This document provides information about electrocardiography (ECG) including:
- ECG records and graphs the electrical activity of the heart over time using leads placed on the body. There are 12 standard leads that provide different views of the heart.
- The ECG waveform includes the P wave, QRS complex, T wave, and intervals like the PR interval and ST segment. Each component represents a different phase of the heart's electrical cycle.
- Abnormalities in the waveform can provide clues to diagnose conditions like myocardial infarction, arrhythmias, and electrolyte imbalances. A full ECG analysis examines the rhythm, rate, intervals, and any abnormal waves or segments.
This document discusses the identification and treatment of various cardiac arrhythmias including tachycardias like sinus tachycardia, atrial fibrillation, atrial flutter, multifocal atrial tachycardia, re-entry tachycardia, monomorphic ventricular tachycardia, polymorphic ventricular tachycardia, and ventricular fibrillation. It also discusses bradycardias like premature ventricular contractions, first degree AV block, second degree AV block types 1 and 2, and third degree AV block. For each arrhythmia, the document provides information on characteristics, identification, and treatment approaches.
This document provides an overview of basics of electrocardiography (ECG) including anatomy and physiology of the heart, conduction system of the heart, blood flow through the heart, electrophysiology of the heart, components of the ECG complex, how to analyze rhythms like normal sinus rhythm and various arrhythmias, diagnosing myocardial infarction using 12-lead ECGs, and distinguishing between ST-elevation and non-ST-elevation myocardial infarctions. The document contains detailed information on interpreting ECGs and using 12-lead ECGs to locate the site of myocardial infarction.
This document provides an overview of electrocardiogram (ECG) interpretation. It discusses the components of ECG complexes and intervals, including the P wave, QRS complex, and T wave. It correlates the ECG tracings with the electrical events in the heart during excitation and recovery. Key points include that the P wave represents atrial depolarization, the QRS complex represents ventricular depolarization, and the T wave represents ventricular recovery. It also discusses normal values for amplitude and duration of the various complexes.
This document provides a basic guide to interpreting electrocardiograms (ECGs). It outlines the key aspects of ECG interpretation including heart rate, rhythm, axis, P waves, PR interval, QRS complex, ST segments, QT interval, and T waves. A systematic approach is recommended over just pattern recognition. The guide defines normal and abnormal findings for each ECG feature and provides example tracings.
The document discusses the conduction system of the heart and components of an electrocardiogram (ECG). It provides descriptions of normal sinus rhythm and several types of heart block, including first, second (Mobitz I and II), and third-degree heart block. Characteristics of the rhythm, rate, P wave, PR interval, and QRS complex are described for each type of block.
Saludos! de parte del Ceipem (Centro de Entrenamiento e instrucción para profesionales en Emergencias Médicas), nuestra misión es brindar al profesional de la salud en un ambiente de simulación( Laboratorio de Simulación ), la oportunidad de adquirir habilidades y destrezas, desarrollar competencias individuales y/o grupales ante emergencias médicas, en los ámbitos pre e intra hospitalarios, contamos con el mejor Staff de profesionales para facilitar su aprendizaje. Cualquier información no dude en consultarnos, 0212 7314967/4063 /info@ceipem.org/ www.ceipem.org y si quieres ver fotos, videos y nuestras actividades ingresa por FACEBOOK en ceipem fundación y estarás en línea directa con nuestra comunidad de alumnos y docentes.
This document discusses the electrocardiogram (ECG) and its components. It begins by describing the myocardial action potential and its phases. It then discusses the pacemaker action potential and ECG waves including the P, QRS, T, and U waves. It explains ECG intervals such as the PR, QT, and ST segments. The document also covers ECG leads, normal values, procedures for recording an ECG, interpreting ECG findings, and clinical applications of the ECG.
The document provides information on measuring and assessing vital signs including temperature, pulse, respirations, and blood pressure. It discusses normal ranges for vital signs and factors that can influence measurements. Proper technique for taking each vital sign is outlined, including use of equipment like thermometers and sphygmomanometers. Key signs of abnormalities are highlighted.
This document discusses the identification and treatment of various cardiac arrhythmias including tachycardias like sinus tachycardia, atrial fibrillation, atrial flutter, multifocal atrial tachycardia, re-entry tachycardia, monomorphic ventricular tachycardia, polymorphic ventricular tachycardia, and ventricular fibrillation. It also discusses bradycardias like premature ventricular contractions, first degree AV block, second degree AV block types 1 and 2, and third degree AV block. For each arrhythmia, the document provides information on characteristics, identification, and treatment approaches.
This document provides an overview of basics of electrocardiography (ECG) including anatomy and physiology of the heart, conduction system of the heart, blood flow through the heart, electrophysiology of the heart, components of the ECG complex, how to analyze rhythms like normal sinus rhythm and various arrhythmias, diagnosing myocardial infarction using 12-lead ECGs, and distinguishing between ST-elevation and non-ST-elevation myocardial infarctions. The document contains detailed information on interpreting ECGs and using 12-lead ECGs to locate the site of myocardial infarction.
This document provides an overview of electrocardiogram (ECG) interpretation. It discusses the components of ECG complexes and intervals, including the P wave, QRS complex, and T wave. It correlates the ECG tracings with the electrical events in the heart during excitation and recovery. Key points include that the P wave represents atrial depolarization, the QRS complex represents ventricular depolarization, and the T wave represents ventricular recovery. It also discusses normal values for amplitude and duration of the various complexes.
This document provides a basic guide to interpreting electrocardiograms (ECGs). It outlines the key aspects of ECG interpretation including heart rate, rhythm, axis, P waves, PR interval, QRS complex, ST segments, QT interval, and T waves. A systematic approach is recommended over just pattern recognition. The guide defines normal and abnormal findings for each ECG feature and provides example tracings.
The document discusses the conduction system of the heart and components of an electrocardiogram (ECG). It provides descriptions of normal sinus rhythm and several types of heart block, including first, second (Mobitz I and II), and third-degree heart block. Characteristics of the rhythm, rate, P wave, PR interval, and QRS complex are described for each type of block.
