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‎⁨شرح جميع حالات ال ECG⁩.pdf

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عباس مشتاق
عباس مشتاق

This document provides information on how to read and interpret an electrocardiogram (ECG). It begins with descriptions of how the limb and chest leads are placed. It then provides normal ECG values and definitions of intervals and segments. The remainder of the document describes the ABC method for ECG interpretation - examining the rhythm, rate, axis, and abnormalities. Several common arrhythmias and conditions are defined through examples, including sinus tachycardia, SA node block, atrial fibrillation, and right and left ventricular hypertrophy.

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‫ﺑ‬ ‫ﺴ‬ ‫ﻢ‬ $ ‫ا‬ ‫ﻟ‬ ‫ﺮ‬ ‫ﲪ‬ ‫ﻦ‬ ‫ا‬ ‫ﻟ‬ ‫ﺮ‬ ‫ﺣ‬ ‫ﲓ‬ ‫ﺳ‬ ‫ـ‬ ‫ﯿ‬ ‫ﺪ‬ ‫ي‬ ‫و‬ ‫ﻣ‬ ‫ﻮ‬ ‫ﻻ‬ ‫ي‬ ‫ا‬ ‫ﳞ‬ ‫ﺎ‬ 7 ‫ﻣ‬ ‫ﺎ‬ ‫م‬ ‫ا‬ ‫ﳌ‬ ‫ﻨ‬ ‫ﺘ‬ ‫ﻈ‬ ‫ﺮ‬ … ‫ﺳ‬ ‫ﻼ‬ ‫م‬ ‫ﷲ‬ ‫و‬ ‫ﻣ‬ ‫ﻼ‬ ‫ﺋ‬ ‫ﻜ‬ ‫ﺘ‬ ‫ﻪ‬ ‫ﻋ‬ ‫ﻠ‬ ‫ﯿ‬ ‫ﻚ‬ ‫و‬ ‫ﻋ‬ ‫ﲆ‬ ‫ا‬ G ‫ﺋ‬ ‫ﻚ‬ ‫ا‬ ‫ﻟ‬ ‫ﻄ‬ ‫ﺎ‬ ‫ﻫ‬ ‫ﺮ‬ ‫ﻳ‬ ‫ﻦ‬ ‫ا‬ ‫ﲚ‬ ‫ﺔ‬ ‫ا‬ ‫ﻟ‬ ‫ﻬ‬ ‫ﺪ‬ ‫ى‬ ‫و‬ ‫ﻣ‬ ‫ﺼ‬ ‫ﺎ‬ ‫ﺑ‬ ‫ﯿ‬ ‫ﺢ‬ ‫ا‬ S T … ‫ﻫ‬ ‫ﺬ‬ ‫ﻩ‬ ‫و‬ ‫ر‬ ‫ﯾ‬ ‫ﻘ‬ ‫ﺎ‬ ‫ت‬ ‫ا‬ ‫ﺿ‬ ‫ﻌ‬ ‫ﻬ‬ ‫ﺎ‬ ‫ﺑ‬ ‫ﲔ‬ ‫ﯾ‬ ‫ﺪ‬ ‫ﯾ‬ ‫ﻚ‬ ‫ﻓ‬ ‫ﺄ‬ ‫ﻧ‬ ‫ﺖ‬ ‫ا‬ ‫ﺣ‬ ‫ﻖ‬ ‫ﲠ‬ ‫ﺎ‬ ‫و‬ ‫أ‬ ‫ﻫ‬ ‫ﻠ‬ ‫ﻬ‬ ‫ﺎ‬ … ‫ﺧ‬ ‫ﻠ‬ ‫ﳱ‬ ‫ﺎ‬ ‫ﻋ‬ ‫ﲆ‬ ‫ﷲ‬ ⑲ ⑰ · !④ j. sg & ⑧ ⑮
: basics of ECG Limb Leads: • I —> From Right Arm (-) To Left Arm (+) • II —> From Right Arm (-) To Left Leg (+) • III —> From Left Arm (-) To Left Leg (+) Chest leads: • V1 —> 4th Right ICS (Intercostal Space) • V2 —> 4th Left ICS • V3 —> Between (V2 - V4) • V4 —> 5th Left ICS & Mid Clavicular Line (Apex) • V5 —> 5th Left ICS & Anterior Axillary Line • V6 —> 5th Left ICS & Axillary Line Normal values • Heart rate (60 - 100 bpm) • PR interval (0.12 - 0.20 s) or (3-5 SS) • QRS interval ≤ 0.12 s or 3 SS • QT interval < half RR interval (males < 0.40 s; females < 0.44 s) • P wave amplitude (in lead II) ≤ 3 mV (mm) or 3 SS • Q wave < 0.04 s (1 mm) and < 1/3 of R wave amplitude in the same lead Intervals and segments • PR Interval: From the start of the P wave to the start of the QRS complex • PR Segment: from the end of the P wave to the start of the QRS complex • J Point: The junction between the QRS complex and the ST segment • QT Interval: From the start of the QRS complex to the end of the T wave • QRS Interval: From the start to the end of the QRS complex • ST Segment: From the end of the QRS complex (J point) to the start of the T wave RA LA RL LL LL RL RA LA ... i
