .aveP .ave

No more than :@< mm inNo more than :@< mm in

heightheight

No more than @-- sec inNo more than @-- sec in

%uration%uration

Positive ) I/II/a09/0Positive ) I/II/a09/0:1*:1*

Aa$ be positive/ negative/ orAa$ be positive/ negative/ orbiphasic ) III/a05/0biphasic ) III/a05/0--


14/53

ECG WAVEFORMSECG WAVEFORMS P intervalP interval

@-: , @:@-: , @:secsecin a%ult/in a%ult/

ma$ be shorter in chil%renma$ be shorter in chil%ren

an% longer in el%ersan% longer in el%ers


15/53

ECG WAVEFORMSECG WAVEFORMS B& ComplexB& Complex

@* , @- sec@* , @- sec

B ) -B ) -ststnegative %efection ater Pnegative %efection ater P

) - ) -ststpositive %efection ater Ppositive %efection ater P & ) negative %efection ater & ) negative %efection ater


16/53

ECG WAVEFORMSECG WAVEFORMS &? &egment&? &egment

Isoelectric 'fat(Isoelectric 'fat(


17/53

ECG WAVEFORMSECG WAVEFORMS? .ave? .ave

5imb lea% ) no more than < mm 'height(5imb lea% ) no more than < mm 'height(

Precor%ial lea% ) no more than - mmPrecor%ial lea% ) no more than - mm

'height('height(


18/53

ECG WAVEFORMSECG WAVEFORMS


19/53

RATE MEASUREMENTRATE MEASUREMENT

5arge 3oxes5arge 3oxes;1 interval;1 interval

&mall 3oxes&mall 3oxes-


20/53

AXIS DEVIATIONAXIS DEVIATION


21/53

ABNORMALABNORMAL

WAVEFORMSWAVEFORMS PP ) tall/ notche%) tall/ notche% P intervalP interval) prolonge%/ shortene%) prolonge%/ shortene%

BB) pathologic B '@4 sec/ :


22/53

ABNORMALABNORMAL

WAVEFORMSWAVEFORMS &? segment )&? segment ) %epression%epression'-'-mm(/mm(/ elevationelevation'- mm in limb'- mm in limb

lea%s or :mm in precor%iallea%s or :mm in precor%ial

lea%s(lea%s(


23/53

ABNORMALABNORMAL

WAVEFORMSWAVEFORMS? .ave? .ave) pea7e%tall/ inverte%/) pea7e%tall/ inverte%/fattene%fattene%


24/53

R-WAVE PROGRESSIONR-WAVE PROGRESSION

Poor 1.ave progression )Poor 1.ave progression )

Inarction 'anteroseptal(Inarction 'anteroseptal(

53335333

502502

&evere C>PD 'emph$sema(&evere C>PD 'emph$sema(


25/53

ATRIAL ENLARGEMENTATRIAL ENLARGEMENT 5et #trial Enlargement5et #trial Enlargement

Notche% P .aveNotche% P .ave

ight #trial Enlargementight #trial EnlargementPea7e% P =avePea7e% P =ave


26/53

VENTRICULARVENTRICULAR

HYPERTROPHYHYPERTROPHY 5et 0entricular 2$pertroph$5et 0entricular 2$pertroph$

& .ave in 0-0: + .ave in 0


27/53


HYPERTROPHYHYPERTROPHY ight 0entricular 2$pertroph$ight 0entricular 2$pertroph$

#D#D

everse% 1.ave progression 'taller .aves an%everse% 1.ave progression 'taller .aves an%

smaller & .aves in 0smaller & .aves in 0--6 06 0:: %eeper & .aves 6 small %eeper & .aves 6 small

.aves in 0.aves in 0


28/53

MYOCARDIALMYOCARDIAL

INFARCTIONINFARCTION


29/53


INFARCTIONINFARCTION#cute inerior m$ocar%ial inarction#cute inerior m$ocar%ial inarction