Saludos! de parte del Ceipem (Centro de Entrenamiento e instrucción para profesionales en Emergencias Médicas), nuestra misión es brindar al profesional de la salud en un ambiente de simulación( Laboratorio de Simulación ), la oportunidad de adquirir habilidades y destrezas, desarrollar competencias individuales y/o grupales ante emergencias médicas, en los ámbitos pre e intra hospitalarios, contamos con el mejor Staff de profesionales para facilitar su aprendizaje. Cualquier información no dude en consultarnos, 0212 7314967/4063 /info@ceipem.org/ www.ceipem.org y si quieres ver fotos, videos y nuestras actividades ingresa por FACEBOOK en ceipem fundación y estarás en línea directa con nuestra comunidad de alumnos y docentes.
This document discusses the electrocardiogram (ECG) and its components. It begins by describing the myocardial action potential and its phases. It then discusses the pacemaker action potential and ECG waves including the P, QRS, T, and U waves. It explains ECG intervals such as the PR, QT, and ST segments. The document also covers ECG leads, normal values, procedures for recording an ECG, interpreting ECG findings, and clinical applications of the ECG.
The document provides information on measuring and assessing vital signs including temperature, pulse, respirations, and blood pressure. It discusses normal ranges for vital signs and factors that can influence measurements. Proper technique for taking each vital sign is outlined, including use of equipment like thermometers and sphygmomanometers. Key signs of abnormalities are highlighted.
Electrophysiologic studies use pacing techniques like programmed electrical stimulation (PES) to evaluate cardiac properties. PES involves pacing the heart with drive trains and extrastimuli to measure refractory periods, conduction dynamics, and induce arrhythmias. Pacing can be unipolar or bipolar, and incremental, decremental, or with extrastimuli. Refractory periods like the effective refractory period and relative refractory period are measured using premature extrastimuli during pacing. These techniques provide important information about normal cardiac function and arrhythmia mechanisms.
Willem Einthoven invented the first practical electrocardiogram (ECG or EKG) in 1903, for which he received the Nobel Prize in Medicine in 1924. The document then provides definitions and objectives for ECG interpretation, characteristics and phases of cardiac action potentials, normal impulse conduction pathways, the leads of ECGs and their placements, mechanical events seen on ECGs like P, QRS, T waves, and intervals, and the pacemakers of the heart. It concludes with explaining the steps for ECG rhythm interpretation and normal sinus rhythm parameters.
1) ST elevation in lead aVR can help differentiate left main coronary artery (LMCA) and proximal left anterior descending artery (LAD) occlusions from other coronary artery disease. ST elevation >1mm in aVR suggests proximal LAD/LMCA occlusion.
2) PR elevation is seen in aVR in inferior atrial infarctions, while PR depression is seen in aVR in anterior atrial infarctions.
3) ST elevation in aVR, along with persistent ST elevation in chest leads and tall R waves in aVR, suggests a left ventricular aneurysm in a patient with an old anterior wall myocardial infarction.
Stepwise interpretation of ECG - #9 no Dx ID 594Anas Nader
This ECG shows a 49-year-old man experiencing severe chest pain for 1 hour who is presenting with an antero-septal injury pattern consistent with an acute myocardial infarction requiring urgent therapy. The ECG shows normal sinus rhythm at 84 beats per minute, a normal PR interval and QRS axis, and no signs of ventricular hypertrophy. It does reveal marked ST elevation in leads V1-V4, confirming the diagnosis of an acute antero-septal infarction.
This document provides an overview of drug therapy for defibrillation and ACLS (Advanced Cardiac Life Support). It discusses the use of defibrillators to treat ventricular fibrillation and tachycardia. It then outlines several drugs used to control heart rate and rhythm such as lidocaine, amiodarone, and adenosine. It also discusses drugs that can improve cardiac output and blood pressure like epinephrine, vasopressin, and norepinephrine. The document provides indications, dosages, and side effects of these core ACLS drugs.
Continue CPR immediately after shock for 2
minutes before reanalysis
Operator: Thank you for the reminder. Yes, CPR should be
resumed immediately after shock delivery for 2 minutes
before reanalysis.
An electrophysiology study involves placing electrode catheters in the heart to assess conduction and induce arrhythmias. It can evaluate conditions like supraventricular tachycardia, ventricular tachycardia, sinus node dysfunction, and conduction abnormalities. The study assesses basic intervals, sinus node function, refractory periods, and the response to atrial and ventricular extra stimuli pacing to determine appropriate therapy. Complications may include vascular or cardiac issues, but the study provides important information to guide treatment of arrhythmias.
This document summarizes an ACLS update and review presentation. It describes a case of a 62-year-old man admitted with back pain who became unresponsive after being given Haldol. His vitals showed bradycardia and hypotension. He received biphasic shocks and regained a pulse but did not follow commands. The presentation reviewed changes to BLS protocols, including performing chest compressions before breaths for lone rescuers and a compression rate of at least 100/min. It also discussed treatment for pulseless arrest, synchronized cardioversion, and amiodarone dosing. The importance of therapeutic hypothermia for unresponsive post-cardiac arrest patients was emphasized.
1. A 65-year-old male presents with syncope and chest pain, with a BP of 70/33 and HR of 128.
2. A 45-year-old woman presents with palpitations, lightheadedness and a HR of 150.
3. A 56-year-old diabetic woman presents with dizziness and chest pain, with a BP of 80/60. Her ECG shows a shockable rhythm.
4. A 40-year-old man is found unconscious with no pulse.
The document defines normal cardiac rhythm and defines cardiac arrhythmia. It discusses the mechanisms of arrhythmia including increased automaticity, triggered automaticity, and reentry. Common types of arrhythmia are described such as sinus rhythms, premature beats, supraventricular arrhythmias, ventricular arrhythmias, and AV junctional blocks. Specific arrhythmias like sinus bradycardia, sinus tachycardia, premature atrial contractions, premature ventricular contractions, atrial fibrillation, atrial flutter, ventricular tachycardia, and ventricular fibrillation are defined.
The document provides descriptions of various cardiac rhythms, conduction abnormalities, myocardial infarctions and other cardiac conditions as assessed by electrocardiogram findings. Key items summarized include descriptions of flutter, fibrillation, supraventricular and atrial tachycardias, bundle branch and fascicular blocks, preexcitation syndromes, degrees of atrioventricular block, signs of acute myocardial infarction in various territories, electrocardiogram patterns associated with electrolyte abnormalities, digoxin effects, cardiomyopathies and other cardiac or pulmonary conditions.
