BASICS OF  E C G   INTERPRETATION
NORMAL E C G <ul><li>RATE: 60 – 100/ mts </li></ul><ul><li>MECHANISM: SINUS </li></ul><ul><li>(P wave precedes QRS)  </li>...
E C G: NORMAL WAVES AND INTERVALS   <ul><li>P WAVE: ATRIAL DEP </li></ul><ul><li>QRS COMPLEX: VENTRICULAR DEP </li></ul><u...
E C G: DURATION OF NORMAL WAVES AND INTERVALS <ul><li>P WAVE: < 0.12s WIDTH / HEIGHT </li></ul><ul><li>PR INTERVAL: 0.12s ...
E C G: DURATION OF NORMAL WAVES AND INTERVALS <ul><li>Q-T INTERVAL </li></ul><ul><li>Measured In A Lead With Initial  q Wa...
E C G: AXIS <ul><li>DEF  : DIRECTION OF MAXIMUM DEP FRONT </li></ul><ul><li>NORMAL AXIS:  </li></ul><ul><li>-30 to +110 </...
HOW TO LOOK FOR AXIS?   <ul><li>METHOD 1:   </li></ul><ul><li>SELECT A LEAD WITH MAXIMUM QRS , AXIS WILL BE TOWARDS THIS L...
E C G : CHAMBER ENLARGEMENT
E C G: CHAMBER ENLARGEMENT <ul><li>RT ATRIAL ENLARGEMENT : </li></ul><ul><li>`P`pulmonale –P wave height>2.5mm </li></ul><...
E C G: CHAMBER ENLARGEMENT <ul><li>ATRIAL ENLARGEMENT </li></ul>
E C G: CHAMBER ENLARGEMENT <ul><li>ATRIAL ENLARGEMENT </li></ul>
E C G: CHAMBER ENLARGEMENT <ul><li>RT VENTRICULAR ENLARGEMENT:   R wave  >7mm in V 1  , R/S ratio in V 1 >1 </li></ul><ul>...
E C G: CHAMBER   ENLARGEMENT <ul><li>VENTRICULAR ENLARGEMENT </li></ul>
E C G: CHAMBER   ENLARGEMENT <ul><li>RT & LT VENTRICULAR ENLARGEMENT </li></ul>
E C G : HEART BLOCKS
E C G:HEART BLOCKS <ul><li>TYPES:  </li></ul><ul><li>S A BLOCK </li></ul><ul><li>A V BLOCK:1 º  A V BLOCK </li></ul><ul><l...
E C G: HEART BLOCKS <ul><li>A V BLOCK: 1 º HEART BLOCK </li></ul>
E C G: HEART BLOCKS <ul><li>A V   BLOCK:2 º HEART BLOCK </li></ul><ul><li>( Wenckebach Type) </li></ul>
E C G: HEART BLOCKS <ul><li>A V BLOCK: 2 º HEART BLOCK </li></ul><ul><li>(Mobitz Type) </li></ul>
E C G:HEART BLOCKS <ul><li>A V BLOCK:2 º HEART BLOCK </li></ul><ul><li>(2:1Block) </li></ul>
E C G: HEART BLOCKS <ul><li>A V BLOCK: 3 º HEART BLOCK </li></ul><ul><li>(Complete Heart Block) </li></ul>
E C G: HEART BLOCKS <ul><li>RT BUNDLE BRANCH BLOCK </li></ul>
E C G: HEART BLOCKS <ul><li>RT BUNDLE BRANCH BLOCK </li></ul>
E C G: HEART BLOCKS <ul><li>LT BUNDLE   BRANCH BLOCK </li></ul>
E C G: HEART BLOCKS <ul><li>LT BUNDLE BRANCH BLOCK </li></ul>
E C G:   HEART BLOCKS <ul><li>RT & LT BUNDLE BRANCH BLOCK </li></ul>
E C G : ISCHEMIC HEART DISEASE
E C G: ISCHEMIC HEART DISEASE <ul><li>TYPES OF CHANGES: </li></ul><ul><li>ISCHEMIA </li></ul><ul><li>INJURY </li></ul><ul>...
E C G: ISCHEMIC HEART DISEASE
E C G: ISCHEMIC HEART DISEASE <ul><li>LEAD GROUPS </li></ul><ul><li>Anterior: V 1 - V 6 </li></ul><ul><li>Septal: V 3  – V...
I H D: ISCHEMIA <ul><li>ANGINA </li></ul>
I H D: MI(SUB ENDOCARDIAL)
I H D: MI( INFERIOR )
I H D:MI(ANTERIOR)
E C G : EXTRASYSTOLES
ECTOPICS : SUPRAVENTRICULAR
ECTOPICS:VENTRICULAR
E C G: TACHYARRHYTHMIAS
E C G:TACHY ARRHYTHMIAS <ul><li>TYPES </li></ul><ul><li>BASED ON ORIGIN:  </li></ul><ul><li>Supra Ventricular Tachycardia,...