: Abc for reading ECG 1- Rhythm • Sinus Rhythm or Non-Sinus Rhythm * If We Find +ve (Up) P Wave And Followed By QRS Complex In Lead I, II ; This Mean Sinus Rhythm; If Opposite This Mean Non-Sinus Rhythm • Regular or Irregular Rhythm * If Interval Between R-R Constant This Mean Regular Rhythm; But If R-R Changes This Mean Irregular Rhythm 2- Heart Rate (This Calculate According to Rhythm) • Regular Rhythm (300 / Numbers of LS Between R-R) • Irregular Rhythm (Numbers of R Wave In 15 LS x 20) * Normal Heart Rate (60 - 100 b/min) * Tachycardia > 100 b/min * Bradycardia < 60 b/min method For Identify Types of Rhythms 17 SS 17SS 17SS 17SS … 1 Large Square = 5 Small Square 1SS = 1 mm = 40 ms 17 SS= 17/5 = 3.4 LS Heart Rate = 300/3.4 = 88 b/min 1 2 3 4 5 6 7 8 9 1 2 3 4 5 Heart Rate = 5 x 20 = 100 b/min P R T P R T S S 3 + 5 + 3+31 + 5 + 5 + S I + i + 5 + 1 - 16 -16 -16 ⑧ 8 ·6
3- Axis (This Depends On R Wave & S Wave In I,II, III, aVF Lead) • Normal Axis * R Wave > S Wave In Lead I, II, III, aVF • Left Axis Deviation * R Wave > S Wave In Lead I * S Wave > R Wave In II, III, aVF • Rt. Ax. Dev. * R Wave > S Wave In Lead II, III, aVF * S Wave > R Wave In Lead I • Extreme Rt. Ax. Dev. (ERAD) • S Wave > R Wave In Lead I, II, III, aVF aVR I (0°) II III aVF (90°) aVL R R R R - S S S S R R ? " -S S R R 2 - Q R R R R R > R R R R R => S S 3 S S R R R R R R R R R - # S 3 - S S S S S - -> R R R R S 3 S S = R R R R * R R R R R R R R S S S S * Signin
1- Sinus Tachycardia • Normal ECG, But Rate More Than 100 bpm • Rhythm — Sinus & Regular • Rate — 97 bpm • Axis — Normal • Abnormalities— Normal • Rhythm — Sinus & Regular • Rate — 131 bpm • Axis — Normal • Abnormalities— Sinus Tachy. • Rhythm — Sinus & Regular • Rate — 143 bpm • Axis — Normal • Abnormalities— Sinus Tachy. Abnormalities of ECG - pR + qR T 3 S R 3.1 3.1 3.1 3,1 - T P Q - - p = , S S - R 12 P T P T a s 9 S & - - 2,3 213 2,3 pi = = - - - - 2.1 2,12,1
2- SA Node Block • Non-Sinus & Irregular Irregular • Normal Axis • Normal Heart Rate or Bradycardia In ECG • Absent One Beat Between R-R Interval • Abnormal R-R Interval = 2 Normal R-R • Rhythm — Non-Sinus & Irregular • Rate — 60 bpm • Axis — Normal • Abnormalities— SA Node Block 38 SS 19 SS 19 SS 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 • Rhythm — Non-Sinus & Irregular • Rate — 40 bpm • Axis — Normal • Abnormalities— SA Node Block 46 SS 23 SS 23 SS • Rhythm — Non-Sinus & Irregular • Rate — 45 bpm • Axis — Normal • Abnormalities— SA Node Block 54 SS 27 SS 27 SS Note/ Often Bradycardia A - > - > - -> - > - - - - i R R P T P T - S S - - i - - - - > i - - > -