This document outlines an approach for interpreting electrocardiograms (ECGs). It discusses justifying ECG use based on symptoms or exam findings. A structured approach is presented: check quality, rate, rhythm, axis, P wave, PR interval, QRS duration/morphology, ST segment, T wave, QT interval. Abnormal findings are defined, such as ST depression indicating ischemia. The goal is to develop skills in systematic ECG interpretation and identifying common abnormalities.
This document provides guidelines for adult BLS and ACLS. It discusses CPR techniques including compressions at a rate of 100-120 per minute with a depth of 2-4 inches. It also discusses airway management, use of an AED, and monitoring during CPR. The document then summarizes algorithms for pulseless arrest, bradycardia, tachycardia, and acute coronary syndrome. It provides details on the management of different cardiac rhythms and guidelines for prognostication, organ donation, and targeted temperature management after cardiac arrest.
Also known as an electrocardiogram or an EKG, an ECG is a test that detects and records the strength and timing of the electrical activity in your heart. This information is recorded on a graph that shows each phase of the electrical signal as it travels through your heart.
This document summarizes guidelines for emergency medicine training in resuscitation. It discusses adult cardiopulmonary resuscitation, including a focus on high-quality chest compressions. It also reviews the treatment of cardiac arrest, including defibrillation and drug therapy. Additional sections cover bradycardia, tachycardia, cardiac rhythms like atrial fibrillation and flutter, and management approaches.
This document provides an overview of electrocardiography (ECG) and how to interpret an ECG. It discusses the history and importance of ECG, the conduction system of the heart, how ECG leads work, what a normal ECG waveform looks like, how to evaluate rhythm and rate, and how to identify common abnormalities. Key aspects of a normal ECG that are described include the P wave, PR interval, QRS complex, ST segment, T wave, and QT interval. Common abnormalities that can be identified on an ECG include arrhythmias, myocardial infarction, chamber enlargement, and electrolyte imbalances.
The document defines ECG interpretation and provides details on obtaining an ECG, interpreting the waves and intervals, and determining heart rate and rhythm. An ECG records electrical activity in the heart over multiple beats and is interpreted by healthcare professionals. Key aspects covered include placing electrodes to obtain 12-lead ECGs, defining the P wave, QRS complex, and T wave, and intervals like PR and QT. Methods for calculating heart rate from the RR interval and determining regularity of rhythm are also outlined.
The document provides an overview of cardiac conduction systems and ECG interpretation. It describes the normal intrinsic conduction rates of the sinoatrial node, atrioventricular node, and bundle of His. It then details the components of the ECG like the P wave, PR interval, QRS complex, ST segment, and T wave. Various arrhythmias are explained like sinus bradycardia, premature atrial contractions, atrial flutter, atrial fibrillation, and different types of heart block. Methods for calculating heart rate from the ECG are also summarized.
The document provides information about electrocardiography (EKG/ECG). It describes the conduction system of the heart and how electrical signals are conducted to trigger heart contractions. It explains how an EKG works, including electrode placement and what different parts of the EKG waveform represent. It also covers how to interpret an EKG, such as measuring heart rate and identifying abnormalities. Common abnormalities, their causes, and clinical significance are discussed.
Electrophysiologic studies use pacing techniques like programmed electrical stimulation (PES) to evaluate cardiac properties. PES involves pacing the heart with drive trains and extrastimuli to measure refractory periods, conduction dynamics, and induce arrhythmias. Pacing can be unipolar or bipolar, and incremental, decremental, or with extrastimuli. Refractory periods like the effective refractory period and relative refractory period are measured using premature extrastimuli during pacing. These techniques provide important information about normal cardiac function and arrhythmia mechanisms.
Willem Einthoven invented the first practical electrocardiogram (ECG or EKG) in 1903, for which he received the Nobel Prize in Medicine in 1924. The document then provides definitions and objectives for ECG interpretation, characteristics and phases of cardiac action potentials, normal impulse conduction pathways, the leads of ECGs and their placements, mechanical events seen on ECGs like P, QRS, T waves, and intervals, and the pacemakers of the heart. It concludes with explaining the steps for ECG rhythm interpretation and normal sinus rhythm parameters.
1) ST elevation in lead aVR can help differentiate left main coronary artery (LMCA) and proximal left anterior descending artery (LAD) occlusions from other coronary artery disease. ST elevation >1mm in aVR suggests proximal LAD/LMCA occlusion.
2) PR elevation is seen in aVR in inferior atrial infarctions, while PR depression is seen in aVR in anterior atrial infarctions.
3) ST elevation in aVR, along with persistent ST elevation in chest leads and tall R waves in aVR, suggests a left ventricular aneurysm in a patient with an old anterior wall myocardial infarction.
Stepwise interpretation of ECG - #9 no Dx ID 594Anas Nader
This ECG shows a 49-year-old man experiencing severe chest pain for 1 hour who is presenting with an antero-septal injury pattern consistent with an acute myocardial infarction requiring urgent therapy. The ECG shows normal sinus rhythm at 84 beats per minute, a normal PR interval and QRS axis, and no signs of ventricular hypertrophy. It does reveal marked ST elevation in leads V1-V4, confirming the diagnosis of an acute antero-septal infarction.
This document provides an overview of drug therapy for defibrillation and ACLS (Advanced Cardiac Life Support). It discusses the use of defibrillators to treat ventricular fibrillation and tachycardia. It then outlines several drugs used to control heart rate and rhythm such as lidocaine, amiodarone, and adenosine. It also discusses drugs that can improve cardiac output and blood pressure like epinephrine, vasopressin, and norepinephrine. The document provides indications, dosages, and side effects of these core ACLS drugs.
Continue CPR immediately after shock for 2
minutes before reanalysis
Operator: Thank you for the reminder. Yes, CPR should be
resumed immediately after shock delivery for 2 minutes
before reanalysis.
An electrophysiology study involves placing electrode catheters in the heart to assess conduction and induce arrhythmias. It can evaluate conditions like supraventricular tachycardia, ventricular tachycardia, sinus node dysfunction, and conduction abnormalities. The study assesses basic intervals, sinus node function, refractory periods, and the response to atrial and ventricular extra stimuli pacing to determine appropriate therapy. Complications may include vascular or cardiac issues, but the study provides important information to guide treatment of arrhythmias.
