ecg presentation
DESCRIPTION
TRANSCRIPT
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