3- SA Node Arrest • Non-Sinus Rhythm & Irregular • Normal Axis • Normal or Bradycardia In ECG • Absent One Beat or More Between R-R Interval • Abnormal R-R Interval = 2 Normal R-R • Rhythm — Non-Sinus & Irregular • Rate — 30 bpm • Axis — Normal • Abnormalities— SA Node Arrest 43 SS 95 SS 43 SS 92 SS 41 SS 41 SS 41 SS 92 SS 92 SS 92 SS • Rhythm — Non-Sinus & Irregular • Rate — 20 bpm • Axis — Normal • Abnormalities— SA Node Arrest Note/ Often Bradycardia ‫ر‬ ‫ﰊ‬ ‫إ‬ ‫ﱐ‬ ‫ا‬ ‫ﺣ‬ ‫ﺎ‬ ‫و‬ ‫ل‬ ‫ﻓ‬ ‫ﺄ‬ ‫ﻋ‬ ‫ﲏ‬ >I ↳ ⑲ - A - - ⑤ - - - - -
4- sa node bradycardia or sinus bradycardia • Normal ECG, But Rate Less Than 60 bpm • Rhythm — Sinus & Regular • Rate — 46 bpm • Axis — Normal • Abnormalities— Sinus Brady. • Rhythm — Sinus & Regular • Rate — 45 bpm • Axis — Normal • Abnormalities— Sinus Brady. 33 SS 33 SS • Rhythm — Sinus & Regular • Rate — 50 bpm • Axis — Normal • Abnormalities— Sinus Brady. - R T P S S R R - P 4 P T Q ① - - R R P < P 4 PR T a, ① S 2, l I S - 11 ... R T - S - - S - - - -
5- Rt. AH (Right atrial hypertrophy) • May Be Rt. Axis Deviation • Heart Rate Normal or Tachycardia • Amplitude P Wave > 2.5 SS In II, III & aVF • Rhythm — Sinus & Regular • Rate — 100 bpm • Axis — Right • Abnormalities— Rt. AH • Rhythm — Sinus & Regular • Rate — 100 bpm • Axis — Right • Abnormalities— Rt. AH Note/ Often Tachycardia & Rt. AD • Rhythm — Sinus & Regular • Rate — 96 bpm • Axis — Right • Abnormalities— Rt. AH - - - > - - - - - pR pR T T Q Q - > -
6- Lt. ah • Duration P Wave > 3 SS In Lead II • In V1 P Wave Inverted (Down) • Rhythm — Sinus & Regular • Rate — 80 bpm • Axis — Left • Abnormalities— Lt. AH • Rhythm — Sinus & Regular • Rate — 107 bpm • Axis — Normal • Abnormalities— Lt. AH • Rhythm — Sinus & Regular • Rate — 79 bpm • Axis — Normal • Abnormalities— Lt. AH R R P ↑I R T R P P S S - P P - - - - > i - - - - - - - - - - - - -
7- Rt. Ventricle Hypertrophy (Rt. Vh) • R Wave Dominant In Lead V1 • S Wave Dominant In Lead V6 • Rt. Axis Deviation • Rhythm — Sinus & Regular • Rate — 107 bpm • Axis — • Abnormalities— Lt. AH • Rhythm — Sinus & Regular • Rate — 93 bpm • Axis — Rt. • Abnormalities— Rt. VH ‫ﻻ‬ ‫ﺗ‬ ‫ﻜ‬ ُ ‫ﻦ‬ ‫ﻋ‬ ‫ﻨ‬ ‫ﴫ‬ q ً ‫و‬ ‫أ‬ ‫ﻛ‬ ‫ﺮ‬ ‫ﻩ‬ ‫ا‬ ‫ﶺ‬ ‫ﯿ‬ ‫ﻊ‬ -> > > > * ⑮ I -> > > > °. )>@. M R R R P P P P Q Q ① S T S T T T S S R R T P P Q S S - - Si - - - - - - p R T pR + p R 5 - - - - - - - - - -