This document summarizes an ACLS update and review presentation. It describes a case of a 62-year-old man admitted with back pain who became unresponsive after being given Haldol. His vitals showed bradycardia and hypotension. He received biphasic shocks and regained a pulse but did not follow commands. The presentation reviewed changes to BLS protocols, including performing chest compressions before breaths for lone rescuers and a compression rate of at least 100/min. It also discussed treatment for pulseless arrest, synchronized cardioversion, and amiodarone dosing. The importance of therapeutic hypothermia for unresponsive post-cardiac arrest patients was emphasized.
1. A 65-year-old male presents with syncope and chest pain, with a BP of 70/33 and HR of 128.
2. A 45-year-old woman presents with palpitations, lightheadedness and a HR of 150.
3. A 56-year-old diabetic woman presents with dizziness and chest pain, with a BP of 80/60. Her ECG shows a shockable rhythm.
4. A 40-year-old man is found unconscious with no pulse.
The document defines normal cardiac rhythm and defines cardiac arrhythmia. It discusses the mechanisms of arrhythmia including increased automaticity, triggered automaticity, and reentry. Common types of arrhythmia are described such as sinus rhythms, premature beats, supraventricular arrhythmias, ventricular arrhythmias, and AV junctional blocks. Specific arrhythmias like sinus bradycardia, sinus tachycardia, premature atrial contractions, premature ventricular contractions, atrial fibrillation, atrial flutter, ventricular tachycardia, and ventricular fibrillation are defined.
The document provides descriptions of various cardiac rhythms, conduction abnormalities, myocardial infarctions and other cardiac conditions as assessed by electrocardiogram findings. Key items summarized include descriptions of flutter, fibrillation, supraventricular and atrial tachycardias, bundle branch and fascicular blocks, preexcitation syndromes, degrees of atrioventricular block, signs of acute myocardial infarction in various territories, electrocardiogram patterns associated with electrolyte abnormalities, digoxin effects, cardiomyopathies and other cardiac or pulmonary conditions.
This document outlines an approach for interpreting electrocardiograms (ECGs). It discusses justifying ECG use based on symptoms or exam findings. A structured approach is presented: check quality, rate, rhythm, axis, P wave, PR interval, QRS duration/morphology, ST segment, T wave, QT interval. Abnormal findings are defined, such as ST depression indicating ischemia. The goal is to develop skills in systematic ECG interpretation and identifying common abnormalities.
This document provides guidelines for adult BLS and ACLS. It discusses CPR techniques including compressions at a rate of 100-120 per minute with a depth of 2-4 inches. It also discusses airway management, use of an AED, and monitoring during CPR. The document then summarizes algorithms for pulseless arrest, bradycardia, tachycardia, and acute coronary syndrome. It provides details on the management of different cardiac rhythms and guidelines for prognostication, organ donation, and targeted temperature management after cardiac arrest.
Also known as an electrocardiogram or an EKG, an ECG is a test that detects and records the strength and timing of the electrical activity in your heart. This information is recorded on a graph that shows each phase of the electrical signal as it travels through your heart.
This document summarizes guidelines for emergency medicine training in resuscitation. It discusses adult cardiopulmonary resuscitation, including a focus on high-quality chest compressions. It also reviews the treatment of cardiac arrest, including defibrillation and drug therapy. Additional sections cover bradycardia, tachycardia, cardiac rhythms like atrial fibrillation and flutter, and management approaches.
This document provides an overview of electrocardiography (ECG) and how to interpret an ECG. It discusses the history and importance of ECG, the conduction system of the heart, how ECG leads work, what a normal ECG waveform looks like, how to evaluate rhythm and rate, and how to identify common abnormalities. Key aspects of a normal ECG that are described include the P wave, PR interval, QRS complex, ST segment, T wave, and QT interval. Common abnormalities that can be identified on an ECG include arrhythmias, myocardial infarction, chamber enlargement, and electrolyte imbalances.
The document defines ECG interpretation and provides details on obtaining an ECG, interpreting the waves and intervals, and determining heart rate and rhythm. An ECG records electrical activity in the heart over multiple beats and is interpreted by healthcare professionals. Key aspects covered include placing electrodes to obtain 12-lead ECGs, defining the P wave, QRS complex, and T wave, and intervals like PR and QT. Methods for calculating heart rate from the RR interval and determining regularity of rhythm are also outlined.
The document provides an overview of cardiac conduction systems and ECG interpretation. It describes the normal intrinsic conduction rates of the sinoatrial node, atrioventricular node, and bundle of His. It then details the components of the ECG like the P wave, PR interval, QRS complex, ST segment, and T wave. Various arrhythmias are explained like sinus bradycardia, premature atrial contractions, atrial flutter, atrial fibrillation, and different types of heart block. Methods for calculating heart rate from the ECG are also summarized.
The document provides information about electrocardiography (EKG/ECG). It describes the conduction system of the heart and how electrical signals are conducted to trigger heart contractions. It explains how an EKG works, including electrode placement and what different parts of the EKG waveform represent. It also covers how to interpret an EKG, such as measuring heart rate and identifying abnormalities. Common abnormalities, their causes, and clinical significance are discussed.
Anesthesia related presentation very helpfulMalikArifUllah
This document provides an overview of coronary circulation, electrocardiography, and EKG interpretation. It describes the electrical conduction system of the heart and how it correlates to the EKG waveform. Key aspects of EKG interpretation including rate, rhythms, intervals, and waveform analysis are discussed. Various cardiac arrhythmias that can be lethal if left untreated are also reviewed.
This document provides an overview of ECG interpretation. It discusses the 12 ECG leads and how they view the heart from different angles. It outlines the normal waveform components of an ECG (P, Q, R, S, T, U waves) and how to analyze rhythm, rate, P wave, PR interval, QRS complex, T wave, QT interval, and ST segment. The document also reviews axis deviation, heart block, abnormal rhythms, and conditions that can cause ECG abnormalities like myocardial infarction and electrolyte imbalances.
The electrocardiogram (ECG or EKG) measures and records the electrical activity of the heart. It was developed in 1893 by Willem Einthoven, who received the Nobel Prize for his work. An ECG works by detecting the tiny electrical changes on the skin that occur with each heartbeat. It shows the heart's rate and rhythm, as well as any damage to heart muscle. A standard 12-lead ECG provides multiple views of the heart and can help diagnose conditions like heart attacks.