30/53


INFARCTIONINFARCTION&eptal .all m$ocar%ial inarction&eptal .all m$ocar%ial inarction


31/53


INFARCTIONINFARCTIONExtensive '.hole( anteriorExtensive '.hole( anteriorm$ocar%ial inarctionm$ocar%ial inarction


32/53


INFARCTIONINFARCTIONInerior .all m$ocar%ial inarctionInerior .all m$ocar%ial inarction.ith a possible posterior .all.ith a possible posterior .all

inarctioninarction

OCMYOCARDIAL


33/53



Evolutionar$ changes inEvolutionar$ changes in

anteroseptal m$ocar%ialanteroseptal m$ocar%ial

inarctioninarction

#@#@ #t a%mission#t a%mission

3@3@ #t :4 hours#t :4 hours

C@C@ #t 4H hours#t 4H hours



34/53



Evolutionar$ changes inEvolutionar$ changes in

inerior an% rightinerior an% right

ventricular inarctionventricular inarction

#@#@ #t a%mission#t a%mission

3@3@ #t -: hours#t -: hours

C@C@ ight chest lea%sight chest lea%s


35/53

CAUSES OFCAUSES OF

DYSRHYTHMIASDYSRHYTHMIAS

Enhance% #utomaticit$Enhance% #utomaticit$

eentr$eentr$

Escape 3eatsEscape 3eats Con%uction DisturbancesCon%uction Disturbances


36/53

SUPRAVENTRICULARSUPRAVENTRICULAR

ARRHYTHMIASARRHYTHMIAS &upraventricular ?ach$car%ia&upraventricular ?ach$car%ia

ate ) -


37/53


ARRHYTHMIASARRHYTHMIAS #trial 9lutter#trial 9lutter

ate ) atrial ) :


38/53


ARRHYTHMIASARRHYTHMIAS #trial 9ibrillation '#9ib(#trial 9ibrillation '#9ib(

ate ) atrial ) ;


39/53


ARRHYTHMIASARRHYTHMIAS 0entricular ?ach$car%ia0entricular ?ach$car%ia

ate ) - , :


40/53


ARRHYTHMIASARRHYTHMIAS 0entricular 9ibrillation0entricular 9ibrillation

ate ) in%eterminateate ) in%eterminate

h$thm ) chaotich$thm ) chaotic

P .aves ) noneP .aves ) none

P interval ) noneP interval ) none B& ) noneB& ) none

VENTRICULAR


41/53


ARRHYTHMIASARRHYTHMIAS ?orsa%es %e Pointes?orsa%es %e Pointes

ate ) : , :


42/53

EXTRASYSTOLEEXTRASYSTOLE #trial Extras$stole '#E&( Premature #trial#trial Extras$stole '#E&( Premature #trial

Contraction 'P#C(Contraction 'P#C( h$thmh$thm ) irregular %ue to the premature beat) irregular %ue to the premature beat

ateate ) %epen%s on its basic rh$thm) %epen%s on its basic rh$thm

PP.ave.ave ) unusual compare to basic rh$thm) unusual compare to basic rh$thmP intervalP interval ) normal/ ma$be shorten) normal/ ma$be shorten

B&B& ) normal) normal


43/53

EXTRASYSTOLEEXTRASYSTOLE 0entricular Extras$stole '0E&( Premature0entricular Extras$stole '0E&( Premature

0entricular Contraction 'P0C(0entricular Contraction 'P0C( h$thmh$thm ) irregular %ue to the premature beat) irregular %ue to the premature beat

ateate ) %epen%s on its basic rh$thm) %epen%s on its basic rh$thm

PP

.ave.ave

) none) none

P intervalP interval ) none) none

B&B& ) @-: sec) @-: sec

?hreatening 0E& )?hreatening 0E& )

