Project: Ghana Emergency Medicine Collaborative
Document Title: Cardiology – EKG Interpretation
Author(s): Patrick Carter ...
Attribution Key
for more information see: http://open.umich.edu/wiki/AttributionPolicy

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•  P wave: the sequential activation
(depolarization) of the right and left atria
•  QRS complex:...
5@<"=2*'+"2>4"?>7'3*26+"
•  U wave: origin for this wave is not clear - but
probably represents "after depolarizations" in...
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•  QT interval: duration of ventricular depolarization
and repolarization
•  RR interval: duratio...
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A.  Anterior Infarction
A.  V1,V2,V3,V4
B.  Left Anterior Descending (LAD)

B.  La...
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Tachycardia

Narrow Complex

Wide Complex

Regular

ST
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Narrow complex, regular; retrograde P waves
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U waves; Can also see PVCs, ST depression, small T waves

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GEMC - Trauma - Cardiology and EKG Interpretation - for Medical Students

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This is a lecture by Dr. Patrick Carter from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.

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GEMC - Trauma - Cardiology and EKG Interpretation - for Medical Students

  1. 1. Project: Ghana Emergency Medicine Collaborative Document Title: Cardiology – EKG Interpretation Author(s): Patrick Carter (University of Michigan), MD 2012 License: Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/ We have reviewed this material in accordance with U.S. Copyright Law and have tried to maximize your ability to use, share, and adapt it. These lectures have been modified in the process of making a publicly shareable version. The citation key on the following slide provides information about how you may share and adapt this material. Copyright holders of content included in this material should contact open.michigan@umich.edu with any questions, corrections, or clarification regarding the use of content. For more information about how to cite these materials visit http://open.umich.edu/privacy-and-terms-use. Any medical information in this material is intended to inform and educate and is not a tool for self-diagnosis or a replacement for medical evaluation, advice, diagnosis or treatment by a healthcare professional. Please speak to your physician if you have questions about your medical condition. Viewer discretion is advised: Some medical content is graphic and may not be suitable for all viewers. !"