Electrocardiography: is the recording of the electrical impulses that are generated in the heart. These impulses initiate the contraction of cardiac muscles.
ecg basics made easy, with description of most common ecg types especially in emergency situation.
easy to memorize points and mnemonics included.
approach to ecg diagnosis.
sample ecgs.
crème de la crème basics to understand electrocardiographic analysis in an easy & simple way with some specifications to its use in Emergency medicine/clinical toxicology practice.
This document provides an overview of electrocardiography (ECG) and how to interpret ECG strips in the context of toxicology. It begins by defining the objectives of learning ECG and its importance in toxicology. It then describes the basic components of an ECG including the waves, intervals, complexes, leads, and normal values. The document explains how to assess heart rate and rhythm on an ECG strip. Finally, it demonstrates some common ECG changes that can occur due to toxic exposures, such as sinus tachycardia, sinus bradycardia, and heart block.
The document provides information on ECG interpretation including:
1) It describes the 12 ECG leads and what areas of the heart each views.
2) It outlines the normal ECG waveform components and how to measure intervals like the PR and QT.
3) Key aspects to evaluate include rhythm, rate, P waves, PR interval, QRS complex, T waves, ST segments, and axes.
4) Common rhythm abnormalities like sinus tachycardia and bradycardia are discussed as well as heart block classifications.
The document provides information about electrocardiography (ECG), including its history, how an ECG machine works, how to perform an ECG, electrode placement, the different leads, and how to interpret an ECG. It discusses normal ECG waves and intervals as well as various arrhythmias and abnormalities that can be seen on an ECG. Modern ECG machines produce computerized readings but interpretation should still be done carefully by a medical professional. A proper ECG involves correctly placing the electrodes on the patient's limbs and chest to measure the heart's electrical activity from multiple angles.
This document provides an overview of electrocardiography (ECG) for paramedics and junior medical officers. It discusses the anatomy and physiology underlying the ECG waveform, including the conduction system of the heart and cardiac action potentials. It then describes how to properly perform and interpret a standard 12-lead ECG, defining the various waves, segments, intervals and other components as well as common abnormalities. Factors that can affect the ECG tracing are also reviewed.
This document provides an overview of basic electrocardiography including:
- The objectives of interpreting an EKG
- General principles such as depolarization, repolarization and the cardiac conduction system
- Definitions of key aspects of an EKG such as waves, intervals, leads and normal values
- How to estimate heart rate from an EKG
- Examples of normal sinus rhythm and common rhythm disturbances
The document provides information about electrocardiography (ECG), including its history, how an ECG machine works, how to perform an ECG, and how to interpret various parts of the ECG such as rate, rhythm, cardiac axis, P wave, QRS complex, and ST segment. It discusses normal ECG patterns as well as various arrhythmias and abnormalities that can be detected on an ECG. Standardized procedures and terminology are explained to accurately analyze and understand ECG readings.
The document provides information about electrocardiography (ECG), including its history, how an ECG machine works, how to perform an ECG, and how to interpret various parts of the ECG such as rate, rhythm, cardiac axis, P wave, QRS complex, and ST segment. It discusses normal ECG patterns as well as various arrhythmias and abnormalities that can be detected on an ECG. Standard procedures for performing and interpreting an ECG are outlined step-by-step.
ANAESTHETIC CONSIDERATIONS IN CRF by Dr.Sravani VishnubhatlaDrSravaniVishnubhatl
This document discusses anesthetic considerations for patients with chronic renal failure (CRF). It covers the pathophysiology and stages of CRF, common causes, and manifestations involving hematological, metabolic, cardiovascular, pulmonary, neurological and other systems. It also discusses dietary considerations, preoperative drug therapy, and immunosuppressant drugs commonly used in CRF patients. The role of the anesthetist is to safely manage the surgery and address complications related to the multiple system effects of chronic kidney disease.
Dr. V.Sravani gave a presentation on spinal and epidural anesthesia. She discussed various types of regional anesthesia techniques including spinal, epidural, combined spinal-epidural, and caudal anesthesia. She described the anatomy related to spinal anesthesia including the vertebrae, spinal cord, and meninges. She discussed the indications, contraindications, effects, and techniques for performing spinal anesthesia, including identifying anatomical landmarks, positioning the patient, and inserting the spinal needle. Potential complications were also mentioned.
ANESTHETIC MANAGEMENT OF TRACHEOESOPHAGEAL FISTULA by Dr.Sravani VishnubhatlaDrSravaniVishnubhatl
Learning Objectives:
Review the clinical presentation of a patient with tracheoesophageal fistula (TEF)
Understand the prevalence of TEF, types, and associated syndrome
Discuss the diagnosis of TEF
Describe the medical and surgical management of TEF
Understand the anesthetic-related implications and develop an anesthetic plan
1) COVID-19 is caused by SARS-CoV-2 virus which binds to ACE2 receptors in lungs causing respiratory disease. It has spread globally since emerging in China in late 2019.
2) SARS-CoV-2's structure includes spike, envelope and membrane proteins and it enters cells by binding to ACE2 receptors. It hijacks host cells to replicate and causes immune response.
3) COVID-19 affects multiple organ systems like lungs, heart and blood vessels. In lungs it causes inflammation and ARDS while heart issues relate to ACE2 expression and coagulation changes.
CONGENITAL HEART DISEASE & ANAESTHESIA by Dr.Sravani VishnubhatlaDrSravaniVishnubhatl
1) Congenital heart defects are the most common birth defects, affecting 1 in 125 live births. They range from simple shunt lesions to complex defects involving multiple structures.
2) The anesthetic goals vary depending on the type of shunt (left-to-right vs right-to-left) and aim to balance systemic and pulmonary vascular resistances.
3) Preoperative evaluation and optimization is important. Regional techniques may be used when hemodynamically appropriate but general anesthesia allows better control of ventilation and hemodynamics for high risk surgery.
The document provides a history of anesthesia, covering developments from ancient times through the 20th century. It discusses early non-drug pain management techniques and the discovery of anesthetic agents such as nitrous oxide, ether, and chloroform. Key developments included Morton's public demonstration of ether anesthesia in 1846, the introduction of tracheal intubation in the late 19th century, advances in ventilation equipment and patient monitoring, and the discovery and use of muscle relaxants and intravenous anesthetics. The history shows how anesthesia evolved from simple restraint to a specialized field utilizing various drugs, equipment, and techniques.
