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.
Biatrial enlargement is diagnosed when criteria for both right and left atrial enlargement are present on the same ECG.
The diagnosis of biatrial enlargement requires criteria for LAE and RAE to be met in either lead II, lead V1 or a combination of leads.
Biatrial enlargement is diagnosed when criteria for both right and left atrial enlargement are present on the same ECG.
The diagnosis of biatrial enlargement requires criteria for LAE and RAE to be met in either lead II, lead V1 or a combination of leads.
Different kind of distance and Statistical DistanceKhulna University
A short brief of distance and statistical distance which is core of multivariate analysis.................you will get here some more simple conception about distances and statistical distance.
An electrocardiogram (ECG or EKG) records the electrical signal from your heart to check for different heart conditions. Electrodes are placed on your chest to record your heart's electrical signals, which cause your heart to beat. The signals are shown as waves on an attached computer monitor or printer
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
263778731218 Abortion Clinic /Pills In Harare ,sisternakatoto
263778731218 Abortion Clinic /Pills In Harare ,ABORTION WOMEN’S CLINIC +27730423979 IN women clinic we believe that every woman should be able to make choices in her pregnancy. Our job is to provide compassionate care, safety,affordable and confidential services. That’s why we have won the trust from all generations of women all over the world. we use non surgical method(Abortion pills) to terminate…Dr.LISA +27730423979women Clinic is committed to providing the highest quality of obstetrical and gynecological care to women of all ages. Our dedicated staff aim to treat each patient and her health concerns with compassion and respect.Our dedicated group ABORTION WOMEN’S CLINIC +27730423979 IN women clinic we believe that every woman should be able to make choices in her pregnancy. Our job is to provide compassionate care, safety,affordable and confidential services. That’s why we have won the trust from all generations of women all over the world. we use non surgical method(Abortion pills) to terminate…Dr.LISA +27730423979women Clinic is committed to providing the highest quality of obstetrical and gynecological care to women of all ages. Our dedicated staff aim to treat each patient and her health concerns with compassion and respect.Our dedicated group of receptionists, nurses, and physicians have worked together as a teamof receptionists, nurses, and physicians have worked together as a team wwww.lisywomensclinic.co.za/
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
Basavarajeeyam is an important text for ayurvedic physician belonging to andhra pradehs. It is a popular compendium in various parts of our country as well as in andhra pradesh. The content of the text was presented in sanskrit and telugu language (Bilingual). One of the most famous book in ayurvedic pharmaceutics and therapeutics. This book contains 25 chapters called as prakaranas. Many rasaoushadis were explained, pioneer of dhatu druti, nadi pareeksha, mutra pareeksha etc. Belongs to the period of 15-16 century. New diseases like upadamsha, phiranga rogas are explained.
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
2. The electrocardiogram (EKG) is a
graphical representation of the
electrical events of the cardiac cycle.
1895 - William Einthoven, credited for
the invention of EKG
1924 - William Einthoven got the Noble
prize for the same
3.
4.
5. SA node is the pacemaker where the electrical
impulse is generated.
Located along the posterior wall of the right
atrium right beneath the opening of the SVC.
It is crescent shaped and about 3 mm wide
and 1 cm long.
The impulse travels from the SA node through
the internodal pathways to the
atrioventricular node (AV node).
6. The AV node is responsible for conduction of
the impulse from the atria to the ventricles.
The impulse is delayed slightly at this point to
allow complete emptying of the atria before
the ventricles contract.
The impulse continues through the AV bundle
and down the left and right bundle branches
of the Purkinje fibers.
8. Turn on machine
Calibrate to 10mm/ mV
Rate at 25mm/ s
Record and print
Label the tracing - Name, DOB, Hospital
number, date and time
9. 10 electrodes in total are placed on the
patient
The 10 leads are lubricated with jelly
then placed over the respective sites
10.
11.
12.
13. Chest leads are labelled “V”(vector) and are
numbered from 1 to 6.
The placement of these electrodes needs to
be exact to give the optimum information.
14. V1 fourth intercostal space, right sternal edge
V2 fourth intercostal space, left sternal edge
V4 at the apex (fifth ICS mid clavicular line)
V3 midway between V2 and V4
V5 same level as V4 but on the anterior
axillary line
V6 same level as V4 and V5 but on the mid
mid-axillary line
15. Electrical impulse (wave of depolarisation) picked up
by placing electrodes on patient
The voltage change is sensed by measuring the
current change across 2 electrodes – a positive
electrode and a negative electrode
If the electrical impulse travels towards the positive
electrode this results in a positive deflection
If the impulse travels away from the positive
electrode this results in a negative deflection
16. P wave: Activation (depolarization) of the
right and left atria
QRS complex: right and left ventricular
depolarization
T wave: ventricular repolarization
17. 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
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 of
atrial rate)
18. Symtoms Palpitation, cyanosis, chest pain, syncope, seizure, poisoning
Signs tachycardia, bradycardia, hypothermia, murmur, Shock
Evaluation of rheumatic heart disease, congenital heart diseases
Evaluation of suspected electrolyte imbalance
Evaluation of cases like drowning, electrocution
During cardiopulmonary resuscitation (CPR).