E C G:TACHY ARRHYTHMIAS
E C G:TACHY ARRHYTHMIAS <ul><li>A : AV Nodal Reentry </li></ul><ul><li>B : AV Reentry </li></ul><ul><li>C : Atrial Tachyca...
E C G: TACHY ARRHYTHMIAS <ul><li>JUNCTIONAL TACHYCARDIA </li></ul>
E C G:TACHY ARRHYTHMIAS <ul><li>ATRIAL FIBRILLATION </li></ul>
E C G: TACHY ARRHYTHMIAS <ul><li>ATRIAL FLUTTER </li></ul>
E C G: TACHY ARRHYTHMIAS <ul><li>MULTIFOCAL ATRIAL TACHYCARDIA </li></ul>
E C G:TACHY ARRHYTHMIAS <ul><li>VENTRICULAR TACHYCARDIA </li></ul><ul><li>NEGATIVE QRS IN V 1 -V 6   </li></ul><ul><li>AV ...
E C G:TACHY ARRHYTHMIAS <ul><li>VENTRICULAR TACHYCARDIA </li></ul>
E C G:TACHY ARRHYTHMIAS <ul><li>TORSADES DE POINTES </li></ul>
E C G:TACHY ARRHYTHMIAS <ul><li>VENTRICULAR FIBRILLATION   </li></ul>
E C G: BRADY ARRYHTHMIAS
E C G:BRADY ARRYHTHMIAS <ul><li>JUNCTIONAL(A V NODAL) RHYTHM </li></ul>
E C G:BRADY ARRHYTHMIAS <ul><li>IDIOVENTRICULAR RHYTHM </li></ul>
E C G : OTHER COMMON CHANGES
PERICARDITIS
PERICARDIAL EFFUSION
HYPERTENSIVE HEART DISEASE
PULMONARY EMBOLISM
E C G:K + ABNORMALITY <ul><li>HYPOKALEMIA </li></ul><ul><li>HYPERKALEMIA </li></ul>
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Ecg presentation

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Ecg presentation

  1. 1. BASICS OF E C G INTERPRETATION
  2. 2. NORMAL E C G <ul><li>RATE: 60 – 100/ mts </li></ul><ul><li>MECHANISM: SINUS </li></ul><ul><li>(P wave precedes QRS) </li></ul><ul><li>RHYTHM: REGULAR </li></ul><ul><li>HEART RATE: </li></ul><ul><li>300/ NO OF LARGE BOXES BETWEEN TWO SUCCESSIVE QRS COMPLEXES </li></ul><ul><li>OR </li></ul><ul><li>1500/ NO OF SMALL SQUARES BETWEEN TWO SUCCESSIVE QRS COMPLEXES </li></ul>
  3. 3. E C G: NORMAL WAVES AND INTERVALS <ul><li>P WAVE: ATRIAL DEP </li></ul><ul><li>QRS COMPLEX: VENTRICULAR DEP </li></ul><ul><li>T WAVE: VENTRICULAR REP </li></ul><ul><li>U WAVE </li></ul><ul><li>PR INTERVAL </li></ul><ul><li>QT INTERVAL </li></ul>
  4. 4. E C G: DURATION OF NORMAL WAVES AND INTERVALS <ul><li>P WAVE: < 0.12s WIDTH / HEIGHT </li></ul><ul><li>PR INTERVAL: 0.12s TO 0.2s </li></ul><ul><li>QRS COMPLEX:<0.12s </li></ul><ul><li>QT INTERVAL:0.35-0.43s </li></ul><ul><li>VAT :<0.04s </li></ul>
  5. 5. E C G: DURATION OF NORMAL WAVES AND INTERVALS <ul><li>Q-T INTERVAL </li></ul><ul><li>Measured In A Lead With Initial q Wave. </li></ul><ul><li>Measured From Beginning Of q Wave To End Of T Wave. </li></ul><ul><li>Shortens With Tachycardia And Lengthens With Bradycardia. </li></ul><ul><li>Q-T Interval Is Corrected For Rate Of 60, Using Bazett ’s Formula. </li></ul>
  6. 6. E C G: AXIS <ul><li>DEF : DIRECTION OF MAXIMUM DEP FRONT </li></ul><ul><li>NORMAL AXIS: </li></ul><ul><li>-30 to +110 </li></ul><ul><li>LEFT AXIS: </li></ul><ul><li>-30 to -90 </li></ul><ul><li>RIGHT AXIS: </li></ul><ul><li>+110 to -1 </li></ul><ul><li>NORTH WEST AXIS: </li></ul><ul><li>-90 to -180 </li></ul>
