ecg technical overview
TRANSCRIPT
Image from Flickr User Rosmarie Voegtli: https://www.flickr.com/photos/rvoegtli/5343361247/sizes/l
Most of the images used are mine or under a creative commons license or are in the public domain. Sources of the other images (ie tracings from journals) are cited.
Image from Wikimedia users Quasar, Mnokal, and Silvia3: http://commons.wikimedia.org/wiki/File:Action_potential_ventr_myocyte.gif
Image from Wikimedia users Diberri and Silvia3: http://commons.wikimedia.org/wiki/File:Pacemaker_potential_annotated.gif
Heart is a public domain image from http://commons.wikimedia.org/wiki/File:Gray501.png and cardiac conduction system is an image from Wikimedia user Madhero88: http://commons.wikimedia.org/wiki/File:Electrical_conduction_system_of_the_heart.svg
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From image created by Wikimedia user Kychot. http://commons.wikimedia.org/wiki/File:ECG-Einthoven-triangle.svg
VI = ΦL - ΦR
VII = ΦF - ΦR
VIII = ΦF - ΦL
Image by Rick Manning from http://commons.wikimedia.org/wiki/File:ECG_Vector.svg
Image derived from original vector graphics by Wikimedia User Jmarchn: http://commons.wikimedia.org/wiki/File:Limb_leads_2_CAT.svg
Image from Wikimedia User Kychot: https://commons.wikimedia.org/wiki/File:ECG-Wilson-R.svg
ΦWCL =(ΦRA + ΦLA + ΦLL)
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Image from Wikimedia User Npatchett: https://en.wikipedia.org/wiki/File:EKG_limb_leads.png
VaVF = ΦF −(ΦL + ΦR)
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VaVL = ΦLA −(ΦR + ΦF)
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VaVR = ΦRA −(ΦL+ ΦF)
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VVF = ΦF −(ΦL +ΦR+ΦF)
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VVL = ΦLA −(ΦL +ΦR+ΦF)
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VVR = ΦRA −(ΦL +ΦR+ΦF)
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Image from Wikimedia User Npatchett: https://en.wikipedia.org/wiki/File:EKG_limb_leads.png
Public domain image from: http://commons.wikimedia.org/wiki/File:Hexaxial_reference_system.svgEinthoven’s triangle from image created by Wikimedia user Kychot. http://commons.wikimedia.org/wiki/File:ECG-Einthoven-triangle.svgLimb Lead Image from Wikimedia user Jmarchn: http://commons.wikimedia.org/wiki/File:Limb_leads_2_CAT.svg
Image from Wikimedia User Kychot: https://commons.wikimedia.org/wiki/File:ECG-Wilson-R.svg
ΦWCL =(ΦRA + ΦLA + ΦLL)
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Image of Precordial Leads by Wikimedia User Mikael Häggström: http://commons.wikimedia.org/wiki/File:Precordial_leads_in_ECG.pngOthe image is public domain: http://commons.wikimedia.org/wiki/File:ECGcolor.svg
Apple images from Wikimedia user benjamint44 http://upload.wikimedia.org/wikipedia/commons/e/ed/Granny_Smith_Apples.jpgand user Rasbak: http://commons.wikimedia.org/wiki/File:Sterappel_dwarsdrsn.jpg
Image from Wikimedia User Npatchett: https://en.wikipedia.org/wiki/File:Directions_of_EKG_leads.png
Image from Ed Burns of Life In the Fast Lane http://lifeinthefastlane.com/ecg-library/normal-sinus-rhythm/
Image by Wikimedia users Hazmat2 and Hank van Helvete: http://commons.wikimedia.org/wiki/File:EKG_Complex_en.svg
Public Domain Image from http://commons.wikimedia.org/wiki/File:ECG_Paper_v2.svg
