Ecg

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  • Cardiac conducting system
  • It’s vital to have a system in place to interpret the ECG.
  • Small square 0.04s; Large square 0.2s
  • It’s vital to have a system in place to interpret the ECG.
  • Can use lead II
  • The normal axis is around 60 degrees.
  • The normal axis is around 60 degrees.
  • It’s vital to have a system in place to interpret the ECG.
  • Not very useful signs.
  • Short PR interval can be accessory pathway or can be normal
  • It’s vital to have a system in place to interpret the ECG.
  • It’s vital to have a system in place to interpret the ECG.
  • ST segment changes are usually in “territories”
  • Tall = can be normal young man
  • Long QT syndrome. Amiodarone, sotalol.
  • Long QT syndrome is associated with Torsades de pointes
  • AF
  • INFERIOR MI
  • LBBB with lateral MI
  • Ecg

    1. 1. ECGinterpretation
    2. 2. ObjectivesJustify the reasons for performing an ECGDevelop a structured approach tointerpreting an ECGPractice interpreting ECGs
    3. 3. The ECG“The ECG (electrocardiogram) is atransthoracic interpretation of the electricalactivity of the heart.”
    4. 4. The ECG
    5. 5. Why perform an ECG? It’s part of the admission bundle Indicated by the patient’s symptoms - symptoms of IHD/MI - symptoms associated with dysrhythmias Indicated by the patient’s examination findings - cardiac murmur
    6. 6. ECG interpretationQuality of ECG?RateRhythmAxisP wavePR intervalQRS durationQRS morphologyAbnormal Q wavesST segmentT waveQT interval
    7. 7. Quality of the ECG Patient name Date of the ECG Is there any interference? Is there electrical activity from all 12leads? Calibration: - speed = 25mm/second - height = 1cm/mV
    8. 8. Calibration
    9. 9. Calibration
    10. 10. ECG interpretationQuality of ECG?RateRhythmAxisP wavePR intervalQRS durationQRS morphologyAbnormal Q wavesST segmentT waveQT interval
    11. 11. Rate 300/number of big squares between Rwaves Rate is either: - normal - bradycardic - tachycardic
    12. 12. Rate
    13. 13. Rhythm Are there P waves? Are they regular? Does one precede every QRS complex? Regular vs. irregular
    14. 14. Axis
    15. 15. Axis
    16. 16. AxisPositive in I and II= NORMALPositive in I andnegative in II = LADNegative in I andpositive in II = RAD
    17. 17. Axis
    18. 18. ECG interpretationQuality of ECG?RateRhythmAxisP wavePR intervalQRS durationQRS morphologyAbnormal Q wavesST segmentT waveQT interval
    19. 19. P wave Are there P waves present? Bifid = P mitrale (LA hypertrophy) Pointy = P pulmonale (RA hypertrophy)
    20. 20. P mitrale
    21. 21. P pulmonale
    22. 22. PR interval Start of P wave to start of QRS complex Normal = 0.12 - 0.2 seconds (3-5 small squares) Decreased = can indicate an accessory pathway Increased = indicates AV block (1st/2nd/3rd)
    23. 23. ECG interpretationQuality of ECG?RateRhythmAxisP wavePR intervalQRS durationQRS morphologyAbnormal Q wavesST segmentT waveQT interval
    24. 24. QRS complex Normal = <0.12 seconds >0.12 seconds = Bundle Branch Block
    25. 25. QRS complex W I LL ia m = LBBBM a RR o w = RBBB
    26. 26. QRS complex Is there LVH? Sum of the Q or S wave in V1 and the tallest R wavein V5 or V6 >35mm is suggestive of LVH
    27. 27. Q waves Q waves are allowed in V1, aVR & III Pathological Q waves can indicate previous MI
    28. 28. ECG interpretationQuality of ECG?RateRhythmAxisP wavePR intervalQRS durationQRS morphologyAbnormal Q wavesST segmentT waveQT interval
    29. 29. ST segment ST depression - downsloping or horizontal =ABNORMAL ST elevation - infarction - pericarditis (widespread)
    30. 30. ST segment
    31. 31. ST segment
    32. 32. ST segment
    33. 33. T wave Small = hypokalaemia Tall = hyperkalaemia Inverted/biphasic = ischaemia/previousinfarct
    34. 34. T wave
    35. 35. T wave
    36. 36. T wave
    37. 37. QT interval Start of QRS to end of T wave Needs to be corrected for HR Normal QTc = < 400ms Long QT can be genetic or iatrogenic
    38. 38. QT interval
    39. 39. ECG quiz
    40. 40. ECG 1
    41. 41. ECG 2
    42. 42. ECG 3
    43. 43. ECG 4
    44. 44. Any questions?
    45. 45. Summary Discussed the indications for performing an ECG Introduced an approach to interpreting ECGs Discussed common ECG abnormalities

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