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22 Ecg
1. ACUTE PULMONARY EMBOLUS
AXIS LAFB = LA HEMI-
LV Hy
OK = +I +VF LOW AMLITUDE
LEFT AXIS = +I -II --VF
SOKOLOW V1 S + V5 R > 35
NORTHWEST = -I -VF RBBB
LATERAL LIMP = I,VL qR
RIGHT = -I +VF CORNELL V1, V3 T INVERSION
MAN V3 S + VL R >20 INFERIORs = II, III, VF = rS
LEFT = +I -II -VF WOMAN V3 S + VL R > 28 III T INVERSION
FRAMINGHAM VL = LATE INTRINSICOID DEFLECTION
> 0.45
VL R >11
4% = MI
RA Hy = V4,V5,V6 R > 25 INFERIOR MI = รรรรรร รร INTRAVENTRICULAR CONDUCTION
DEFECT
III P > I P I R + III S > 25 II, III, VF ST ELEVATION = LAD
V1,...,V6 ST DEPRESSION
IIP> 2.5mm V1P>1.5mm ร ร รรรรร, รรรรรรร รรรรร,
V1QRS<5mm NOT JUST INFERIOR รรรรรรรรร รรร รร, รรรรร รรรรรรร
V2/V1 >6 P : HIGH AMPLITUDE รรรรรรฒ รรรรรร รรร รร
30% ++ LV MI oR ++ RV MI
-- CAD + : รรรรรรร รรร รร
V1 QR, Qr, qR, qRs HYPERTENSION RV -- INFERIOR MI
COL PULMONALE HYPOTENSION LEFT AXIS + RBBB = LA HEMI--
KUSSMAULCLEAR LUNG SOUND INDICATIVE
V4 ST ELEVETION
V4 R
LA Hy PR = 0.12 - 0.20 = 3 - 5
: INFUSIONS, NTG, MORPHINE
IIIP > IP PR DISPLACED = MI,
ACUTE PERICARDITIS
LPFB = LP HEMI--
LIMP = II,III,VF P MSHAPE OR NOTCH
>0.O4 sec INFERIOR OLD = III Q > 1mm THE POSTERIOR BRANCH DOES NOT
VF Q > 0.5 CONTRUCT FROM AV NODE
V1 P = DIPHASIC QRS II Q
TERMINAL NEGATIVE > 1mm
I, II, III < 0.05 - 0.10 = 1~ - 2~
>0.04 sec
RIGHT AXIS
V1,..,V6 = 0.06 - 0.12 = 1~ - 3 ANTERIOR MI = รรรรรร
V1, V6, VL ST ELEVATION
II, III, VF ST DEPRESSION
Sensitivity = 50%; Specificity = 90%
V1 R V3,V4 = LAD = LV DISFUNCTION
CHF, CARDIOGENIC
RV Hy SHOCK
WPW
RV Hy
MI POSTERIOR
NORMAL IF YOUNG
Right axis deviation
POSTERIOR MI = ร รรรรร
RV R = TALL LV S = DEEP V1,V2,V3 ACUTE INJURY
TALL T
Slight increase in QRS duration
SINUS TACHYCARDIA
ST-T changes directed opposite to %% COEXISTS INFERIOR or/and
LATERAL MI
QRS direction (i.e., wide QRS/T angle) IS - III Q
May V1,V2,V3,V4 = LAC = POSTERIOR MI
incomplete RBBB pattern or
V1 qR
HYPOCALCEMIA V1, V2 = SEPTAL LEADS = LAD
BUNDLE HIS and BBB = 2nd, 3rd TYPE
Evidence of right atrial enlargement PROLONGATION : ST - QT
BLOCK
IF QRS <0.12 sec
HYPERCALCEMIA
Right axis deviation SHORT QT
VR R > 5mm
VR R > VR Q
V5, V6, I, VL LATERAL MI
LONG QRS + NO P MAY AV BLOCK
%% OTHER AREAS COEXIST
= JUNCTIONAL ESCAPE
V1:
or
R/S ratio > 1 and negative T wave
INTRAVENTRICULAR DEFICIT LBBB
V1 qR
QRS > 120 msec
V1 rS or V1 QS
R > 6 mm, or S < 2mm, or rSR' with I, V6 MONOPHASIC R
R' >10 mm
SUPRAVENTRICULAR RHYTHM
HYPOKALEMIA EM, AORTA STENOSIS,
Other chest lead criteria: DILATED MCy, CAD,
FLAT, INVERTED, ABSENT T ร ร รรรรร --> รรรรรรร รรรรร รรรรรร -> รร
V1 R + V5,V6 S
10mm +
U > T K < 2.7 meq /Lt
V5, V6 R/S < 1
Rรรร = RV ACTIVATED LATE BY LBB
V5, V6 R < 5mm QRS >100 HEMI- >120 q COMPLETE
HYPERCALEMIA
TALL, PEAKED T V1 rSR' = TERMINAL R
V5, V6 S
> 7mm V6 qRs
NO P I, V6 SLURRED R
SUPRAVENTRICULAR RHYTHM
LONG QRS
IF LA HEMI- [+]
III S > 15 = LV HY TERMINAL R = R, rR', rsR', qR