Evaluation of patients with implanted defibrillators and pacemakers
To detect myocardial injury, ischemia, and the presence of prior
infarction as well.
Effects and side effects of pharmacotherapy
Evaluation of metabolic disorders processes among others.
Contraindications
No absolute contraindications
patient refusal, exist.
patients allergies to adhesive used to affix the leads
19.
20. Limb leads Poles E.g.
Bipolar Positive and
negative poles
I, II, III
Unipolar Positive and zero
poles
aVL, aVR, aVF, chest
leads
25. Horizontally
◦ One small box - 0.04 s
◦ One large box - 0.20 s
Vertically
◦ One large box - 0.5 mV
◦ 25mm = 1s
26. Height 10mm = 1mV
Half standardisation 5mm=1mV
One fourth standardisation 2.5mm= 1mV
(only amplitude is changed not speed)
Paper speed = 25mm/ s
25 mm (25 small squares / 5 large squares)
equals one second
27. If the heart rate is regular
Count the number of large squares
between R waves i. e. the RR interval
in large squares
Rate = 300/RR(no. of large boxes)
= 1500/RR(no. of small boxes)
28. If the rhythm is irregular it may be better to estimate
the rate using the rhythm strip at the bottom of the
ECG (usually lead II)
The rhythm strip is usually 25cm long (250mm i. e.
10 seconds)
Count the number of R waves on that strip and
multiple by 6 you will get the rate
Heart rate
Regular slow 300/RR (large square)
Regular fast 1500/RR (small square)
Irregular R wave in rhythm strip X 6
30. Normal rhythm must have a P wave before each QRS
complex
The easiest way to tell is to take a sheet of paper and
line up one edge with the tips of the R waves on the
rhythm strip.
Mark off on the paper the positions of 3 or 4 R wave
tips
Move the paper along the rhythm strip so that your
first mark lines up with another R wave tip
See if the subsequent R wave tips line up with the
subsequent marks on your paper
If they do line up, the rhythm is regular. If not, the
rhythm is irregular
31. Absent P wave – indicate non sinus rhythm
SA block
AV rhythm (may be present)
Atrial fibrillation
Idioventricular rhythm
Multiple P waves
◦ Atrial flutter
◦ Atrial fibrillation
◦ 2nd ar 3rd degree block
Changing P wave shape
◦ Wandering atrial pacemaker
32.
33. The axis is the overall direction of
the cardiac impulse or wave of
depolarisation of the heart
An abnormal axis (axis deviation)
can give a clue to possible
pathology
43. Right Axis Deviation - Right ventricular hypertrophy,
Anterolateral MI, Left Posterior Hemi-block, COPD,
pulmonary arterial hypertension or large pulmonary
embolism
Left Axis Deviation- Ventricular tachycardia, Left
ventricular hypertrophy, Left Anterior hemi-block
Wolff-Parkinson-White syndrome can cause both
Left and Right axis deviation
44. Normal values
1. up in all leads
except aVR.
2. Duration.
< 2.5 mm.
3. Amplitude.
< 2.5 mm.
Abnormalities
1. Inverted P-wave
Junctional rhythm.
2. Wide P-wave (P- mitrale)
LAE
3. Peaked P-wave (P-
pulmonale)
RAE
4. Saw-tooth appearance
Atrial flutter
5. Absent normal P wave
Atrial fibrillation
45.
46.
47.
48.
49.
50.
51.
52.
53. Definition: the time
interval between
beginning of P-
wave to beginning
of QRS complex.
Normal PR interval
<3yrs – 0.08sec
3-16 yrs – 0.10sec
>16 – 0.12sec
Abnormalities
1. Short PR interval
WPW syndrome
2. Long PR interval
First degree heart
block
56. If the PR interval is constant with a missed
QRS complex: 2nd degree heart block,
Mobitz type II, each QRS followed after P
wave
If there is no relationship between the P
waves and the QRS complexes: 3rd degree
heart block
Block Relation Electrical origin
1st degree Each P has QRS SA node
2nd degree Each QRS has P SA node
3rddegree No Relation Fasciular,Ventricular, or other
57.
58.
59. Q waves <0.04 second.
That’s is less than one small square duration.
Present commonly in I,II,III,aVF, and always
present in V5 and V6 (lateral leads)
Absent in V1
Height < 1/4 of R wave height.
60.
61.