  2. 2. Attribution Key for more information see: http://open.umich.edu/wiki/AttributionPolicy Use + Share + Adapt { Content the copyright holder, author, or law permits you to use, share and adapt. } Public Domain – Government: Works that are produced by the U.S. Government. (17 USC § 105) Public Domain – Expired: Works that are no longer protected due to an expired copyright term. Public Domain – Self Dedicated: Works that a copyright holder has dedicated to the public domain. Creative Commons – Zero Waiver Creative Commons – Attribution License Creative Commons – Attribution Share Alike License Creative Commons – Attribution Noncommercial License Creative Commons – Attribution Noncommercial Share Alike License GNU – Free Documentation License Make Your Own Assessment { Content Open.Michigan believes can be used, shared, and adapted because it is ineligible for copyright. } Public Domain – Ineligible: Works that are ineligible for copyright protection in the U.S. (17 USC § 102(b)) *laws in your jurisdiction may differ { Content Open.Michigan has used under a Fair Use determination. } Fair Use: Use of works that is determined to be Fair consistent with the U.S. Copyright Act. (17 USC § 107) *laws in your jurisdiction may differ Our determination DOES NOT mean that all uses of this 3rd-party content are Fair Uses and we DO NOT guarantee that your use of the content is Fair. #" To use this content you should do your own independent analysis to determine whether or not your use will be Fair.
  3. 3. $%&'()*'+" •  ,'*-'."/0"1234-2("56'(73/89:+-/6/;:" •  51<"=2*'+"2>4"?>7'3*26+" •  5@<"A'24+B"A-C%D"E>7'3-/3"2>4"EF;C'>7'4" A'24+" •  G9'"H2+-(+"/0"5@<"?>7'383'72)/>" •  5I2C86'"12+'+" J"
  4. 4. 1234-2("56'(73/89:+-/6/;:" Madhero88, Wikimedia Commons K"
  5. 5. 5@<"=2*'+"2>4"?>7'3*26+" Skvalen, Wikimedia Commons L"
  6. 6. 5@<"=2*'+"2>4"?>7'3*26+" •  P wave: the sequential activation (depolarization) of the right and left atria •  QRS complex: right and left ventricular depolarization (normally the ventricles are activated simultaneously) •  ST-T wave: ventricular repolarization M"
  7. 7. 5@<"=2*'+"2>4"?>7'3*26+" •  U wave: origin for this wave is not clear - but probably represents "after depolarizations" in the ventricles •  PR interval: time interval from onset of atrial depolarization (P wave) to onset of ventricular depolarization (QRS complex) •  QRS duration: duration of ventricular muscle depolarization N"
  8. 8. 5@<"=2*'+"2>4"?>7'3*26+" •  QT interval: duration of ventricular depolarization and repolarization •  RR interval: duration of ventricular cardiac cycle (an indicator of ventricular rate) •  PP interval: duration of atrial cycle (an indicator or atrial rate) O"
