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Basic ECG interpretation

A presentaion used to train medical students in basic ECG interpretation
by

Gregg Morris

on 1 May 2013

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Transcript of Basic ECG interpretation

P wave Atrial depolarization
<2.5mm amplitude
<0.12 sec (3 squares)
1:1 association with a QRS QRS Ventricular depolarisation
<0.12 sec
Composition and polarity vary depending on lead viewed T wave Ventricular repolarization
Negative T waves in V1, SIII and aVR can be normal
Always remember... 1500/R-R interval
(Small squares)

<60 = bradycardia
>100 = tachycardia Rate Axis Regular
Irregularly irregular
Regularly irregular Look at SI and SIII
Reaching towards = Right
Leaning away = Left Rhythm 1:1 association
Height + duration
Morphology
Axis P wave 0.12-0.20 sec
Consistent PR interval <0.12 sec duration
morphology
Amplitude QRS T & ST Elevated/depressed
Upright/inverted
Hyperacute/flat
Morphology Atrial fibrillation - No P waves + irregular ventricular rate Right atrial hypertrophy - P > 2.5mm "peaky P's" Left atrial hypertrophy - P > 0.12 sec in SII "P mitrale" Mobitz I (Wenckebach) - ? 1:1 conduction ?
- Lengthening PR interval
- Intermittent non conducted P's 1st degree AV block - Long PR interval Mobitz II - ? 1:1 conduction ?
- PR same
- Intermittent non conducted P's Complete AV block - ? 1:1 conduction ?
- Atrial + Ventricular rate independent RBBB - QRS > 0.12 sec
- RSR morphology in V1 LBBB - QRS > 0.12 sec
- Wide bizarre QRS WPW - Delta wave
- Short PR interval LVH - S wave in V1 + R wave in V5 or V6 = >35mm Atrial flutter - Saw tooth flutter waves Pericarditis - Widespread "saddle shaped" ST elevation
- May have PR depression Acute MI - ST elevation V1-V4
- reciprocal depression in SII, III and aVF Acute MI - ST elevation SII, SIII and aVF
- reciprocal depression V1-V3 Brugada - Coved ST segment elevation V1-V3
- RBBB HOCM Hyperkalaemia - Deep T wave inversion in precordial leads + LVH - Tall peaked T waves
- slurred QRS References http://ecg.utah.edu/img_index
http://www.cardiachealth.org/heart-information/heart-arrhythmia/bundle-branch-block
http://osuemed.wordpress.com/tag/brugada/
http://meds.queensu.ca/central/assets/modules/ECG/Slide15.JPG
http://circ.ahajournals.org/content/124/7/857/F1.large.jpg
http://cardiophile.org/wp-content/uploads/2010/01/sinus-brady-with-first-degree-AV-block.jpg
http://www.emedu.org/ecg/images/ans/23rd_1a.jpg
http://thejarvik7.files.wordpress.com/2011/04/hyperkalemia-ekg051.jpg
http://lifeinthefastlane.com/wp-content/uploads/2012/01/HOCM1.jpg
http://lifeinthefastlane.com/ecg-library/basics/left-ventricular-hypertrophy/
http://www.emedu.org/ecg/lbbb.htm
http://www.aic.cuhk.edu.hk/web8/inferior_mi.htm
http://cardiologycases.wordpress.com/2010/02/28/ecg-case-10-anterior-stemi/
http://hqmeded-ecg.blogspot.co.uk/2012/11/chest-pain-and-right-bundle-branch.html
http://openi.nlm.nih.gov/detailedresult.php?img=2628935_1752-1947-3-5-1&req=4 Quick quiz Asystole - Lack of cardiac activity VF - Rapid irregular ventricular rhythm Inferior Lateral Septal Anterior Normal Sinus Rhythm 60/R-R interval (ms)

or

number of QRS's on ECG x 6
Full transcript