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ECG for Cardiothoracic Surgeons | IACTS SCORE 2020
- 1. PRASANNA SIMHA MOHAN RAO SJICR BANGALORE ECG FOR THE EXAM-SCORE 2020
- 2. GOAL OF AN ECG • TO BUILD A PICTURE OF THE PATIENT • WHAT IS THE ELECTRICAL CONDUCTION OF THE HEART • CHAMBERS OF THE HEART THAT ARE ENLARGED AND ITS TYPE • SPECIFIC DIAGNOSTIC MORPHOLOGY OF ECG’S • HOW DOES THE ECG DIFFER FROM WHAT PICTURE HAS BEEN DRAWN CLINICALLY AND WRT OTHER INVESTIGATIONS
- 3. STANDARD PROTOCOL FOR AN ECG • STANDARDIZATION AND SPEED • RATE RHYTHM • AXIS • LOOP • P WITH ATRIAL CHAMBER ENLARGEMENT • PR • QRS WITH VENTRICULAR CHAMBER ENLARGEMENT • J POINT ST • T • U • ADDITIONAL THING LIKE QT
- 4. • LOOK AT THE STANDARDIZATION SIGNAL • WHAT IS THE LARGE VERTICAL ARROW EQUAL TO IN A REGULAR ECG ? • WHAT DOES THE SMALL HORIZONTAL VALUE REPRESENT IN A REGULAR ECG • HALF STANDARDIZATION – WHEN IS IT USED ? • HIGHER SPEEDS – WHEN IS IT USED ? SPEED AND STANDARDIZATION
- 5. • WHAT IS ECG SPEED IN A STANDARD ECG • 25MM/SECOND • ONE SMALL SQUARE -40 MICROSEC OR 0.04 SEC • RATEIS DETERMINED BY • ?/ RR INTERVAL -SMALL SQUARE • ? RR INTERVAL/- LARGE SQUARE • HOW IS RATE CALCULATED IN AFIB ? • BRADYCARDIA ? • SCENARIOS – • CONGENITAL HEART DISEASE WITH BRADYCARDIA • IHD WITH BRADYCARDIA • OPCAB BRADYCARDIA • VALVE DISEASE BRADYCARDIA • TACHYCARDIA ? RATE
- 6. • SINUS RHYTHM • HEART BLOCKS RHYTHM
- 7. AXIS • HOW TO CALCULATE THE AXIS ? • RIGHT AXIS / LEFT AXIS • INAPPROPRIATE AXIS • ASD WITH LEFT AXIS ? • TOF WITH LEFT AXIS ? • TOF WITH NORTHWEST AXIS ?
- 8. LOOP • WHAT IS • CLOCKWISE LOOP • ANTICLOCKWISE LOOP • TOF WITH ANTICLOCKWISE LOOP ? • ASD WITH ANTICLOCKWISE LOOP ?
- 9. • ELECTROCARDIOGRAPHIC SEGMENT: : LINE (USUALLY ISOELECTRIC) THAT CONNECTS TWO WAVES WITHOUT INCLUDING EITHER ONE OF THEM. • ELECTROCARDIOGRAPHIC INTERVAL: PORTION OF THE EKG (ECG) THAT INCLUDES A SEGMENT AND ONE OR MORE WAVES. • PR INTERVAL – SURGICAL IMPLICATIONS • QT INTERVAL SURGICAL IMPLICATIONS QT > ½ RR • ST SEGMENT ELEVATION DEPRESSION SURGICAL IMPLICATIONS WHAT IS AN INTERVAL AND WHAT IS A SEGMENT ?
- 10. P WAVE • NEGATIVE TERMINAL DEFLECTION IN LEAD V1 MORE THAN 1MM IN DEPTH • P MITRALE ? • P CONGENITALE/TRICUSPIDALE/PULMONALE • MECHANISM OF P MITRALE • ASD WITH ABNORMAL P WAVE AXIS ? (inverted P wave in lead III) • HIMALAYAN P WAVE
- 11. PR INTERVAL • VALVE DISEASE WITH FIRST DEGREE HEART BLOCK ? • FIRST DEGREE HEART BLOCK AND TACHYCARDIA ? • FEVER ,CARDIAC DISEASE AND HEART BLOCK ? • FEVER WITH INAPPRORIATE TACHYCARDIAAND PROLONGED PR INTERVAL ?
- 12. QRS • NORMAL QRS WIDTH • IRBBB RBBB (rSR’) • LBBB (M pattern) • ASD • WHAT HAPPENS TO IRBBB AFTER SURGERY • WHAT HAPPENS TO SPLIT AFTER SURGERY • TOF – QRS • ABSENCE OF SUDDEN TRANSITION • SINGLE VENTRICLE QRS • SPLINTERED QRS
- 13. Q WAVE • INFARCT Q WAVE /NON INFARCT Q WAVE • Q WAVE – LVVO • Q WAVE LOOP • ECG FEATURES OF AN MI
- 14. ST SEGMENT • ST SEGMENT DEPRESSION • ST SEGMENT ELEVATION • NON INFARCT ST SEGEMENT ELEVATION / DEPRESSION • DIG EFFECT
- 15. T WAVE • TALL T WAVES • HYPOTHERMIA • T WAVE INVERSION ?
- 16. U WAVE • HYPOKALEMIA • THYROTOXIICOSIS • HYPERCALCEMIA • LAD DISEASE IN WIDOW MAKER LESION • DON’T FORGET NORMAL IN THE YOUNG
- 17. SUMMARY • ALWAYS PREDICT ECG BASEDON CLINICAL FINDINGS • WRITE DOWN WHAT ARE THE ECG FINDINGS IN THE GIVEN CASE • FIND OUT WHY THERE IS A DISCORDANCE IF ANY • HOW DO ADDITIONAL INVESTIGATIONS BRING ANY LIGHT TO THIS DISCORDANCE