  7. 7. HOW TO LOOK FOR AXIS? <ul><li>METHOD 1: </li></ul><ul><li>SELECT A LEAD WITH MAXIMUM QRS , AXIS WILL BE TOWARDS THIS LEAD. </li></ul><ul><li>METHOD 2: </li></ul><ul><li>SELECT A LEAD WITH EQUIPHASIC QRS, AXIS WILL BE AT 90 º TO THIS LEAD. </li></ul><ul><li>METHOD 3: </li></ul><ul><li>IF TWO LEADS HAVE QRS OF SAME HEIGHT, </li></ul><ul><li>AXIS WILL BE BETWEEN TWO SUCH LEADS. </li></ul>
  8. 8. E C G : CHAMBER ENLARGEMENT
  9. 9. E C G: CHAMBER ENLARGEMENT <ul><li>RT ATRIAL ENLARGEMENT : </li></ul><ul><li>`P`pulmonale –P wave height>2.5mm </li></ul><ul><li>LT ATRIAL ENLARGEMENT : </li></ul><ul><li>`P`mitrale -P wave width >2.5mm </li></ul><ul><li>Notched P wave </li></ul><ul><li>BIATRIAL ENLARGEMENT : </li></ul><ul><li>Biphasic P wave in V 1 </li></ul><ul><li>Morris index : P wave depth >2 mm and </li></ul><ul><li>duration >0.04 s of terminal deflection, </li></ul><ul><li>suggests LT atrial enlargement </li></ul>
  10. 10. E C G: CHAMBER ENLARGEMENT <ul><li>ATRIAL ENLARGEMENT </li></ul>
  11. 11. E C G: CHAMBER ENLARGEMENT <ul><li>ATRIAL ENLARGEMENT </li></ul>
  12. 12. E C G: CHAMBER ENLARGEMENT <ul><li>RT VENTRICULAR ENLARGEMENT: R wave >7mm in V 1 , R/S ratio in V 1 >1 </li></ul><ul><li>R in V 1 + S in V 6 >11mm </li></ul><ul><li>LT VENTRICULAR ENLARGEMENT: </li></ul><ul><li>R in V 6 = R in V 5 ; R in V 6 >20mm </li></ul><ul><li>S in V 1 >30mm ; R in V 6 + S in V 1 >35mm </li></ul><ul><li>Romhilt -Estes Score >5 </li></ul>
  13. 13. E C G: CHAMBER ENLARGEMENT <ul><li>VENTRICULAR ENLARGEMENT </li></ul>
  14. 14. E C G: CHAMBER ENLARGEMENT <ul><li>RT & LT VENTRICULAR ENLARGEMENT </li></ul>
  15. 15. E C G : HEART BLOCKS
  16. 16. E C G:HEART BLOCKS <ul><li>TYPES: </li></ul><ul><li>S A BLOCK </li></ul><ul><li>A V BLOCK:1 º A V BLOCK </li></ul><ul><li>2 º A V BLOCK </li></ul><ul><li>(Wenckebach,Mobitz ,2:1 block ) </li></ul><ul><li>3 º A V BLOCK( complete block) </li></ul><ul><li>BUNDLE BRANCH BLOCK ( Rt and Lt ) </li></ul><ul><li>FASCICULAR BLOCK (Rt and Lt ) </li></ul>
  17. 17. E C G: HEART BLOCKS <ul><li>A V BLOCK: 1 º HEART BLOCK </li></ul>
  18. 18. E C G: HEART BLOCKS <ul><li>A V BLOCK:2 º HEART BLOCK </li></ul><ul><li>( Wenckebach Type) </li></ul>
  19. 19. E C G: HEART BLOCKS <ul><li>A V BLOCK: 2 º HEART BLOCK </li></ul><ul><li>(Mobitz Type) </li></ul>
  20. 20. E C G:HEART BLOCKS <ul><li>A V BLOCK:2 º HEART BLOCK </li></ul><ul><li>(2:1Block) </li></ul>
  21. 21. E C G: HEART BLOCKS <ul><li>A V BLOCK: 3 º HEART BLOCK </li></ul><ul><li>(Complete Heart Block) </li></ul>
  22. 22. E C G: HEART BLOCKS <ul><li>RT BUNDLE BRANCH BLOCK </li></ul>
  23. 23. E C G: HEART BLOCKS <ul><li>RT BUNDLE BRANCH BLOCK </li></ul>
  24. 24. E C G: HEART BLOCKS <ul><li>LT BUNDLE BRANCH BLOCK </li></ul>
  25. 25. E C G: HEART BLOCKS <ul><li>LT BUNDLE BRANCH BLOCK </li></ul>
  26. 26. E C G: HEART BLOCKS <ul><li>RT & LT BUNDLE BRANCH BLOCK </li></ul>