From Wikimedia user Madhero88: http://commons.wikimedia.org/wiki/File:Myocardial_infarction_ECG.svg
• 1500 / Number of small squares
• "Eye-balling" method
• Irregular Rhythms: Number of QRS complexes in a six second strip x 10
Image from ECGpedia,.org: http://en.ecgpedia.org/wiki/File:Ecgfreq.png
Public Domain Image from Wikimedia users Agateller and atom:http://commons.wikimedia.org/wiki/File:SinusRhythmLabels.svg
Image from Ed Burns of Life In the Fast Lane http://lifeinthefastlane.com/ecg-library/normal-sinus-rhythm/
Image from Wikimedia user Cburnett : http://commons.wikimedia.org/wiki/File:Contiguous_leads.svg
Image from Ed Burns of Life In the Fast Lane http://lifeinthefastlane.com/ecg-library/normal-sinus-rhythm/
Image from Ed Burns: http://cdn.lifeinthefastlane.com/wp-content/uploads/2011/12/sinus-tachycardia.jpg
Image from Ed Burns: http://lifeinthefastlane.com/ecg-library/sinus-bradycardia/
Image from Ed Burns: http://cdn.lifeinthefastlane.com/wp-content/uploads/2012/01/AF-2.jpg
Image from Ed Burns: http://lifeinthefastlane.com/ecg-library/premature-atrial-complex-pac/
Image from Ed Burns: http://lifeinthefastlane.com/ecg-library/basics/pvc/
Image from Heikenwaelder Hugo: http://commons.wikimedia.org/wiki/File:Heart.jpg
From Life in the Fast Lane Blog: http://lifeinthefastlane.com/ecg-library/basics/p-wave/
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Images from Ed Burns: http://lifeinthefastlane.com/ecg-library/basics/p-wave/
Credits Chung and Nelson’s “ECG – A Pictorial Primer“, URL: http://www.medicine-on-line.com/html/ecg/e0001en.htm
V1
http://en.ecgpedia.org/wiki/File:RVH.pnghttp://en.ecgpedia.org/wiki/File:LVH.png
From Life in the Fast Lane Blog: http://lifeinthefastlane.com/ecg-library/basics/left-ventricular-hypertrophy/
From Life in the Fast Lane Blog: http://lifeinthefastlane.com/ecg-library/basics/right-ventricular-hypertrophy/
Public domain image from the National Heart Lung and Blood Insitute (NIH):https://commons.wikimedia.org/wiki/File:Atherosclerosis_2011.jpg
Public domain image from the National Heart Lung and Blood Insitute (NIH):https://commons.wikimedia.org/wiki/File:Heart_attack-NIH.gif
Images from Life in the Fast Lane: http://lifeinthefastlane.com/ecg-library/myocardial-ischaemia/
Image from Life in the Fast Lane: http://lifeinthefastlane.com/ecg-library/myocardial-ischaemia/
Image from http://www.nottingham.ac.uk/nursing/practice/resources/cardiology/acs/changes.php
Image from Ed Burns: http://lifeinthefastlane.com/ecg-library/basics/t-wave/
Public domain image from http://commons.wikimedia.org/wiki/File:12_Lead_EKG_ST_Elevation_tracing_color_coded.jpg
Image from Ed Burns: http://lifeinthefastlane.com/ecg-library/basics/inferior-stemi/
Heart is a public domain image from http://commons.wikimedia.org/wiki/File:Gray501.png and cardiac conduction system is an image from Wikimedia user Madhero88: http://commons.wikimedia.org/wiki/File:Electrical_conduction_system_of_the_heart.svg
Image from Life in the Fast Lane Blog: http://lifeinthefastlane.com/ecg-library/basics/left-bundle-branch-block/
Image from Life in the Fast Lane Blog: http://lifeinthefastlane.com/ecg-library/basics/right-bundle-branch-block/
Image from Life in the Fast Lane Blog: http://lifeinthefastlane.com/ecg-library/basics/left-bundle-branch-block/
Image from Life in the Fast Lane Blog: http://lifeinthefastlane.com/ecg-library/basics/right-bundle-branch-block/
