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How to read 12 lead ECG
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How to read 12 lead ECG

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  • 1. How to read ECG PG corner
  • 2. Mr do not Miss  Lead reversal and ECG artefacts
  • 3. Technology does not understood science of ECG  Do not believe in COMPUTERIZED ECG INTERPRETATIONS
  • 4. At least 14 observations before answering
  • 5. Standardizati on  Usual 1 mV = 10 mm  In special cases ECG may be intentionally recorded at one-half standardization (1 mV =5mm) or two times normal standardization (1 mV = 20 mm). However, overlooking this change in gain may lead to the mistaken diagnosis of low or high voltage.
  • 6. Rhythm  Sinus rhythm  bradycardia or tachycardia  SR with APBs orVPBs  SR with AV block  Nonsinus:PSVT),Afib or flutter,VT and AV junctional escape
  • 7. Sinus rhythm  Discrete P waves that are always positive (upright) in lead II (and negative in aVR
  • 8. Heart Rate  Normally, the ventricular (QRS) rate and atrial (P) rates are the same (1:1 AV conduction)  Tachycardia >100  Bradycardia <60  Irregular  Regularly irregular :Wenchebach’s  Irregularly irregular :Fib
  • 9. PR Interval  The normal PR interval (measured from the beginning of the P wave to the beginning of the QRS complex) is 0.12 to 0.2 sec  First-degree AV block  A short PR interval with sinus rhythm and with a wide QRS complex and a delta wave is seen in theWolff-Parkinson-White (WPW) pattern  A short PR interval with retrograde P waves (negative in lead II) generally indicates an ectopic (atrial or AV junctional) pacemaker.
  • 10. P wave  Normal not exceed 2.5 mm in amplitude and is less than 3 mm (120 ms) wide in all leads  Tall, peaked P waves may be a sign of right atrial overload (P pulmonale)  Wide (and sometimes notched P) waves are seen with left atrial abnormality.
  • 11. QRS Interval  0.1 sec (100 ms) or less, measured by eye  110 ms if measured by computer
  • 12. QT/QTc Interval  Shortened :hyperkalaemia and digitalis effect  Prolonged:hypocalcemia or hypokalemia, drug effects (quinidine, procainamide, amiodarone, or sotalol), or myocardial ischemia
  • 13. QRSVoltage  Stick to criteria for Normal /LVH/RVH
  • 14. QRS Axis  Frontal plane  Normal: −30° to +100°
  • 15. R wave progression  Inspect leadsV1 toV6  Normal increase in R/S ratio occurs as you move across the chest  Poor: (small or absent R waves in leadsV1 toV3)  AWMI  The term reversed R wave progression  Tall R waves in leadV1 that progressively decrease in amplitude:RVH, posterior (or posterolateral) infarction, and dextrocardia
  • 16. Q,T,U Document changes
  • 17. UWave  U Waves Look for prominent U waves.These waves, usually most apparent in chest leadsV2-V4, may be a sign of hypokalemia or drug effect or toxicity (e.g., ami-odarone ami-odarone, dofetilide, quinidine, or sotalol).
  • 18. Normal frontal loop: 1.q in II/III/aVF 2.No q in I/AVL
  • 19. Counter clock loop in frontal plane: 1.q inAVL 2.No q in II/III/AVF
  • 20. (1) standardization—10 mm/mV; 25 mm/sec (2) rhythm—normal sinus (3) heart rate—75 beats/min (4) PR interval—0.16 sec (5) P waves—normal size (6) QRS width—0.08 sec (normal) (7) QT interval—0.4 sec (slightly prolonged for rate) (8) QRS voltage—normal (9) QRS axis—about 30° (biphasic QRS complex in lead II with positive QRS complex in lead I) (10) R wave progression:early precordial transition with relatively tall R wave in lead V2 (11) abnormal Q waves—leads II, III, and aVF (12) ST segments: elevated in leads II, III, aVF,V4,V5, andV6 slightly depressed in leads V1 and V2 (13)T waves—inverted in leads II, III, aVF, andV3 throughV6 (14) U waves—not prominent. Impression:This ECG is consistent with an inferolateral (or infero-posterolateral) wall myocardial infarction of indeterminate age, possibly recent or evolving. Comment:The relatively tall R wave in lead V2 could reflect loss of lateral potentials or actual posterior wall involvement EXAMPLE
  • 21. Calcium and 12 Lead ECG
  • 22. What ECG findings may be present in pulmonary embolus?  Sinus tachycardia (the most common ECG finding)  Right atrial enlargement (P pulmonale)—tall P waves in the inferior leads  Right axis deviation  T wave inversions in leadsV1-V2  Incomplete right bundle branch block (IRBBB)  S1Q3T3 pattern—an S wave in lead I, a Q wave in lead III, and an invertedT wave in lead III.Although this is only occasionally seen with pulmonary embolus, it is quite suggestive that a pulmonary embolus has occurred.
  • 23. I can only give you hint because I know less