  27. 27. E C G : ISCHEMIC HEART DISEASE
  28. 28. E C G: ISCHEMIC HEART DISEASE <ul><li>TYPES OF CHANGES: </li></ul><ul><li>ISCHEMIA </li></ul><ul><li>INJURY </li></ul><ul><li>NECROSIS </li></ul>
  29. 29. E C G: ISCHEMIC HEART DISEASE
  30. 30. E C G: ISCHEMIC HEART DISEASE <ul><li>LEAD GROUPS </li></ul><ul><li>Anterior: V 1 - V 6 </li></ul><ul><li>Septal: V 3 – V 4 </li></ul><ul><li>Lateral: I, aVL, V 5 , V 6 </li></ul><ul><li>High Lateral: I, aVL </li></ul><ul><li>Inferior: II, III, aVF </li></ul><ul><li>Posterior: Mirror Image In V 1 , V 2 </li></ul>
  31. 31. I H D: ISCHEMIA <ul><li>ANGINA </li></ul>
  32. 32. I H D: MI(SUB ENDOCARDIAL)
  33. 33. I H D: MI( INFERIOR )
  34. 34. I H D:MI(ANTERIOR)
  35. 35. E C G : EXTRASYSTOLES
  36. 36. ECTOPICS : SUPRAVENTRICULAR
  37. 37. ECTOPICS:VENTRICULAR
  38. 38. E C G: TACHYARRHYTHMIAS
  39. 39. E C G:TACHY ARRHYTHMIAS <ul><li>TYPES </li></ul><ul><li>BASED ON ORIGIN: </li></ul><ul><li>Supra Ventricular Tachycardia, Ventricular </li></ul><ul><li>Tachycardia </li></ul><ul><li>BASED ON MORPHOLOGY: </li></ul><ul><li>Narrow QRS Tachycardia, Broad QRS </li></ul><ul><li>Tachycardia </li></ul><ul><li>BASED ON RHYTHM: </li></ul><ul><li>Regular Tachycardia , Irregular Tachycardia </li></ul><ul><li>BASED ON MECHANISM: </li></ul><ul><li>Reentry, Non Reentry, Pre excitation </li></ul>
  40. 40. E C G:TACHY ARRHYTHMIAS
  41. 41. E C G:TACHY ARRHYTHMIAS <ul><li>A : AV Nodal Reentry </li></ul><ul><li>B : AV Reentry </li></ul><ul><li>C : Atrial Tachycardia </li></ul>
  42. 42. E C G: TACHY ARRHYTHMIAS <ul><li>JUNCTIONAL TACHYCARDIA </li></ul>
  43. 43. E C G:TACHY ARRHYTHMIAS <ul><li>ATRIAL FIBRILLATION </li></ul>
  44. 44. E C G: TACHY ARRHYTHMIAS <ul><li>ATRIAL FLUTTER </li></ul>
  45. 45. E C G: TACHY ARRHYTHMIAS <ul><li>MULTIFOCAL ATRIAL TACHYCARDIA </li></ul>
  46. 46. E C G:TACHY ARRHYTHMIAS <ul><li>VENTRICULAR TACHYCARDIA </li></ul><ul><li>NEGATIVE QRS IN V 1 -V 6 </li></ul><ul><li>AV DISSOCIATION </li></ul><ul><li>QR COMPLEXES IN V 4 -V 6 </li></ul><ul><li>LT / NORTH WEST AXIS </li></ul><ul><li>CAPTURE BEATS </li></ul><ul><li>NARROW R WITH SLURRED DELAYED S </li></ul><ul><li>QRS > 0.12s </li></ul>
  47. 47. E C G:TACHY ARRHYTHMIAS <ul><li>VENTRICULAR TACHYCARDIA </li></ul>
  48. 48. E C G:TACHY ARRHYTHMIAS <ul><li>TORSADES DE POINTES </li></ul>
  49. 49. E C G:TACHY ARRHYTHMIAS <ul><li>VENTRICULAR FIBRILLATION </li></ul>
  50. 50. E C G: BRADY ARRYHTHMIAS
  51. 51. E C G:BRADY ARRYHTHMIAS <ul><li>JUNCTIONAL(A V NODAL) RHYTHM </li></ul>
  52. 52. E C G:BRADY ARRHYTHMIAS <ul><li>IDIOVENTRICULAR RHYTHM </li></ul>
  53. 53. E C G : OTHER COMMON CHANGES
  54. 54. PERICARDITIS
  55. 55. PERICARDIAL EFFUSION
  56. 56. HYPERTENSIVE HEART DISEASE
  57. 57. PULMONARY EMBOLISM
  58. 58. E C G:K + ABNORMALITY <ul><li>HYPOKALEMIA </li></ul><ul><li>HYPERKALEMIA </li></ul>
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