This document discusses pacemakers and their management during anesthesia. It begins by describing the components of the heart's conducting system and types of pacemakers. It then discusses indications for pacemakers and implantable cardioverter defibrillators. The key points regarding anesthetic management are to have the device interrogated preoperatively, monitor it closely intraoperatively, and avoid potential electromagnetic interference from devices like electrocautery or defibrillation. Regional anesthesia is usually safe but general anesthesia requires avoiding drugs that could interfere with pacemaker function.
LIMB GIRDLE DYSTROPHY AND CAESARIAN SECTION by Dr.Sravani VishnubhatlaDrSravaniVishnubhatl
Limb-girdle muscular dystrophy is a genetic disorder characterized by progressive weakness and wasting of the muscles around the pelvic and shoulder girdles. It can be inherited in an autosomal dominant or recessive pattern. While the rate of progression is slow, symptoms worsen over time and include difficulty walking within 20 years. Anesthetic management for surgeries in those with limb-girdle muscular dystrophy aims to prevent respiratory complications and includes careful airway assessment, regional techniques when possible, and postoperative respiratory support. Cesarean sections in those affected may require general anesthesia and postoperative ventilation due to risks of abnormal breathing with neuraxial blockade or vaginal delivery due to weakened muscles.
Histololgy of Female Reproductive System.pptxAyeshaZaid1
Dive into an in-depth exploration of the histological structure of female reproductive system with this comprehensive lecture. Presented by Dr. Ayesha Irfan, Assistant Professor of Anatomy, this presentation covers the Gross anatomy and functional histology of the female reproductive organs. Ideal for students, educators, and anyone interested in medical science, this lecture provides clear explanations, detailed diagrams, and valuable insights into female reproductive system. Enhance your knowledge and understanding of this essential aspect of human biology.
Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...Oleg Kshivets
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1. DR. VISHNUBHATLA SRAVANI (PG)
MD (ANAESTHESIA)
MODERATOR: DR.OMKAR SIR
ECG
Dr.Sravani Vishnubhatla
2. ECG
➢ ECG is define as ‘’ recording of electrical activity of heart
on a graph paper.’’
Or
➢ Graphical representation of electrical activity of heart.
Dr.Sravani Vishnubhatla
3. ECG leads.
➢ leads are electrodes which record the electrical potential of heart at
different sites.
➢ There are 12 ECG leads.
a) 3 bipolar limb leads.
b) 3 augmented limb leads.(unipolar).
c) 6 chest leads.
Dr.Sravani Vishnubhatla
4. Bipolar limb leads.
➢ Lead 1 = left arm + ve , right arm -ve
➢ Lead 2 = right arm -ve ,left leg + ve..
➢ Lead 3 = left arm -ve , left leg +ve.
Dr.Sravani Vishnubhatla
7. Augmented limb leads.
➢ A
VR
➢ AVL
➢ AVF
attach to right arm..
attach to left arm.
attach to left foot.
Dr.Sravani Vishnubhatla
8. The limb electrodes
RA - On the right arm, avoiding thick muscle
LA – On the left arm this time.
RL - On the right leg, lateral calf muscle
LL- On the left leg this time.
The 6 chest electrodes
V1 - Fourth intercostal space, right sternal border.
V2 - Fourth intercostal space, left sternal border.
V3 - Midway between V2 and V4.
V4 - Fifth intercostal space, left midclavicular line.
V5 - Level with V4, left anterior axillary line.
V6 - Level with V4, left mid axillary line.
Electrodes
Usually consist of a conducting gel, embedded
in the middle of a self-adhesive pad onto
which cables clip. Ten electrodes are used for a
12-lead ECG.
Placement of electrodes
Dr.Sravani Vishnubhatla
12. ECG PAPER
➢Recorded as a graph, with time represented
on x axis and voltage on y axis .
➢Divided into grid like boxes .
➢Each of small boxes is 1mm square .
➢Paper moves at a speed of 25 mm / sec
➢So horizontally each unit represents 0.04 sec.
➢1 mv = 10 mm in y axis , so each box is 0.1 mv
Every 5th line is highlighted and darker than
other lines , to define large box ,which consist
of 5 small squares vertically and horizontally .
Dr.Sravani Vishnubhatla
14. ❖P WAVE :denotes atrial depolarization
[electrical vector is directed from the SA node
towards the AV node].
❖QRS COMPLEX : denotes depolaization of
ventricle as well as repolarization of atrium.
❖T WAVE : denotes the repolarization [ or
recovery]of the ventricle.
The interval from the beginning of the QRS
complex to the apex of the T wave is referred
to as the ABSOLUTE REFRACTORY
PERIOD.
The last of the T WAVE is referred to as
the RELATIVE REFRACTORY PERIOD
Dr.Sravani Vishnubhatla
15. P WAVE
➢1st positive deflection.
➢Activation of atria.
➢Normal width / duration : <2.5mm or 3 small squares .
➢+ve → L1 , L2 ,Avf & V2 – V6 .
➢-ve → Avr.
➢Can be Biphasic in V1 or V2 .
Dr.Sravani Vishnubhatla
16. Abnormalities of P wave.
➢ P .pulmonale :- This is tall and peaked P wave in lead 1 and lead 2
and 3 in right atrial hypertrophy. (pulmonary
hypertension).
➢ P. mitrale ;_ It is biphasic or broad P wave seen in left atrial
hypertrophy.(mitral stenosis).
➢ -. Best seen in lead 2.
Dr.Sravani Vishnubhatla
18. Q wave..
➢It is the 1st negative deflection .
➢Represents depolarization of Inter Ventricular Septum , by septal fascicle of
Lt bundle branch.
➢width : <1 mm (0.04 sec)
➢ht : ¼ of R wave in same lead .
Dr.Sravani Vishnubhatla
19. Low voltage QRS complex.
when the height of R or S wave is not more than 5mm… it is seen
in..
➢ Hypothyroidism.
➢ Pericardial effusion.
➢ Thick chest wall.
➢ Problem in ECG machine.
Dr.Sravani Vishnubhatla
20. High voltage QRS complex.
➢ This is present in ventricular hypertrophies.
➢ The maximum voltage of QRS complex may be 35 mv(35 small square).
