lecture one ecg.pptx hhhhhhhhhhhhhgyuuuhh

 Discuss basic ECG findings.
 Explain high risk findings on ECG.
 Identify ECG findings.
 Conditions that predispose to sudden cardiac death
 Arrhythmias most commonly seen in the college
population

I. Rate
II. Rhythm
III.
IV.
V.
VI.
VII.
VIII.
IX.
X.
Axis
P wave
PR interval
PR segment
QRS complex
ST segment
T wave
QT duration
U wave
XI.

I.
II.
Rate
Rhythm
III.
IV.
V.
VI.
VII.
VIII.
IX.
X.
Axis
P wave
PR interval
PR segment
QRS complex
ST segment
T wave
QT duration
U wave
XI.

 How to Estimate HR:
 1) 30 Large Boxes = 6 seconds
 HR = # QRS or P wave x 10
4x10
40/min
16x10
160/min

 How to Estimate HR:
 2) RR Interval (# Big Boxes)
 HR = 300 150 100 75 60 50 43 37 33 30
#1 #2 #3 #4 #5 #6 #7 #8 #9 #10
#7
43/min
#2
150/min

 Normal
 60-100/min
 Bradycardia
 <60/min
 Tachycardia
 >100/min

I. Rate
II. Rhythm
Axis
P wave
PR interval
PR segment
QRS complex
ST segment
T wave
III.
IV.
V.
VI.
VII.
VIII.
IX.
X. QT duration
U wave
XI.

Normal Sinus rhythm
P wave regular proceed
each QRS
R to R will be regular

 Atrial Fibrillation
 Atrial Flutter
 Junctional
 SVT

 First Degree AV Block
 Second Degree AV Block Type 1
 Second Degree AV Block Type 2
 Third Degree AV Block

 Ventricular Fibrillation
 Ventricular Tachycardia
 Torsade de Pointes

I. Rate
II. Rhythm
III. Axis
IV.
V.
P wave
PR interval
PR segment
QRS complex
ST segment
T wave
VI.
VII.
VIII.
IX.
X. QT duration
U wave
XI.

 Normal (-30 - +100)
 Lead I R+
R+
 Lead AVF

 LAD (>-30)  RAD (>+100)
 Lead I
 Lead I R+ neg
R+
 Lead AVF neg  Lea

I.
II.
Rate
Rhythm
III. Axis
IV. P wave
V. PR interval
PR segment
QRS complex
ST segment
T wave
QT duration
U wave
VI.
VII.
VIII.
IX.
X.
XI.

 Atrial Contraction
 Normal
 <2-3 mm amplitude
 <0.11 second width
 Gently rounded
 Upright in I, II, AVF, V4-6
 Inverted in AVR
 Diphasic or inverted in III
 Variable in AVL, V1-2

 Atrial enlargement/dilatation
 Increased Amplitude (>2-3mm)
 Increased Width (>0.12 second)
 Ectopic atria or AV junctional
 Inversion
 Absence
 AV junctional
 SA block

I.
II.
III.
Rate
Rhythm
Axis
IV. P wave
V. PR interval
VI.
VII.
VIII.
IX.
X.
XI.
PR segment
QRS complex
ST segment
T wave
QT duration
U wave

 Beginning P wave to beginning QRS
 Atria through AV junction
 Normal
 0.12-0.20 second

I.
II.
III.
IV.
V.
Rate
Rhythm
Axis
P wave
PR interval
VI. PR segment
VII.
VIII.
IX.
X.
XI.
QRS complex
ST segment
T wave
QT duration
U wave

 End P wave to beginning QRS
 Normal
 Isoelectric
 Displaced
 Atrial infarction
 Acute pericarditis

I.
II.
III.
IV.
V.
Rate
Rhythm
Axis
P wave
PR interval
PR segment
VI.
VII. QRS complex
VIII.
IX.
X.
ST segment
T wave
QT duration
U wave
XI.

 Ventricular depolarization
 Normal
 Duration
0.08 - 0.10 seconds greater of 0.12 is
regarded abnormal
 Q wave
 Normal but Small (<0.03 second)
 V5-V6, II, III, AVF

 SV1 + RV5 or RV6
 >35mm
OR
 R Lead I >14mm
OR
 R aVL >12mm

 R V1 + S V5 >10.5 mm
 RAD

 ECG Findings:
 LVH
 ST seg
 T wav

 ECG Findings
 Sinus Tachycardia

 S1
 RBBB

 ECG
 V1 rSR, wide R
 V6 qRS, wide S
Complete: >0.12 s
 Causes
 Pulmonary embolism
 COPD with pulmonary hypertension
 RVH

 ECG
 V1 Wide QS or rS
 V6 Wide, tall R
No Q
 Complete: >0.12 s
 Causes
 Hypertensive heart disease
 Valvular lesions
 Cardiomyopathy
 LVH

I.
II.
III.
IV.
V.
VI.
VII.
Rate
Rhythm
Axis
P wave
PR interval
PR segment
QRS complex
VIII. ST segment
IX.
X.
XI.
T wave
QT duration
U wave

 J pt (QRS takeoff) to beginning T wave
 Beginning ventricular repolarization
 Normal
 Isoelectric
 <1mm elevation limb
 <2mm elevation chest
 <0.5mm depression

 Depression
 >0.5mm depression
 Causes
 Myocardial ischemia
 Hypokalemia
 Elevation
 >1mm elevation limb
 >2mm elevation chest
 Causes
 Myocardial ischemia
 Acute pericarditis
 Hyperkalemia


 ECG Findings:
 Right precordial (V1-3)
 ST elevation
 T wave inversi

 ECG Findings:
 ST elevations
 PR depression

I.
II.
Rate
Rhythm
III.
IV.
V.
VI.
VII.
VIII.
Axis
P wave
PR interval
PR segment
QRS complex
ST segment
IX. T wave
X.
XI.
QT duration
U wave

 Ventricular repolarization
 Normal
 Upright I, II, V3-V6
 Inverted AVR
 Variable III, AVL, AVF, V1-2
 <5mm limb
 <10mm chest

 ECG Findings:
 Tall, Peaked T waves

I.
II.
Rate
Rhythm
Axis
III.
IV.
V.
VI.
VII.
VIII.
IX.
P wave
PR interval
PR segment
QRS complex
ST segment
T wave
X. QT duration
XI. U wave

 Beginning QRS to end T wave
 Total ventricular re/depolarization
 Normal
 QTc <0.44 sec Male
 QTc <0.46 sec Female

I.
II.
Rate
Rhythm
III.
IV.
V.
VI.
VII.
VIII.
IX.
X.
Axis
P wave
PR interval
PR segment
QRS complex
ST segment
T wave
QT duration
XI. U wave

 Final phase ventricular repolarization
 Normal
 Small, rounded
 Prominent
 Hypokalemia
 Drugs
 Quinidine, phenothiazine
 CVA
 Negative
 MI, LVH

 ECG Findings
 Prolonged QT interval
 Flat T wave
 Prominent U
 Hypokalemia

lecture one ecg.pptx hhhhhhhhhhhhhgyuuuhh

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