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EKG Overview

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Reshi Kanuru

on 22 October 2012

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Transcript of EKG Overview

How to Read an EKG Narrated by Reshi Kanuru MD Outline: 1. What is an EKG?
2. What do the deflections on an EKG represent?
3. How should I approach reading an EKG?
4. How to recognize abnormalities on an EKG? What is an EKG? An EKG stands for electrocardiogram
Otherwise known as ECG
The sum of all electrical activity in the heart from different vantage points (or leads) over several seconds
Allows healthcare staff to identify heart abnormalities What is cellular depolarization? Na K Cl Myocardial tissue EKG Basics 0.04 secs 1 mV 0.2 Secs = = = + + + + + + Approach to EKG Reading RRAHIBI Rhythm
Blocks Intervals Types of Rhythms: Sinus vs. Ventricular
P wave before every QRS
QRS duration < 0.12 secs Regularity:
Equal spacing between each QRS complex
Regular vs. Irregular Origin: Basic Deflections on an EKG How is electrical activity recorded on an EKG? How is an EKG recorded? P QRS T P Wave Represents atrial depolarization
Height and width of the p wave can indicate enlargement of the atria Basic Cardiac Anatomy Limb Leads Right Arm Left Arm Left Leg Lead I Lead II Lead III aVL aVF aVR - + - - + + QRS complex
Represents ventricular depolarization
RV depolarizes before LV T wave
Represents Ventricular repolarization Rate 300 Rule
HR = 300/ # of large boxes between consecutive waves SA Node Pulmonary Artery Aorta LA RA SVC IVC RV LV AV node Axis aVf Lead I Normal Axis -30 +90 Precordial Leads Precordial leads placed on chest
V1 = 4th intercostal space (ICS), right of sternum
V2 = 4th ICS left of sternum
V3 = Between V2 &V4 V4 = 5th ICS at midclavicular line
V5 = 5th ICS at left anterior axillary line
V6 = 5th ICS at midaxillary line aVL 0 -180 +180 II +60 Lead I Normal Axis -30 aVL 0 -180 +180 Lead I + + + + + + + + + + + + + + + + + + + - - - - - - - - - - - aVf aVf Lead I Normal Axis -30 +90 aVL 0 -180 +180 II +60 Lead II + aVf Lead I Normal Axis -30 +90 aVL 0 -180 +180 II +60 aVF + + + + + + + + + + - - - - - - - - - - - - + - - - - - - - - - + + + + + + + + - aVf Lead I Normal Axis -30 +90 aVL 0 -180 +180 II +60 aVf Lead I Normal Axis -30 +90 aVL 0 -180 +180 II +60 aVf Lead I Normal Axis -30 +90 aVL 0 -180 +180 II +60 If positive deflection in Lead I If postive deflection in aVF Normal axis aVf Lead I Normal Axis -30 +90 aVL 0 -180 +180 II +60 aVf Lead I Normal Axis -30 +90 aVL 0 -180 +180 II +60 aVf Lead I Normal Axis -30 +90 aVL 0 -180 +180 II +60 If negative deflection in Lead I If negative deflection in aVF Extreme right axis Left axis Right axis Extreme right axis + + + + + + - - - - - - aVf Lead I Normal Axis -30 +90 aVL 0 -180 +180 II +60 aVf Lead I Normal Axis -30 +90 aVL 0 -180 +180 II +60 aVf Lead I Normal Axis -30 +90 aVL 0 -180 +180 II +60 If positive deflection in Lead I If negative deflection in aVF Normal Axis aVf Lead I Normal Axis -30 +90 aVL 0 -180 +180 II +60 Positive deflection in lead II - - - + + + Hypertrophy Atrial Hypertrophy - Enlargement of the atrium
Right atrial hypertrophy - Height > 2.5 mm in lead II
Left atrial hypertrophy - P wave is biphasic in V1, if negative terminal portions is longer and deeper than 1 small box; Also if notch between peaks is > 0.04 secs

Ventricular hypertrophy
Left ventricular hypertrophy:
1. R wave height in aVL > 11 mm
2. R wave height in Lead I plus the S wave depth in Lead III exceeds 25 mm
3. S wave depth in V1 + Height of R in V5 > 35 mm.
Right ventricular hypertrophy - Right axis deviation, Height of R wave > depth of S wave in V1 Infarction Cardiac tissue oxygen demand exceeds oxygen supply
Q wave
First negative deflection in QRS is > 1mm by 1 mm
Must be in Contiguous leads
May indicate previous ischemic event though nonspecific
T wave inversion
T waves normally a positive deflection
Negative deflection may indicate previous ischemic event Infarction Blocks ST segment Depression
Indicates subendocardial ischemia
ST segment is below EKG baseline
ST segment elevation
Indicates acute myocardial infarction
New LBBB or RBBB First degree AV block:
Prolonged PR interval > 0.2 sec (5 small boxes)
Slowed AV conduction
May be due to structural abnormality, medications, increased vagal tone AV Blocks Second Degree AV block: Mobitz I or Wenkebach: PR interval lenthening with a dropped QRS after a normal P wave Mobitz II: Dropped QRS after normal P wave with NO PR interval lengthening Third Degree AV block:
Complete failure of AV node to conduct resulting in atria beating separate from ventricles Blocks Bundle Branch Blocks If QRS complex duration is greater than or equal to 120 msec (3 small boxes) then bundle branch block is present Types of block:
Right Bundle Branch Block (RBBB)
Left bundle Branch Block (LBBB) Left Bundle Branch Block
QRS duration greater than or equal to 120 msec
Broad R wave with small notch at peak in leads I, aVL, V5, and V6 Right Bundle Branch Block
QRS duration greater than or equal to 120 msec
R wave, S wave, R wave in leads V1, V2 (Looks like an 'M') Infarction Distribution Precordial leads (V1,V6) Anterior Wall Infarction II, III, and aVF Inferior Wall Infarction Right Coronary artery
Left Circumflex artery Left Anterior Descending Artery V1-V3 only Apical Wall infarction V4-V6 only Anterior lateral infarction I, aVL only Lateral wall infarction PR interval - Normally < 0.2sec; if greater consider AV block QT interval
Measure of ventricular repolarization
Includes QRS complex, ST segment and T wave
Varies with heart rate
Adjustment for heart rate is called QTc
prolonged QTc (440 msec in men 460 msec in women) can lead to significant arrhythmias
Prolongation may be due to genetics, medications, Intervals
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