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Basic ECG Reading1 April 2006

Basic ECGBasic ECGReadingReading

Basic ECG Reading1 April 2006

Basic ECG Reading1 April 2006

ECG terminology

Basic ECG Reading1 April 2006

Normal ECG

Basic ECG Reading

1 April 2006

Approach to Interpretat ion of the ECG

Rate

Regularity Axis

PQRSTU

Basic ECG Reading

1 April 2006

Determining the Heart Rate

The number of large squares between 2

consecutive R waves = X

Heart Rate = 300 / X

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Basic ECG Reading1 April 2006

1 small square =

0.04 s

1 large square =

0.2 s

5 large squares =1s

1 QRS per s

Heart rate = 60 per minCount the number of large

squares between 2 RR

intervals and divide into 300

Basic ECG Reading1 April 2006

Is there any electrical activity?

If there is no activity,

Check - connections

QRS gain

In 2 other Leads, eg Lead I & II

If still no activity -ASYSTOLE

Basic ECG Reading1 April 2006

Asystole

Complete absence of QRS

P waves may occur

If no organised QRS complex is seen and the patient has a pulse

then the ECG is improperly connected, turned off or improperly

calibrated

VF may masquerade as asystole; it is best always to check 2 leads

perpendicular to each other to make sure that asystole is not VF

Basic ECG Reading1 April 2006

Ventricular Fibrillation

Totally disorganised pattern

No distinguishable QRS complexes

Continuous erratic movement of the baseline

Rate is very rapid and too disorganised to count

Coarse VF vs Fine VF

Management : Immediate defibrillation

Basic ECG Reading

1 April 2006

Pulseless Electrical Activity

Basic ECG Reading

1 April 2006

Pulseless electrical activity

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Basic ECG Reading1 April 2006

What is the rhythm?

Analyse P-QRS

Assess:

P wave - present / absent

morphology

QRS morphology and width

Relation between P wave and QRS

Basic ECG Reading1 April 2006

Complete heart block

Basic ECG Reading1 April 2006

Sinus tachycardia

Basic ECG Reading1 April 2006

What is the width of QRS?

Widened QRS Complex

(> 0.12s)

Narrow QRS Complex

Basic ECG Reading

1 April 2006

Irregular narrow complex

tachycardia

Basic ECG Reading

1 April 2006

Narrow complex tachycardia

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Basic ECG Reading1 April 2006

Wide complex tachycardia

Basic ECG Reading1 April 2006

Electrocardiogram of ACS

May be normal when pain free

Subtle features

- Horizontality of the ST segment

- Squaring of the ST-T wave angle

Ideal to do ECG at time of symptoms

Basic ECG Reading1 April 2006

Ischaemia - ST depression

Basic ECG Reading1 April 2006

Acute Ischemia

Basic ECG Reading

1 April 2006

Acute anteroseptal MI

Basic ECG Reading

1 April 2006

Evolved Anterior MI

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Basic ECG Reading1 April 2006

Acute Anterior MI

Basic ECG Reading1 April 2006

Acute inferior + RV Mi

Basic ECG Reading1 April 2006

Pericarditis

Basic ECG Reading1 April 2006

69 years old female Hyperkalemia

Basic ECG Reading

1 April 2006

Acute pulmonary embolism