![ACUTE PULMONARY EMBOLUS
AXIS LAFB = LA HEMI-
LV Hy
OK = +I +VF LOW AMLITUDE
LEFT AXIS = +I -II --VF
SOKOLOW V1 S + V5 R > 35
NORTHWEST = -I -VF RBBB
LATERAL LIMP = I,VL qR
RIGHT = -I +VF CORNELL V1, V3 T INVERSION
MAN V3 S + VL R >20 INFERIORs = II, III, VF = rS
LEFT = +I -II -VF WOMAN V3 S + VL R > 28 III T INVERSION
FRAMINGHAM VL = LATE INTRINSICOID DEFLECTION
> 0.45
VL R >11
4% = MI
RA Hy = V4,V5,V6 R > 25 INFERIOR MI = รรรรรร
รร INTRAVENTRICULAR CONDUCTION
DEFECT
III P > I P I R + III S > 25 II, III, VF ST ELEVATION = LAD
V1,...,V6 ST DEPRESSION
IIP> 2.5mm V1P>1.5mm ร ร
รรรรร, รรรรรรร รรรรร,
V1QRS<5mm NOT JUST INFERIOR รรรรรรรรร รรร
รร, รรรรร
รรรรรรร
V2/V1 >6 P : HIGH AMPLITUDE รรรรรรฒ รรรรรร รรร
รร
30% ++ LV MI oR ++ RV MI
-- CAD + : รรรรรรร รรร
รร
V1 QR, Qr, qR, qRs HYPERTENSION RV -- INFERIOR MI
COL PULMONALE HYPOTENSION LEFT AXIS + RBBB = LA HEMI--
KUSSMAULCLEAR LUNG SOUND INDICATIVE
V4 ST ELEVETION
V4 R
LA Hy PR = 0.12 - 0.20 = 3 - 5
: INFUSIONS, NTG, MORPHINE
IIIP > IP PR DISPLACED = MI,
ACUTE PERICARDITIS
LPFB = LP HEMI--
LIMP = II,III,VF P MSHAPE OR NOTCH
>0.O4 sec INFERIOR OLD = III Q > 1mm THE POSTERIOR BRANCH DOES NOT
VF Q > 0.5 CONTRUCT FROM AV NODE
V1 P = DIPHASIC QRS II Q
TERMINAL NEGATIVE > 1mm
I, II, III < 0.05 - 0.10 = 1~ - 2~
>0.04 sec
RIGHT AXIS
V1,..,V6 = 0.06 - 0.12 = 1~ - 3 ANTERIOR MI = รรรรรร
V1, V6, VL ST ELEVATION
II, III, VF ST DEPRESSION
Sensitivity = 50%; Specificity = 90%
V1 R V3,V4 = LAD = LV DISFUNCTION
CHF, CARDIOGENIC
RV Hy SHOCK
WPW
RV Hy
MI POSTERIOR
NORMAL IF YOUNG
Right axis deviation
POSTERIOR MI = ร รรรรร
RV R = TALL LV S = DEEP V1,V2,V3 ACUTE INJURY
TALL T
Slight increase in QRS duration
SINUS TACHYCARDIA
ST-T changes directed opposite to %% COEXISTS INFERIOR or/and
LATERAL MI
QRS direction (i.e., wide QRS/T angle) IS - III Q
May V1,V2,V3,V4 = LAC = POSTERIOR MI
incomplete RBBB pattern or
V1 qR
HYPOCALCEMIA V1, V2 = SEPTAL LEADS = LAD
BUNDLE HIS and BBB = 2nd, 3rd TYPE
Evidence of right atrial enlargement PROLONGATION : ST - QT
BLOCK
IF QRS <0.12 sec
HYPERCALCEMIA
Right axis deviation SHORT QT
VR R > 5mm
VR R > VR Q
V5, V6, I, VL LATERAL MI
LONG QRS + NO P MAY AV BLOCK
%% OTHER AREAS COEXIST
= JUNCTIONAL ESCAPE
V1:
or
R/S ratio > 1 and negative T wave
INTRAVENTRICULAR DEFICIT LBBB
V1 qR
QRS > 120 msec
V1 rS or V1 QS
R > 6 mm, or S < 2mm, or rSR' with I, V6 MONOPHASIC R
R' >10 mm
SUPRAVENTRICULAR RHYTHM
HYPOKALEMIA EM, AORTA STENOSIS,
Other chest lead criteria: DILATED MCy, CAD,
FLAT, INVERTED, ABSENT T ร ร
รรรรร --> รรรรรรร รรรรร รรรรรร -> รร
V1 R + V5,V6 S
10mm +
U > T K < 2.7 meq /Lt
V5, V6 R/S < 1
Rรรร = RV ACTIVATED LATE BY LBB
V5, V6 R < 5mm QRS >100 HEMI- >120 q COMPLETE
HYPERCALEMIA
TALL, PEAKED T V1 rSR' = TERMINAL R
V5, V6 S
> 7mm V6 qRs
NO P I, V6 SLURRED R
SUPRAVENTRICULAR RHYTHM
LONG QRS
IF LA HEMI- [+]
III S > 15 = LV HY TERMINAL R = R, rR', rsR', qR](https://image.slidesharecdn.com/22ecg-091216160434-phpapp01/85/22-Ecg-1-320.jpg)