62. The width of the QRS complex should be
less than 0.12 seconds (3 small squares)
Height of R wave is (V1-V6) >8 mm in at
least one of chest leads.
Morphology: progression from Short R and
deep S (rS) in V1 to tall R and short S in V6
(qRs).
63. New born +125
1 month +90
3 years +60
Adult +50
Preterm 0.04s
Full term 0.0.5s
1 -3yrs 0.06s
>3 years 0.07s
Adult 0.08s
65. Abnormally large
deflections (positive
or negative)
◦ Ventricular
hypertrophy
◦ Ventricular
conduction defects
like - BBB,
preexication,artificial
ventricular
pacemaker
Low voltage
complex – limb lead
less than 5mm
◦ Myocarditis
◦ Pericardial effusion
◦ Hypothyroidism
◦ Pericarditis
66.
67. Right axis deviation of +110° or more.
Dominant R wave in V1
Dominant S wave in V5 or V6
Right atrial enlargement (P pulmonale).
Right ventricular strain pattern = ST
depression / T wave inversion in the right
precordial (V1-4) and inferior (II, III, aVF)
leads.
68.
69. Left axis deviation
Increased R wave amplitude in the left-sided ECG leads (I, aVL and
V4-6) and
Increased S wave depth in the right-sided leads (III, aVR, V1-3).
The thickened LV wall leads to prolonged depolarisation and delayed
repolarisation (ST and T-wave abnormalities) in the lateral leads.
Left atrial enlargement (P mitrale).
Left ventricular strain pattern = ST depression / T wave inversion in
the lateral (I, aVL,V5-V6) leads.
70.
71. In RBBB, activation of the right ventricle is delayed as depolarisation
has to spread across the septum from the left ventricle.
The left ventricle is activated normally, meaning that the early part of
the QRS complex is unchanged.
The delayed right ventricular activation produces a secondary R wave
(R’) in the right precordial leads (V1-3) and a wide, slurred S wave in
the lateral leads (V5-6)
Delayed activation of the right ventricle also gives rise to secondary
repolarization abnormalities, with ST depression and T wave inversion
in the right precordial leads (V1-3)
QRS duration ≥ 120ms
rSR’ pattern or notched R wave in V1-3 along with
T wave inversion
Wide S wave in I and V6
72.
73.
74. Normally the septum is activated from left to right, producing small Q waves
in the lateral leads.
In LBBB, the normal direction of septal depolarisation is reversed (becomes
right to left), as the impulse spreads first to the RV to the LV via the septum.
Eliminates the normal septal Q waves in the lateral leads.
.
The overall direction of depolarisation (from right to left) produces tall R
waves in the lateral leads (I, V5-6) and deep S waves in the right precordial
leads (V1-3)
As the ventricles are activated sequentially (right, then left) rather than
simultaneously, this produces a broad or notched (‘M’-shaped) R wave in the
lateral leads.
QRS duration ≥ 120ms
Broad R wave in I, aVL, and V5-6
Prominent QS wave in V1-3
Absence of q waves (including physiologic q waves) in I and V6
75.
76.
77. The ST segment should sit on the isoelectric
line (at least in the begining)
It is abnormal if there is planar (i.e. flat)
elevation or depression of the ST segment
78. 1. ST elevation:
More than one small
square
Infarcts
Angina.
Acute pericarditis.
Early repolarization
ST depression:
More than one small
square
Ischemia.
Ventricular strain.
BBB.
Hypokalemia.
Digoxin effect.
81. T wave is best measured in left
precordial leads
In V5 <1yr 11mm
>1yr 14mm
Abnormalities:
1. Peaked T-wave:
Posterior wall MI.
Hyperkalemia.
.
2. T- inversion:
Ischemia.
Myocardial
infarction.
Myocarditis
Ventricular strain
BBB.
Hypokalemia.
Digoxin effect.
82.
83.
84. The normal range for QT is 0.38-0.42 (≤ 11mm )
Definition: Time interval between beginning of
QRS complex to the end of T wave.
QT interval varies with heart rate - As the heart
rate gets faster, the QT interval gets shorter
It is possible to correct the QT interval with
respect to rate by using the following formula:
Bazzet’s formula QTc = QT/ √RR
(QTc = corrected QT)
85. Long QTc – causes
◦ Drugs – procanamide, quinidine
◦ Hypocalcemia,
◦ hypomagnesemia,
◦ hypokalemia
◦ Hypothermia
◦ AMI
◦ Congenital
Jerwell and Lange-Neilsen syndrome
Romano- Ward syndrome
Short QT interval: hypercalcemia, digitalis
Abnormalities:
86.
87. U waves occur after the T wave and
are often difficult to see
They are thought to be due to
repolarisation of the atrial septum
Prominent U waves can be a sign of
hypokalaemia