  9. 9. P/3C26"?>7'3*26+" •  Q," –  RS#R"+'("T6'++"792>"/>'" 623;'"%/IU" •  V,W" –  RSRO"X"RS!R"+'("T!Y#"+C266" %/I'+U" •  VG" –  KLR"C+"->"C'>D"KMR"C+"->" ./C'>" –  H2+'4"/>"+'I"Z"9'237"327'" –  [260"79'",Y,"->7'3*26".-79" >/3C26"[," " Agateller, Wikimedia Commons
  10. 10. W72>4234"A-C%"A'24+" Kychot, Wikimedia Commons !R"
  11. 11. E>7'3-/3"A-C%"A'24+" •  ]!B"3-;97"K79"->7'3(/+726"+82('" •  "]#B"6'^"K79"->7'3(/+726"+82('" •  "]JB"9260.2:"%'7.''>"]#"2>4" ]K" •  "]KB"6'^"L79"->7'3(/+726"+82('D" C-4Y(62*-(F623"6->'" •  "]LB"9/3-_/>726"7/"]KD"2>7'3-/3" 2I-6623:"6->'" •  "]MB"9/3-_/>726"7/"]LD"C-4Y 2I-6623:"6->'" Mikael Häggström, Wikimedia Commons !!"
  12. 12. H-8/623"2>4"EF;C'>7'4"A'24+" Adnav, Wikimedia Commons !#"
  13. 13. G9'"H2+-(+"/0"5@<"?>7'383'72)/>" •  ,27'" •  ,9:79C" •  EI-+" •  E]"H6/(`+"2>4"?>7'3*26+" •  HF>46'"H32>(9"H6/(`+" •  [:8'373/89:" •  ?>023()/>Z?+(9'C-2" !J"
  14. 14. ,27'" •  W->F+",9:79C"a"WE"P/4'"b-+(923;'" –  MRY!RRZC->" –  $*'343-*'"WF883'++'+"EF7/C2)(-7:"c/(-" •  [,"d"!RR"a"G2(9:(234-2" •  [,"e"MR"a"H324:(234-2" •  EF7/C2)(-7:"c/(-" –  E73-2"MRYORZC->" –  E]"fF>()/>"KRYORZC->" –  ]'>73-(6'+"#RYKRZC->" !K"
  15. 15. ,27'"?>7'383'72)/>" Source Undetermined !L"
  16. 16. ,9:79C" •  W->F+",9:79C" –  $3-;->2)>;"03/C"WE" >/4'" –  Q".2*'"%'0/3'" '*'3:"V,W" –  Q".2*'"->"+2C'" 4-3'()/>"2+"V,W" Skvalen, Wikimedia Commons !M"
  17. 17. !"#$%&'()*+,'-./0.$' Source Undetermined ()*+,'1#%2/3%#2)%' Source Undetermined ()*+,'4%3./3%#2)%' Source Undetermined !N"
  18. 18. EI-+"?>7'383'72)/>" !  Represents the overall direction of the heart’s activity !  Axis of –30 to +90 degrees is normal !O"
  19. 19. G9'"VF2432>7"E883/2(9" •  V,W"F8"->"?"2>4"F8"->"2]c"a"P/3C26" !"
  20. 20. E73-/*'>73-(F623"H6/(`+" •  E]"%6/(`+" –  c-3+7"4';3''"%6/(`""" •  Q,"->7'3*26"gI'4"2>4"d"RS#"+'("" –  W'(/>4"4';3''"%6/(`D"h/%-7_"7:8'"!""T='>`'%2(9U" •  Q,";324F266:"6'>;79'>'4D"79'>"43/8"V,W"" –  W'(/>4"4';3''"%6/(`D"h/%-7_"7:8'"#""" •  Q,"gI'4D"%F7"43/8"V,W"32>4/C6:" –  G:8'"J"%6/(`"" •  Q,"2>4"V,W"4-++/(-27'4" #R"
  21. 21. +7"b';3''"E]"H6/(`" ! Source Undetermined #!"
  22. 22. >4"b';3''"E]"H6/(`" # 5"6)07'4/89':';<9*=96%3.>' Source Undetermined 5"6)07'4/89'::' Source Undetermined ##"
  23. 23. J34"b';3''"E]"H6/(`"T1/C86'7'" ['237"H6/(`U" Source Undetermined #J"
  24. 24. Q3/6/>;'4"VG" •  P/3C26"" –  h'>"KLRC+" –  =/C'>""KMRC+" •  1/33'(7'4"VG"TVG(U"126(F62)/>" –  VGCZiT,Y,U" •  12F+'+" –  –  –  –  –  –  b3F;+"TP2"(92>>'6"%6/(`'3+U" [:8/(26('C-2D"9:8/C2;>'+'C-2D"9:8/`26'C-2" [:8/79'3C-2"" E(F7'"h:/(234-26"?>023()/>" 1/>;'>-726" ?>(3'2+'4"?>732(32>-26"Q3'++F3'" #K"
  25. 25. HF>46'"H32>(9"H6/(`+" •  A'^"HF>46'"H32>(9"H6/(`" –  h/>/892+-(",".2*'"->"?"2>4"]MD"V,W"d"RS!#"+'(" –  A/++"/0",".2*'"->"83'(/34-26"6'24+" –  V,W"G".2*'"4-+(/342>('"?D"]!D"]M" –  1/>+-4'3"(234-2("-+(9'C-2"-0"2">'."g>4->;" •  ,-;97"HF>46'"H32>(9"H6/(`" –  ]!B",W,"83-C'"82j'3>".-79"->*'37'4"G".2*'" –  ]MB"=-4'"4''8"+6F33'4"W".2*'"" #L"