➢ V1 and V2 show high voltage QRS complex in right ventricular
hypertrophy.( s wave)
➢ V5 and V6 show such QRS complex in left ventricular
hypertrophy. (r wave)
Dr.Sravani Vishnubhatla
22. T wave
➢Represents ventricular repolarization .
➢Same direction as QRS complex .
➢ L2 → always + ve , aVR → always –ve , V4–6 →normally +ve .
➢V1-2 → can be +ve or –ve or isoelectric .
Dr.Sravani Vishnubhatla
23. T wave.
➢ T wave should not be more than one third of R wave.
➢ T wave inversion represent ischemia of heart.
➢ Tall and peaked T wave is present in hyperkalemia.
➢ Flattened T waves in pericarditis and myocarditis.
Dr.Sravani Vishnubhatla
24. U wave
➢Small round , upright wave followed by T wave .
➢In 20–30 % , it is seen .
➢Represents repolarization of purkinje fibers .
➢Also known as wave of late v.repolarization .
➢Mostly seen in slow HR .
Dr.Sravani Vishnubhatla
25. J POINT
➢Also called as J junction .
➢Marks the end of QRS complex and beginning of ST segment .
➢J point , ST segment and T wave represents whole process of v.repolarization
➢V .repolarization starts at j point
Dr.Sravani Vishnubhatla
26. INTERVALS AND SEGMENTS
➢SEGMENT IS A STRAIGHT LINE CONNECTING 2 WAVES .
➢INTERVAL CONSIST OF ATLEAST 1 WAVE PLUS THE CONNECTING
LINE .
Dr.Sravani Vishnubhatla
27. PR segment:
➢Time taken by the AV node to conduct the impulse .
➢Straight line from end of p wave to start of qrs complex .
➢Measures the time from end of atrial depolarization to start of ventricle
depolarization .
PR interval:
➢Measured from beginning of p wave to beginning of qrs complex.
➢Measures the time from start of atrial depolarization to start of v.depolarization .
➢Normal → 3 – 5 mm (0.12 - .20 sec )
Dr.Sravani Vishnubhatla
28. Prolong PR interval.
➢ Prolong PR interval shows delayed conduction from SA to AV node….
➢ In first degree heart , 2nd degree and complete heart block.
➢ Digitalis therapy.
➢ Hyperkalemia.
Dr.Sravani Vishnubhatla
29. ST segment
➢Time gap btwn v.d & v.r .
➢No specific duration , but should be at same level as PR segment .
➢Starts from J point to beginning of T waves .
➢Represents the time when all cells are just depolarized and muscle cells are in
state at sustained contraction .
Dr.Sravani Vishnubhatla
30. ST segment
➢ Elevation . Seen in recent MI and hyperkalemia.
➢ Depression. Seen in ischemia, digitalis therapy and hypokalemia.
Dr.Sravani Vishnubhatla
31. Qt interval
➢Includes QRS complex , ST segment and T wave .
➢Measures the time from begining of v.depolarization to end of v.repolarization .
➢Represents total ventricular activity .
➢Normal → <0.42 sec in men & <0.44 sec in women .
Dr.Sravani Vishnubhatla
33. Arrhythmias Classification
• The arrhythmias are categorizes into two major groups:
• 1.Bradycardias
• 2.Tachycardias.
The tachycardia group is then subdivided into narrow and wide
(broad) QRS complex variants, which are a major focus of ECG differential
diagnosis in acute care medicine and in referrals to cardiologists.
Dr.Sravani Vishnubhatla
34. Bradycardias: Simplified Classification
➢Sinus bradycardia, including sinoatrial block
➢Atrioventricular (AV) junctional (nodal) and ectopic atrial escape
rhythms
➢AV heart block (second- or third-degree) or AV dissociation variants
➢Idioventricular escape rhythm (rule out hyperkalemia)
Dr.Sravani Vishnubhatla
35. Major Tachyarrhythmias: Simplified
Classification
Narrow QRS
Complexes (NCT)
Wide QRS Complexes
(WCT)
Sinus tachycardia Ventricular tachycardia
(Paroxysmal)
supraventricular
tachycardias (PSVTs)*
Supraventricular tachycardia
with aberration/anomalous
conduction caused by:
(a) bundle branch block-type
pattern
(b) Wolff–Parkinson–White
preexcitation with (antegrade)
conduction down the bypass
tract
Atrial flutter
Atrial fibrillation
Dr.Sravani Vishnubhatla
37. ➢ Rhythm:
-regular
-irregular
1.irregularly irregular----AF
2.regularly irregular--sinus arrhythmia,2nd degree heart
block
➢Rate:
If rhythm is regular,
300/no.of big suares b/w 2 consecutive R waves
1500/small suares b/w 2 consecutive R waves
If rhythm is irregular,
no. of R waves in 6 seconds * 10
Dr.Sravani Vishnubhatla
40. Step 1: Determine regularity
➢Look at the R-R distances (using a caliper or markings on a pen or paper).
R R
Dr.Sravani Vishnubhatla
41. Step 2: Calculate Rate
➢Option 1- Count the # of big squares between two R-R interval and divide
300 with that number.
300 / 3 = 100
➢Option 2 - Count the # of small squares between two R-R interval and
divide 1500 with that number.
1500 / 16 = 90
Dr.Sravani Vishnubhatla
42. Step 3: Assess the P waves
➢Are there P waves?
➢Do the P waves all look alike?
➢Do the P waves occur at a regular rate?
➢Is there one P wave before each QRS?
Dr.Sravani Vishnubhatla
45. Rhythm Summary
▪ Rate 90-95 bpm
▪ Regularity regular
▪ P waves normal
▪ PR interval 0.12 s
▪ QRS duration 0.08 s
▪ Interpretation?
Normal Sinus Rhythm
Dr.Sravani Vishnubhatla
46. Normal Sinus Rhythm (NSR)
➢Etiology: the electrical impulse is formed in the SA node and
conducted normally.
➢This is the normal rhythm of the heart; other rhythms that do not
conduct via the typical pathway are called arrhythmias.
