ecgs (again!) mary l. dohrmann, md professor of clinical medicine division of cardiovascular...
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ECGs (again!)
Mary L. Dohrmann, MDProfessor of Clinical Medicine
Division of Cardiovascular Medicine
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ECG Interpretation
Practice!
Practice!
Practice!
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http://ecg.bidmc.harvard.edu/maven/mavenmain.asp
What is ECG Wave-Maven?Proficiency in electrocardiogram (ECG) interpretation is an essential skill for medical students, housestaff, and clinicians. However, medical school and postgraduate resources to develop and upgrade the necessary high level of "ECG literacy" are severely limited. Further, current textbook and classroom instructional materials do not adequately integrate ECG interpretation into specific contexts where waveform findings must be correlated with other clinical data. We have begun to address the limitations in traditional approaches to ECG pedagogy by creating the infrastructure for a unique web-based tutorial.
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ECG Interpretation
Observation
Conclusion
Clinical context/significance
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Rhythm
Sinus Not sinus
VentricularSupravent.Morphology
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Morphology Hierarchy
WPW > LBBB > LVH > MI
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The Normal ECG
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The Normal ECG
Sinus rhythm (P before @ QRS)
Rate 50 – 100 bpm
Axis +90o to –30o
Intervals: PR .12-.21 sec
QRS <.10 sec
QTc <.46 sec (observed QT⁄ √ (RR) interval)
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51 y/o male with chest pain100% occlusion of a diagonal
(also had 3 vessel disease, normal LVEF)
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29 y/o with chest painDiffuse ST elevation c/w pericarditis,
?PR segment depression
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47 y/o male with chest painAcute inferior MI – culprit vessel RCA
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41 y/o male with severe SOBExtensive anterior/anterolateral MI
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54 y/o male with exertional chest painAMI, indeterminate age; RBBB and left axis
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60 y/o comatose s/p MVALow voltage
Simple cifferential of low voltage: air, fat, fluid, no muscle
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60 y/o with chest painLVH with LAD, ST-T abn, & LAE
In patient with angina and LVH, always think of aortic stenosis and hypertrophic cardiomyopathy in differential diagnosis
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40 y/o with chest pain & palpitationsshort PR/delta wave c/w preexcitation
(WPW) – note pseudo-Qs inferiorly
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70 y/o with exertional chest painLBBB
If need stress test in this patient, use pharmacologic stress with adenosine combined with imaging modality (sestamibi or cardiac MRI)