Upcoming SlideShare
×

# 8 morphology of qrs

1,533 views

Published on

1 Like
Statistics
Notes
• Full Name
Comment goes here.

Are you sure you want to Yes No
• Be the first to comment

Views
Total views
1,533
On SlideShare
0
From Embeds
0
Number of Embeds
7
Actions
Shares
0
76
0
Likes
1
Embeds 0
No embeds

No notes for slide

### 8 morphology of qrs

2. 2. QRS ComplexThe morphology of the QRS complex willassist us in identifying BBBs, V-tach, LVH, RVH, and infarction.
3. 3. QRS Complex • Height & Morphology will vary, depending on the lead. • Normal Width – > 0.10 seconds – < 0.12 seconds
4. 4. Bundle Branches
5. 5. Bundle Branch Blocks• Right Bundle Branch Block (RBBB) – The single right fascicle is blocked.• Left Bundle Branch Block (LBBB) – Both left fascicles are blocked.• Non-Specific Intraventricular conduction delay (IVCD) – BBB that doesn’t meet RBBB or LBBB criteria.
6. 6. Bundle Branch Blocks• May mimic an MI• The side that is blocked conducts last and takes longer.
7. 7. Bundle Branch Blocks Mean vector• Normal conduction 4 Cardiac vector without a block. 1 3 3 2 2
8. 8. Right Bundle Branch Block + + A B A + BMean vector moves towards positive electrode = positive QRSMean vector moves away from positive electrode = negative QRSMean vector is perpendicular to positive electrode = equiphasic QRS
9. 9. Bundle Branch Blocks • With a RBBB, the right fascicle is blocked, so the left ventricle is1 conducted first and 2 then the impulse 3 returns to the right.
10. 10. Bundle Branch Blocks • With a LBBB, the right ventricle is conducted first, and the impulse1 travels back to the 2 left. 3
11. 11. Bundle Branch BlocksV1
12. 12. Bundle Branch Blocks V1 J-PointsThe J-point is the exact point where the QRS ends
13. 13. Bundle Branch BlocksV1
14. 14. Bundle Branch BlocksV1
15. 15. Bundle Branch BlocksV1
16. 16. Bundle Branch BlocksV1 = RBBBV1 = LBBB
17. 17. Bundle Branch BlocksV1 LBBB RBBB
18. 18. Right Bundle Branch Block • RBBB morphologiesV1
19. 19. Right Bundle Branch Block
20. 20. Left Bundle Branch Block V1
21. 21. Left Bundle Branch Block
22. 22. Intraventricular Conduction Delay• A Non-specific IVCD is less common than a RBBB or LBBB• They are wide, atrial rhythms that usually look like a left or right BBB in V1, but do not match the criteria in I & V6.
23. 23. Ventricular Enlargement• Left Ventricular Hypertrophy (LVH) – The left ventricle is enlarged – Probably due to left-sided heart failure• Right Ventricular Hypertrophy (RVH) – The right ventricle is enlarged – Probably due to right sided heart failure – May be due to pulmonary disease
24. 24. Ventricular Enlargement• Left Ventricular Hypertrophy (LVH) – May cause left axis deviation – May cause a left ventricular strain pattern • Often mimics an anterior MI• Right Ventricular Hypertrophy (RVH) – May cause right axis deviation – May cause a right ventrcular strain pattern • May mimic a inferior or posterior wall MI
25. 25. LVHNormal LVH RV LV Hypertrophy
26. 26. LVHLVH Criteria – Large QRS complexes • Deepest S-wave in V1 or V2 • Tallest R-wave in V5 or V6 – Add them together » If the result is > 25mm = LVH
27. 27. LVH V5 or V6V1 or V2 S + R
28. 28. LVHLets take a look at an example
29. 29. LVHLets take a look at an example
30. 30. LVHLets take a look at an example
31. 31. LVHLets take a look at an example 14mm
32. 32. LVHLets take a look at an example 14mm
33. 33. LVH14 + 15 = 29mm 14mm 15mm
34. 34. LVH• Since our total was 29mm, and a total of > 25mm meets LVH criteria, we can assume that this ECG is that of a patient with LVH.*LVH may look a lot like a narrow LBBB.
35. 35. LVH • A wave that is too tall or deep may be cut off by the monitor • This is a indicator of hypertrophy
36. 36. LVH • A wave that is too tall or deep may be cut off by the monitor • This is a indicator of hypertrophy
37. 37. LVHAdditional LVH Criteria Any precordial > 45mm lead aVL > 11mm Lead I > 12mm aVF > 20mm