8- Lt. Vh • Amplitude Of R Wave In Lead V5 + Amplitude Of S Wave In Lead V2 > 35 SS • Rhythm — Sinus & Regular • Rate — 50 bpm • Axis — Normal • Abnormalities— Lt. VH 33 SS 40 SS • Rhythm — Sinus & Regular • Rate — 75 bpm • Axis — Normal • Abnormalities— Lt. VH • Rhythm — Sinus & Regular • Rate — 66 bpm • Axis — Normal • Abnormalities— Lt. VH > - - - - - S - - - -
9- Atrial Fibrillation (AF) • Non-Sinus & Irregular Rhythm • Absent P Wave • Rhythm — Non- Sinus & Irregular • Rate — 60 bpm • Axis — Lt. AD • Abnormalities— Atrial Fibrillation • Rhythm — Non- Sinus & Irregular • Rate — 120 bpm • Axis — Lt. AD • Abnormalities— Atrial Fibrillation • Rhythm — Non- Sinus & Irregular • Rate — 80 bpm • Axis — Normal • Abnormalities— Atrial Fibrillation R R R 9 9 T - > ° > as as a s - - - - - - - R R R R 4 T 4 9 S S S S - - - -
10- Atrial Flutter • Sinus & Irregular Rhythm • Every QRS Complex Prior By More Than P Wave • Loss Of The Iso-Electric Baseline • Saw-Tooth In Lead II, III & aVF • Rhythm — Sinus & Irregular • Rate — 40 bpm • Axis — Normal • Abnormalities— Atrial Flutter • Rhythm — Sinus & Irregular • Rate — 80 bpm • Axis — Normal or Lt. AD • Abnormalities— Atrial Flutter • Rhythm — Sinus & Irregular • Rate — 80 bpm • Axis — Normal • Abnormalities— Atrial Flutter - - - - > R R R R P < ppp + p,4 + 4Pa,P44P Q Q - - - -
11-av node block • First Degree Av Block (1st AVB) * P-R Interval More Than (5 SS) * Every P Wave Following By QRS Complex • Rhythm — Sinus & Regular • Rate — 60 bpm • Axis — Normal • Abnormalities— 1st AVB • Rhythm — Sinus & Regular • Rate — 88 bpm • Axis — Normal • Abnormalities— 1st AVB • Rhythm — Sinus & Regular • Rate — 75 bpm • Axis — Normal • Abnormalities— 1st AVB ‫ﯾ‬ ‫ﻮ‬ ‫ﻣ‬ ‫ﺎ‬ً ‫ﻣ‬ ‫ﺎ‬ ‫ﺳ‬ ‫ﺘ‬ ‫ﺒ‬ ‫ﺘ‬ ‫ﺴ‬ ‫ﻢ‬ ‫و‬ ‫ﺗ‬ ‫ﻘ‬ ‫ﻮ‬ ‫ل‬ q ‫ﷲ‬ ‫ﻫ‬ ‫ﺬ‬ ‫ا‬ ‫أ‬ ‫ﻛ‬ ‫ﱶ‬ ‫ﳑ‬ ‫ﺎ‬ ‫د‬ ‫ﻋ‬ ‫ﻮ‬ ‫ت‬ ‫إ‬ ‫ﻟ‬ ‫ﯿ‬ ‫ﻪ‬ A ⑱ . . . . . . . . . . . - ⑮ - R R T P T - S Ess S R T P R 4 P R - - S - - - P R = p R + pR + p R Es => s - - > - R R P =" T - R R R 7 P P Q Q ⑦ - - - - - - -
• Second Degree AV Block 1- Type One Or Mobitz One * Progressively Increase Duration Of P-R Interval * Drop Or Absent QRS Complex, But P Wave Should Be Present * Then Return This Cycle * Sinus & Irregular Rhythm • Rhythm — Sinus & Irregular • Rate — 60 bpm • Axis — Lt. AD • Abnormalities— 2nd AVB Mob 1 • Rhythm — Sinus & Irregular • Rate — 80 bpm • Axis — Normal • Abnormalities— 2nd AVB Mob 1 - R R 4 P P S - - > P R R 1 YRS 9 R = Msios - - - - - as a3 - - - - R R R P ↑ p + p = bQRS ↓ QRS - P -as - - - 45 7