PR Interval
• 1st degree AVB – PR > 0.2 sec
• 2nd degree AVB• Type I Mobitz – “Wenkebach”, progressively longer PR
then “dropped beat”• Type II Mobitz – Sudden “dropped” beat
• 3rd degree AVB• Atria and Ventricles are “independent” of each other• Atrial rate > ventricular rate
Image from Ed Burns: http://cdn.lifeinthefastlane.com/wp-content/uploads/2011/02/1st-degree-heart-block-on-call.jpg
Image from Life in the Fast Lane, Ed Burns: http://cdn.lifeinthefastlane.com/wp-content/uploads/2011/04/Wenckebach.jpg
Image from Wikimedia user Jer5150: http://commons.wikimedia.org/wiki/File:Type_I_A-V_block_5-to-4_Wenckebach_periods.png
Image from Ed Burns: http://cdn.lifeinthefastlane.com/wp-content/uploads/2011/04/Mobitz_II.gif
Image from Wikimedia User Jer5150: http://commons.wikimedia.org/wiki/File:Sinus_rhythm_with_3-to-2_and_2-to-1_Type_II_A-V_block.png
Image from CardioNetworks / ECGPedia: http://commons.wikimedia.org/wiki/File:2_1_LBBB_RBBB_(CardioNetworks_ECGpedia).jpg
Image from Wikimedia User Jer5150: http://upload.wikimedia.org/wikipedia/commons/9/9a/Complete_A-V_block_with_resulting_junctional_escape.png
Image from From Wikimedia user: https://commons.wikimedia.org/wiki/User:Stevenfruitsmaak
Public Domain image from https://commons.wikimedia.org/wiki/File:Pacemaker_NIH.jpg Image from Wikimedia User Lucien Monfils: https://commons.wikimedia.org/wiki/File:Herzschrittmacher_auf_Roentgenbild.jpg
Image from Ed Burns: http://lifeinthefastlane.com/ecg-library/pacemaker/
Images from http://lifeinthefastlane.com/ecg-library/basics/hyperkalaemia/
Image from Ed Burns: http://lifeinthefastlane.com/ecg-library/basics/hyperkalaemia/
Image from Ed Burns: http://lifeinthefastlane.com/ecg-library/basics/hyperkalaemia/
Image from Ed Burns: http://lifeinthefastlane.com/ecg-library/basics/hyperkalaemia/
Images from http://lifeinthefastlane.com/ecg-library/basics/hypokalaemia/
Images from http://lifeinthefastlane.com/ecg-library/basics/hypokalaemia/
Images from http://lifeinthefastlane.com/ecg-library/basics/hypokalaemia/
Image from http://lifeinthefastlane.com/ecg-library/basics/hypokalaemia/
Image and info from Wikimedia user Jer5150: http://commons.wikimedia.org/wiki/File:Combined_hyperkalemia_and_hypocalcemia.png
Image from Dr. Michael Agbayani.
Image from Ed Burns: http://cdn.lifeinthefastlane.com/wp-content/uploads/2011/08/chb4.png
Image from Wikimedia User CardioNetworks: https://commons.wikimedia.org/wiki/File:De-Avnrt_ecg2_(CardioNetworks_ECGpedia).jpg
Image from Ed Burns: http://lifeinthefastlane.com/ecg-library/ventricular-tachycardia/
From Dr. Smith’s ECG Blog: http://hqmeded-ecg.blogspot.com/2013/10/polymorphic-ventricular-tachycardia.html
Image from Ed Burns: http://lifeinthefastlane.com/ecg-library/ventricular-fibrillation/
Image from Wikimedia user D Dinneen~commonswiki: https://commons.wikimedia.org/wiki/File:EKG_Asystole.jpg
Holter image from Wikimedia user Misscurry: https://en.wikipedia.org/wiki/Holter_monitor#/media/File:Alex_CM4000.jpg
Brignole et al. J Am Coll Cardiol 2011;58:167–73
Interpretation
• Standardization
• Rhythm
• Heart rate
• PR Interval / AV conduction
• QRS Interval
• QT interval
• Mean QRS Axis
• P waves
• QRS voltages
• Precordial R Wave Progression
• Abnormal Q Waves
• ST Segments
• T waves
• U waves
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