BASICS OF ECG

1. ECG SERIES
A.SASIDHARAN MODERATOR
JUNIOR RESIDENT DR. RAMESH KUMAR
PAEDIATRICS

2. CASE SCENERIO
MASTER SANJEEV 4 YEARS OLD MALE CHILD,
C/O
FEVER x 1 WEEK,LOW GRADE , INTERMITTENT, NOT ASSOC WITH
CHILLS & RIGOR, RELIEVED BY MEDICATIONS,
COUGH AND COLD FOR 1 WEEK
NECK SWELLING FOR 5 DAYS
NO OTHER POSITIVE HISTORY
Immunization history: only birth vaccines given.

3. O/ E :
 Gc fair , afebrile
pr – 81 / min BP- 102/ 50 mm HG
RR – 24 / min temp : 98.4 f
S/E:
Cvs: s1 , s2 heard. No murmur
Rs: b/l AE present . No added sounds
Cns: Nfnd
Pa: soft, non – tender
L/E : membrane present over B/L tonsils.

4. CXR

5. DAY 1 ECG

6. POINTS TO BE REMEMBERED …..
 Standardization
 Heart rate
 Rhythm
 The P-wave amplitude and duration
 The QRS axis
 Intervals: PR, QRS, and QT
 The QRS wave
 ST-segment and T-wave abnormalities

7. STANDARDIZATION

8. Heart rate

9. RHYTHM:
 Sinus rhythm:
 Ventricle depolarisation is controlled by SA node

10. JUNCTIONAL RHYTHM
 Ventricular depolarisation is controlled by AV Node
 Atria and ventricle depolarise simultaneously

11. Types Of Junctional Rhythm

12. Idioventricular rhythm:
 Ventricular depolarisation controlled by pacemaker which is below bundle of his
 Wide QRS will be there

13. p wave
 P wave more reliable lead II
 P wave denotes RA and LA function.
 LA enlargement :
 p wave width > 2.5 mm – p mitrale
 RA ENLARGEMENT:
 P wave height > 2.5 mm known as p pulmonale

14. In our case ???
 Absent p wave

15. PR INTERVAL :
 START OF P WAVE TO START OF QRS COMPLEX
 PR INTERVAL – AV NODE CONDUCTION

16. QRS complex:
 Normal width 0.8 – 0.11 sec

17. Nomenclature of QRS complex

18. Abnormality of QRS complex:
 Rbbb- rabbit ear pattern
 Lbbb – m pattern

19. DAY 2 ECG -LBBB

20. RVH
 Voltage criteria for RVH – R WAVE IN V 1 > 7 MM
 LVH :
 VOLTAGE CRITERIA FOR LVH:
 S WAVE DEPTH IN V1 + R WAVE HEIGHT IN V5 OR V6 > 25MM EQUALS TOTAL
OF > 35 MM

21. AXIS :
 NORMAL QRS AXIS = 0 – 90*
 AXIS DEVIATION :

22. DAY 2 ECG – LEFT AXIS DEVIATION

23. CONCLUSION
 STANDARDISED
 VENTRICULAR RATE – 88 / MIN
 RHYTHM – AV DISSOCIATION WITH VENTRICULAR ESCAPE PROBABLY A
JUNCTIONAL RYTHM
 LEFT AXIS DEVIATION

24. THANK YOU