  26. 26. Source Undetermined Source Undetermined #M"
  27. 27. Source Undetermined #N"
  28. 28. Source Undetermined Source Undetermined #O"
  29. 29. Source Undetermined #"
  30. 30. [:8'373/89:" !  A'^"]'>73-(F623"[:8'373/89:"13-7'3-2B"" !  E44"79'"623;'3"W".2*'"/0"]!"/3"]#"->"CCD"7/"79'"623;'3",".2*'"/0" ]L"/3"]MS"" !  WFC"-+"d"JLCC"a"A][" Source Undetermined JR"
  31. 31. ?+(9'C-2" •  k+F266:"->4-(27'4"%:"WG"(92>;'+" – 56'*2)/>"a"E(F7'"->023()/>" – b'83'++-/>"a"?+(9'C-2" •  12>"C2>-0'+7"2+"G".2*'"(92>;'+" •  ,'C/7'"-+(9'C-2"+9/.>"%:"V".2*'+" " J!"
  32. 32. 5*/6F)/>"/0"h:/(234-26"?+(9'C-2" The cat, Wikimedia Commons J#" Displaced, Wikimedia Commons
  33. 33. 1/3/>23:"H6//4"WF886:" Patrick J. Lynch, Wikimedia Commons JJ"
  34. 34. 19232(7'3-+)(+"/0"2"h:/(234-26"?>023(7" A.  Anterior Infarction A.  V1,V2,V3,V4 B.  Left Anterior Descending (LAD) B.  Lateral Infarction A.  I, AVL B.  Circumflex branch of Left Coronary Artery C.  Posterior Infarction A.  Depression in V1,V2,V3 B.  Right Coronary C.  Provides blood supply to SA Node, AV Node, His Bundle D.  Inferior Infarction A.  II, III, AVF B.  Right or Left Coronary A.  Most Commonly Right Coronary JK"
  35. 35. ?@A((:?'?A-B:A?'?A(C'CDA5E@C(' JL"
  36. 36. 12+'"l"!" •  #":Z/"C26'"83'+'>7+".-79"(9-'0"(/C862->7"/0" m19'+7"82->n" –  W9238"(9'+7"82->"6/(26-_'4"7/"+F%Y+7'3>26"3';-/>" –  Q6'F3-)("Y"./3+'".Z"4''8"%3'279->;D">/"324-2)/>" –  E++/(-27'4".-79"+9/37>'++"/0"%3'279" –  P/">2F+'2"/3"4-289/3'+-+" –  ,'('>7"6/.Y;324'"0'*'3D"(9-66+" –  P/"2%4/C->26"82->D"*/C-)>;D"4-2339'2" JM"
  37. 37. 12+'"l"!" •  Q9:+-(26"5I2C" –  G"a"JOS#D"Qa!RRD"HQ"a"!!LZNLD",,"a"!#D"W2$#"a"Oo" –  <5P5,EAB""Ep$"I"JD"PEb" –  [55PGB"P1ZEGD"Q5,,AD"5$h?D"$Q"16'23" –  P51@B"WF886'D"P/"AEb" –  [5E,GB",,,D"P/"hF3CF3+D"<266/8+" –  AkP<WB"1GE"%-627'3266:" –  EHbB"W/^D"PbD"PGD"P/"C2++'+" –  5qGB"==QD"#p"QF6+'+" –  P5k,$B"Ep$"I"JD"P/"0/(26"P'F3/"b'g(-7+" JN"
  38. 38. Source Undetermined JO"
  39. 39. Source Undetermined J"
  40. 40. Q'3-(234-)+" •  5@<"c->4->;+" – b-rF+'"1/>(2*'"WG"56'*2)/>" – 1/>(/342>7"G".2*'"(92>;'+".Z"WG" +';C'>7" – WG"b'83'++-/>"->"2],D"]!" – Q,"b'83'++-/>" – P/",'(-83/(26"192>;'+" KR"
  41. 41. 12+'"l"#" •  KM":Z/"C26'"83'+'>7+".-79"11"/0"W:>(/8'" –  Q2)'>7"3'8/37+"9'".2+"+72>4->;"27"+->`"->"`-7(9'>"2>4"0'67" 6-;979'24'4" –  Q2)'>7">/7'4"(9'+7"83'++F3'"2>4");97>'++"->"+F%Y+7'3>26"3';-/>" –  P/"324-2)/>S"P/">2F+'2"/3"4-289/3'+-+S" –  Q2)'>7"82++'4"/F7"2>4"A$1"I"#"C->S"P/"+'-_F3'"2()*-7:S" –  Q2)'>7"(/>)>F'+"7/">/7'"+9/37>'++"/0"%3'279D"6-;979'24'4>'++"2>4" >'23"+:>(/826"+'>+2)/>" •  Q2+7"h'4-(26"[-+7/3:B"b-2%'7'+D"1/3/>23:"E37'3:"b-+'2+'D"h:/(234-26" ?>023()/>" •  h'4+B"E+8-3->D"Q62*-ID"h'7/83/6/6D"A-8-7/3" •  E66'3;-'+B"P@bE" •  W[B"p"WC/`'3D"P/"5G$[D"P/"?]bk" K!"