Dr.Sravani Vishnubhatla
48. Arrhythmia Formation
Arrhythmias can arise from problems in the:
➢Sinus node
➢Atrial cells
➢AV junction
➢Ventricular cells
Dr.Sravani Vishnubhatla
49. SA Node Problems
The SA Node can:
➢fire too slow
➢fire too fast
Sinus Bradycardia
Sinus Tachycardia
Dr.Sravani Vishnubhatla
50. Atrial Cell Problems
Atrial cells can:
➢fire occasionally from a focus
➢fire continuously due to a
looping re-entrant circuit
Premature Atrial Contractions (PACs)
Atrial Flutter
Atrial fibrillation
Dr.Sravani Vishnubhatla
51. AV Junctional Problems
The AV junction can:
➢fire continuously due to a
looping re-entrant circuit
➢ block impulses coming from
the SA Node
Paroxysmal Supraventricular
Tachycardia
AV Junctional Blocks
Dr.Sravani Vishnubhatla
52. Ventricular Cell Problems
Ventricular cells can:
➢fire occasionally from 1 or more
foci
➢fire continuously from multiple
foci
➢fire continuously due to a
looping re-entrant circuit
Premature Ventricular Contractions
(PVCs)
Ventricular Fibrillation
Ventricular Tachycardia
Dr.Sravani Vishnubhatla
55. Remember …
• When an impulse originates anywhere in the atria (SA node, atrial
cells, AV node, Bundle of His) and then is conducted normally
through the ventricles, the QRS will be narrow (0.04 - 0.12 s).
Dr.Sravani Vishnubhatla
63. Rhythm #8
➢ Rate? 60bpm
➢ Regularity? regular
➢ P waves? normal
➢ PR interval? 0.36s
➢ QRS duration? 0.08s
➢ Interpretation? 1st Degree AV Block
Dr.Sravani Vishnubhatla
64. Rhythm #9
➢ Rate? 50bpm
➢ Regularity? Regularly irregular
➢ P waves? nl, but 4th no QRS
➢ PR interval? lengthens
➢ QRS duration? 0.08s
➢ Interpretation? 2nd Degree AV Block, Type I
Dr.Sravani Vishnubhatla
65. 2nd Degree AV Block, Type I
➢Etiology: Each successive atrial impulse encounters a longer and
longer delay in the AV node until one impulse (usually the 3rd or
4th) fails to make it through the AV node. It is otherwise called
“Wenckebach phenomenon”
Dr.Sravani Vishnubhatla
66. Rhythm #10
➢ Rate? 40bpm
➢ Regularity? regular
➢ P waves? nl, 2 of 3 no QRS
➢ PR interval? 0.14s
➢ QRS duration? 0.08s
➢ Interpretation? 2nd Degree AV Block, Type II
Dr.Sravani Vishnubhatla
67. Rhythm #11
Rate? 40bpm
Regularity? regular
P waves? no relation to QRS
PR interval? none
QRS duration? Wide (> 0.12s)
Interpretation? 3rd Degree AV Block
Dr.Sravani Vishnubhatla
68. 3rd Degree AV Block
➢Etiology: There is complete block of conduction in the AV junction,
so the atria and ventricles form impulses independently of each other.
Without impulses from the atria, the ventricles own intrinsic
pacemaker kicks in at around 30 - 45 beats/minute.
Dr.Sravani Vishnubhatla
69. PR-INTERVAL
Wolff–Parkinson–White syndrome
Wolf Parkinson White Syndrome One
beat from a rhythm strip in V2
demonstrating characteristic findings in
WPW syndrome. Note the characteristic
delta wave (above the blue bar), the short
PR interval (red bar) of 0.08 seconds, and
the long QRS complex (green) at 0.12
seconds
Accessory pathway (Bundle of Kent)
allows early activation of the ventricle
(delta wave and short PR interval)
Dr.Sravani Vishnubhatla
71. VENTRICULAR BIGEMINY:
Every other beat is a PVC.
Treatment:
▪ Beta Blockers
▪ Calcium channel Blockers
▪ Anti Arrhythmics
▪ Cardiac Ablation in severe cases who cannot take medication
▪ Cessation of smoking, alcohol and Caffeine
Dr.Sravani Vishnubhatla
72. VENTRICULAR TRIGEMINY:
Every third beat is a PVC.
Treatment:
▪ Beta Blockers
▪ Calcium channel Blockers
▪ Anti Arrhythmics
▪ Cardiac Ablation in severe cases who cannot take medication
▪ Cessation of smoking, alcohol and Caffeine
Dr.Sravani Vishnubhatla
73. Bundle Branch Blocks
With Bundle Branch Blocks you will see two changes on the ECG.
1. QRS complex widens (> 0.12 sec).
2. QRS morphology changes (varies depending on ECG lead, and if
it is a right vs. left bundle branch block).
Dr.Sravani Vishnubhatla
74. Bundle Branch Blocks
Why does the QRS complex widen?
When the conduction pathway is blocked it will
take longer for the electrical signal to pass
throughout the ventricles.
Dr.Sravani Vishnubhatla
75. Right Bundle Branch Blocks
What QRS morphology is characteristic?
V1
For RBBB the wide QRS complex assumes a unique, virtually
diagnostic shape in those leads overlying the right ventricle (V1 and V2).
“Rabbit Ears”
Dr.Sravani Vishnubhatla
77. Left Bundle Branch Blocks
What QRS morphology is characteristic?
For LBBB the wide QRS complex assumes a characteristic change in shape
in those leads the left ventricle (right ventricular leads - V1 and V2).
Broad,
deep S waves
Normal
Dr.Sravani Vishnubhatla
79. LVH VS RVH
LVH
➢Deepest s wave in v1 or v2
+
➢Tallest R wave v5 or v6
➢If total >35mm, then it is
LVH
RVH
➢Right ax is deviation
➢R/S >1 in V1
<1 IN V5 V6
➢R wave in v1 >7mm
Dr.Sravani Vishnubhatla
82. LEFT ANTERIOR FASCICULAR BLOCK/
HEMIBLOCK
ON ECG:
LAD( usually -45 to-90)
qR complexes in lead 1, avL
rS complexes in lead 2 3 avF
PROLONGED R wave
peak time in avL> 45ms
Dr.Sravani Vishnubhatla
83. REFERENCES
➢BASIC AND BEDSIDE ELECTROCARDIIOGRAPHY BY
ROMULO.F.BALTAZAR.
➢ECG MADE WASY BY JOHN R HAMPTON
Dr.Sravani Vishnubhatla