This document provides an overview of common chest x-rays and electrocardiograms (ECGs). It discusses how to read ECGs, including assessing heart rate, rhythm, intervals, axis, and signs of chamber enlargement or blocks. Common arrhythmias like SVT, VT, atrial flutter are described. Chest x-ray findings for conditions like consolidation, atelectasis, pleural effusion, pneumothorax, pulmonary edema, emphysema, lung tumors and pneumonia are also reviewed. The document aims to equip readers with the basics of interpreting these common diagnostic imaging tests.

1. Common chest X-rays
and common ECGs
Maryam Majid Al Ezairej
Collage of medicine
RAKMHSU

2. ECG

3. Electrocardiogram
Tracing of heart Tracing of heart’s electrical activity s electrical activity

4. 12-leads ECG

6.  Check
 Name
 DoB
 time and date
 Indication
 Any previous or subsequent ECGs
 Is it part of a serial ECG sequence? In which case it may be numbered

9. rate
 HR of 60-100 per minute is normal
 HR > 100 = tachycardia
 HR < 60 = bradycardia

10. Rhythm
 Sinus
 Originating from SA node
 P wave before every QRS
 P wave in same direction as QRS

11. intervals
 PR
 0.20 sec (3-5)
 QRS
 0.08 – 0.10 sec (2.5)
 QT
 450 ms in men, 460 ms in women
 Based on sex / heart rate
 Half the R-R interval with normal HR

12. axis

13.  Left axis deviation:

14.  Right axis deviation

15. Chamber enlargement

16. atria

18. ventricles

20. RVH

21. Heart blocks

23. First degree AV block
 PR is fixed and longer than 0.2 sec

24. second degree block type 1 (Wenckebach)

25. second degree block type 2

27. 3rd degree AV block

33. SVT
 Reentrant arrhythmia at AV node that is spontaneous in onset
 May have neck fullness, hypotension and/or polyuria due to ANP
 Narrow QRS with tachycardia
 First line is vagal maneuvers
 Second line is adenosine or verapamil
 For chronic SVT, class 1A or 1C or amiodarone or sotalol work well
 Ablation will cure it too, but we usually do this only in young patients

34. Narrow complex, regular; retrograde P
waves, rate <220

35. VT
 Impulse is initiated from the ventricle itself
 Wide QRS, Rate is 140-250
 If unstable DC cardiovert
 If not, IV Amiodarone and/or DCCV
 Consider procainamide
 Nonsustained ventricular tachycardia needs no treatment

36. Ventricular fibrillation
 Most common in acute MI, also drug overdose, anesthesia, hypothermia &
electric shock can precipitate
 Absence of ventricular complexes
 Usually terminal event
 Use Amiodarone if refractory to DCCV.

37. Atrial flutter
 Atrial activity of 240-320 with sawtooth pattern. Usually a 2:1 conduction
pattern; if it is 3:1 or higher, there is AV node damage
 Treatment is to slow AV node conduction with amiodarone, propafenone or
sotalol
 DC cardiovert if <48 hours or unstable
 You can also ablate the reentry pathway within the atrium between the
tricuspid and the IVC.

41. hypokalemia
U waves
Can also see PVCs, ST depression, small T waves

42. hyperkalemia
Tall, narrow and symmetric T waves

43. Differential Diagnosis of Tachycardia

44. Myocardial infarction

48. CHEST XRAY

51. 1-R Atrium
2-R Ventricle
3-Apex of L Ventricle
4-Superior Vena Cava
5-Inferior Vena Cava
6. Tricuspid Valve
7-Pulmonary Valve
8-Pulmonary Trunk
9. R PA 10. L PA

53. consildations
The lung is said to be consolidated when the
alveoli and small airways are filled with
dense material.
This dense material may consist of:
Pus (pneumonia)
Fluid (pulmonary edema)
Blood (pulmonary hemorrhage)
Cells (cancer)

54. Atelectasis
Almost always associated with a linear
increased density due to volume loss
Indirect indications of volume loss include
vascular crowding or mediastinal shift toward
the collapse
Possible observance of hilar elevation with an
upper lobe collapse, or a hilar depression
with a lower lobe collapse

56. Pleural effusion
On an upright film, an effusion will cause blunting on the lateral costophrenic
sulcus and, if large enough, on the posterior costophrenic sulcus.
 Approximately 200 ml of fluid are needed to detect an effusion in a PA film,
while approximately 75 ml of fluid would be visible in the lateral view
In the AP film, an effusion will appear as a graded haze that is denser at the base
A lateral decubitus film is helpful in confirming an effusion as the fluid will
collect on the dependent side

57. A patient with bilateral pleural effusions.
Note the concave menisci blunting both posterior
costophrenic angles.

58. Pneumothorax
 Appears in the chest radiograph as air without lung markings
 In a PA film it is usually seen in the apices since the air rises to the least
dependent part of the chest
 The air is typically found peripheral to the white line of the visceral pleura
 Best demonstrated by an expiration film

62. pulmonary edema
There are two basic types of pulmonary edema:
 Cardiogenic pulmonary edema caused by increased hydrostatic pulmonary
capillary pressure
 Noncardiogenic pulmonary edema caused by either altered capillary
membrane permeability or decreased plasma oncotic pressure

65. Emphysema
Common features seen on the chest radiograph include:
 Hyperinflation with flattening of the diaphragms
 Increased retrosternal space
 Bullae
 Enlargement of PA/RV (cor pulmonale)

66. Hyperlucent lung fields
Multiple blebs
Avascular zones
Prominent pulmonary arteries

70. Lung tumours
 A lung mass will typically present as a lesion with sharp margins and a
homogenous appearance, in contrast to the diffuse appearance of an
infiltrate.

72. Pneumonia
Typical findings on the chest radiograph include:
 Airspace opacity
 Lobar consolidation
 Interstitial opacities

74. thank you 