LL on ?M 0E& on ?M 0E&

0E& * timesmin0E& * timesmin3igemini 0E&3igemini 0E&

Aultiocal 0E&Aultiocal 0E&

Consecutive 0E&Consecutive 0E&


44/53

EXTRASYSTOLEEXTRASYSTOLE


45/53

BLOCKSBLOCKS --ststDegree #0 3loc7Degree #0 3loc7

ate ) normalate ) normal

h$thm ) regularh$thm ) regular

P .aves ) normalP .aves ) normal

P interval ) prolonge% '@: sec( but constantP interval ) prolonge% '@: sec( but constant B& ) usuall$ @- sec or lessB& ) usuall$ @- sec or less


46/53

BLOCKSBLOCKS ::n%n%Degree #0 3loc7 ?$pe IAobitz ?$peDegree #0 3loc7 ?$pe IAobitz ?$pe

I=enc7ebachI=enc7ebach ate ) atrial ventricularate ) atrial ventricular

h$thm ) atrial regular ventricular irregularh$thm ) atrial regular ventricular irregular

P .ave ) normalP .ave ) normal P interval ) lengthen .ith each c$cle until P .aveP interval ) lengthen .ith each c$cle until P .ave

appears .ithout a B& complexappears .ithout a B& complex

B& ) usuall$ @- sec or lessB& ) usuall$ @- sec or less


47/53

BLOCKSBLOCKS ::n%n%Degree #0 3loc7 ?$pe IIAobitz ?$pe IIDegree #0 3loc7 ?$pe IIAobitz ?$pe II

ate ) atrial ventricularate ) atrial ventricular

h$thm ) atrial regular ventricular irregularh$thm ) atrial regular ventricular irregular

P .ave ) normalP .ave ) normal

P interval ) normal or slightl$ prolonge% but constantP interval ) normal or slightl$ prolonge% but constantor the con%ucte% beats there ma$be some shorteningor the con%ucte% beats there ma$be some shortening

o the P interval that ollo.s a non1con%ucte% P .aveo the P interval that ollo.s a non1con%ucte% P .ave

B& ) usuall$ @- sec or lessB& ) usuall$ @- sec or less

Con%uction ratio :)-/ ;)-/ 4)-Con%uction ratio :)-/ ;)-/ 4)-


48/53

BLOCKSBLOCKS ;;r%r%Degree #0 3loc7Complete #0 3loc7?otal 2eartDegree #0 3loc7Complete #0 3loc7?otal 2eart

3loc73loc7 ate ) atrial ventricular@ate ) atrial ventricular@

h$thm ) atrial regular ventricular regular '#0h$thm ) atrial regular ventricular regular '#0

%issociation(%issociation( P .ave ) normalP .ave ) normal

P interval ) none the atria an% ventricles beatP interval ) none the atria an% ventricles beat

in%epen%entl$in%epen%entl$

B& ) narro. or .i%eB& ) narro. or .i%e


49/53

BLOCKSBLOCKS 5et 3un%le 3ranch 3loc7 '5333(5et 3un%le 3ranch 3loc7 '5333(


50/53

BLOCKSBLOCKS ight 3un%le 3ranch 3loc7 '333(ight 3un%le 3ranch 3loc7 '333(


51/53

BLOCKSBLOCKS 9ascicular 3loc72emibloc79ascicular 3loc72emibloc7

5et #nterior 9ascicular 3loc7 '5#93( )5et #nterior 9ascicular 3loc7 '5#93( )

5#D5#D

5et Posterior 9ascicular 3loc7 '5P93( )5et Posterior 9ascicular 3loc7 '5P93( )#D#D

PULSELESS ELECTRICALPULSELESS ELECTRICAL


52/53

PULSELESS ELECTRICALPULSELESS ELECTRICAL

ACTIVITY (PEA)ACTIVITY (PEA)

Electrical activit$ is seen in ECG butElectrical activit$ is seen in ECG but

no pulse is %etecte% .hen palpatingno pulse is %etecte% .hen palpating

the arter$the arter$


53/53

Dan7e Dan7e

ecg at a glance

Documents