"ECG for MRCP" Edited by: Dr. Osama Amin MRCP UK Part I, MRCPI part I, MRCPI part II written. April 2005.Dedication to the Republic of IRAQ, Freedom and Humanity Special thanks to: Professor…Full description
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ECG Facts
Descrição: hebrew for biblical interpretation
Descripción: hebrew for biblical interpretation
Descripción: Workbook de CALUSAC
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All the important topics related to Interpretation of Statutes are being covered in these notes including the leading case laws.Full description
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Este trabajo es un resumen del trabajo realizado en el laboratorio de biomédicas, el cual presenta detalles de diseño e implementación de un sistema de adquisición y procesamiento de señales…Descripción completa
ecg
Quickref ECG
12 L ECG
MOONLIGHT MEDICINE Diana Tamondong-Lachica, MD, FPCP
ELECTROCARDIOGRAM
•
Lead placement
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Normal ECG
•
Important morphologies
•
Important rhythms
LEAD PLACEMENT
LEAD PLACEMENT
NORMAL ECG
NORMAL MORPHOLOGY
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PR interval: 0.12-0.20
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PR segment: 0.05-0.12
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QRS complex: 0.08-0.12
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QT interval: ! 0.45 in males,
! 0.47 in females •
Corrected QT •
QT/ " (R-R)
NORMAL SINUS RHYTHM
NORMAL SINUS RHYTHM
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Heart Rate •
300/number of big boxes
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1500/number of small boxes
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1 big box = 5 small boxes
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1 small box =
•
Normal: 60-100 bpm •
3 to 5 big boxes
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15 to 25 small boxes
NORMAL AXIS
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Axis calculation • 90 x aVF | I+aVF | •
Sign is determined by aVF
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Normal axis is -30 to +110
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Leaving: LEFT axis deviation
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Returning: RIGHT axis deviation
ABNORMAL AXIS
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Left axis deviation •
Left ventricular hypertrophy
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Inferior wall myocardial infarction
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Hyperkalemia
ABNORMAL AXIS
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Right axis deviation •
Right ventricular hypertrophy
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Anterolateral myocardial infarction
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Pulmonary embolism
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Chronic lung disease
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ASD, VSD
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Normal variant (children, thin adults)
PATHOLOGIES IN MORPHOLOGY
P WAVE Left atrial enlargement (Lead II and V1) Right atrial enlargement (Lead II and V1)
QRS COMPLEX
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Widened QRS
QRS COMPLEX
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Pathologic Q waves •
Any Q wave in V2-V3
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Q wave # 0.03 s or > 0.1 mV deep in I, II, aVL, aVF, V4-V6 (contiguous leads)
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Lead III often shows Q waves alone – NORMAL
ST SEGMENT
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•
ST segment changes are “normal” or expected in •
Bundle branch blocks
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PVCs, arrhythmias
ST segment changes are abnormal in •
Intrinsic myocardial disease
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Cardioactive drug use
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Electrolyte abnormalities
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Neurogenic factors (stroke, trauma)
ST SEGMENT
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Concordant leads •
Anterior wall: V2 to V5
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Anteroseptal wall: V1 to V3
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Anterolateral wall: V4 to V6
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High lateral wall: I and aVL
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Inferior wall: II, III and aVF
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Posterior wall: V1 to V3 depression
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Right ventricle: Right-sided leads
ST SEGMENT
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Depression = ischemia •
Take the segment 2-3 small boxes away from QRS
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Should be > 0.1 mV V5-V6, or1.5 mm aVF, III
•
Reciprocal leads
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Other causes •
RVH/LVH
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Digoxin
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Hypokalemia
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LBBB/RBBB
ST SEGMENT
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Elevation = infarct •
Take the segment 2-3 small boxes away from QRS
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Should be > 0.1 mV in limb leads, or> 0.2 mV in chest leads
•
Reciprocal leads
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Other causes •
Early repolarization
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Pericarditis
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LVH, LBBB
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Hyperkalemia
T WAVE AND U WAVE
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T wave inversion •
Myocardial infarction
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Subacute pericarditis
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Subarachnoid hemorrhage
PATHOLOGIES IN RHYTHM
R-R INTERVAL
Sinus tachycardia (< 3 big boxes) Sinus bradycardia (>5 big boxes) Atrial fibrillation Count number of QRS complexes in 6 big boxes (6 second strip) Rapid ventricular response: > 100 Slow ventricular response: < 60
P-R INTERVAL AND AV BLOCKS
First degree AV block Second degree AV block Mobitz 1 Second degree AV block Mobitz 2 Third degree AV block
VENTRICULAR RHYTHMS
PAC vs PVC Supraventricular tachycardia Ventricular tachycardia Ventricular fibrillation Clues Supporting the Diagnosis of VT AV dissociation Atrial capture, Fusion beats
Widened QRS at V1 LBBB > 0.16, RBBB > 0.14 Axis -90 to +180 RBBB or LBBB morphology Concordance in all leads