  42. 42. 12+'"l"#" •  Q9:+-(26"5I2C" –  ]WB"GaJNSMD"Q"a"JRD"HQ"a"OLZKLD",,"a"!#D"$#"+27"a"No" –  <5PB"b3/.+:D">/"3'+8-327/3:"4-+73'++" –  [55PGB"P1ZEGD"Q5,,AD"5$h?D"$Q"16'23" –  P51@B"WF886'D"P/"AEb" –  [5E,GB"H324:(234-(D"3';F623D"P/"hF3CF3+" –  AkP<WB"1GE"%Z6S"P/"=9''_'+Z,26'+S" –  EHbB"HWpD"W/^D"PGD"PbD">/"C2++'+" –  5qGB"G93'24:"8F6+'+D">/"(:2>/+-+S"P/"'4'C2S" –  P5k,$B"b3/.+:S"P/"0/(26"4'g(-7+S" K#"
  43. 43. Source Undetermined KJ"
  44. 44. Source Undetermined KK"
  45. 45. 1/C86'7'"['237"H6/(`" •  1/C86'7'"4-++/(-2)/>"/0"273-26"2>4" *'>73-(F623"2()*-7:" •  ,'+F67+"03/C"(/>4F()/>"%6/(`"" –  A'*'6"/0"79'"E]">/4'" –  HF>46'"/0"[-+" –  QF3`->&'"g%'3+" •  G3'27C'>7" –  E73/8->'"" •  k+'"12F)/F+6:"->"82)'>7+".Z"h?"2>4".-4'"V,W" (/C86'I'+" –  G32>+(F72>'/F+"Q2(->;" –  G32>+*'>/F+"Q2(->;" KL"
  46. 46. CFG'E-A?4:?C' KM"
  47. 47. b-r'3'>)26"b-2;>/+-+"/0"G2(9:(234-2" Tachycardia Narrow Complex Wide Complex Regular ST SVT Atrial flutter ST w/ aberrancy Irregular SVT w/ aberrancy VT A-fib w/ aberrancy A-fib A-flutter w/ variable A-fib w/ WPW conduction VT MAT KN"
  48. 48. Source Undetermined KO"
  49. 49. E73-26"c6Fj'3" Source Undetermined K"
  50. 50. Source Undetermined LR"
  51. 51. E73-26"c-%3-662)/>" Source Undetermined L!"
  52. 52. Source Undetermined L#"
  53. 53. =-4'"1/C86'I"G2(9:(234-2" •  b-r'3'>)26"b-2;>/+-+" –  ]'>73-(F623"G2(9:(234-2" –  W]G".-79"E%'332>(:" LJ"
  54. 54. Source Undetermined LK"
  55. 55. WF832*'>73-(F623"G2(9:(234-2" Retrograde P waves Narrow complex, regular; retrograde P waves Source Undetermined LL"
  56. 56. Source Undetermined LM"
  57. 57. A4-:A@'H@I44C-'<:4J'KA-:A1@C' 1@L?F' LN"
  58. 58. Source Undetermined LO"
  59. 59. A!4C-L(CE4A@'5ML?A-B:A@' :!HA-?4:L!' L"
  60. 60. Source Undetermined MR"
  61. 61. :!HC-:L-'EL(4C-:L-'5ML?A-B:A@' :!HA-?4:L!' M!"
  62. 62. Source Undetermined M#"
  63. 63. 5A((:KC'A5:NNNN' MJ"
  64. 64. Source Undetermined Source Undetermined MK"
  65. 65. EL@M5L-EJ:?'KC!4-:?I@A-' 4A?JM?A-B:A' 4L-(ABC('BC'EL:!4C(' ML"
  66. 66. Source Undetermined MM"
  67. 67. KC!4-:?I@A-'H:1-:@@A4:L!' MN"
  68. 68. Source Undetermined MO"
  69. 69. Th/+7"A-`'6:D"h/>/C/893-("]'>73-(F623"G2(9:(234-2U" <:BC'?L5E@CD'4A?JM?A-B:A' M"
  70. 70. Source Undetermined NR"
  71. 71. (K4'<:4J'(:G!('LH'-A4C' BCEC!BC!4':(?JC5:A' N!"
  72. 72. [:8/`26'C-2" U waves; Can also see PVCs, ST depression, small T waves Source Undetermined N#"
  73. 73. [:8'3`26'C-2" Tall, narrow and symmetric T waves Source Undetermined NJ"
  74. 74. VF'+)/>+s" Dkscully, Flickr NK"

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