2- Type Two Or Mobitz Two * Normal P-R Interval (3-5 SS) * Drop Or Absent QRS Complex, But P Wave Should Be Present * Sinus & Irregular Rhythm • Rhythm — Sinus & Irregular • Rate — 80 bpm • Axis — Lt. AD • Abnormalities— 2nd AVB Mob 1 • Rhythm — Sinus & Irregular • Rate — 80 bpm • Axis — Lt. AD • Abnormalities— 2nd AVB Mob 1 MEETING YOU WAS A NICE ACCIDENT !" - - - - 9 R+ RpRspRsPye Rsp - - - yes,I ~
• Third Degree AV Block * Wide QRS Complex * Bradycardia * Sinus & Irregular Rhythm * Atrial & Ventricles Are Depolarizing Independently “No Association Between Atria & Ventricles” • Rhythm — Sinus & Irregular • Rate — 20 bpm • Axis — Lt. AD • Abnormalities— 3rd AVB • Rhythm — Sinus & Irregular • Rate — 40 bpm • Axis — Lt. AD • Abnormalities— 3rd AVB Note/ May Be Often Lt. AD - - - - See sites is sis
12- svt (supra-ventricular tachycardia) • Narrow QRS Complex • Tachycardia • Often Non-Visible P Wave • Rhythm — Regular • Rate — 270 bpm • Axis — Normal • Abnormalities— SVT • Rhythm — Regular • Rate — 200 bpm • Axis — Normal • Abnormalities— SVT • Rhythm — Regular • Rate — 270 bpm • Axis — Normal • Abnormalities— SVT
13- vt (ventricular tachycardia) • Wide QRS Complex • Tachycardia • Often Rt. Bundle Branch Block • Often Non-Visible P Wave • Rhythm — Regular • Rate — 187 bpm • Axis — • Abnormalities— VT • Rhythm — Regular • Rate — 250 bpm • Axis — • Abnormalities— VT • Rhythm — Regular • Rate — 170 bpm • Axis — Normal • Abnormalities— VT pattern of vt
14- Ischemic heart disease (ihd) • STEMI (ST-Elevation Myocardial Infarction) * S-T Segment Elevation * May Be T Wave Inversion # Septal MI (STE In V1-V2) —> Lt. Anterior Descending Artery (LAD) # Apical MI (STE In V3-V4) —> Distal LAD # Anterio-Lateral MI (STE In V5-V6) —> LAD + Lt. Circumflex Artery (LCX) # Lateral MI (STE In I, aVL) —> Proximal LCX # Inferior MI (STE In II, III, aVF) —> Rt. Coronary Artery + Distal LCX • Rhythm — Sinus & Regular • Rate — 78 bpm • Axis — Lt. AD • Abnormalities— Septal MI • Rhythm — Sinus & Regular • Rate — 83 bpm • Axis — Lt. AD • Abnormalities— Anterio-lateral MI • Rhythm — Sinus & Regular • Rate — 83 bpm • Axis — Normal • Abnormalities— Inferior & Antero-Lateral MI - - - - - - I ↓ 2i aV I I - > - - - - -
• Non- STEMI (Angina) * S-T Segment Depression • Rhythm — Sinus & Regular • Rate — 83 bpm • Axis — Normal • Abnormalities— Non-SEMI • Rhythm — Sinus & Regular • Rate — 88 bpm • Axis — Normal • Abnormalities— Non-SEMI • Rhythm — Sinus & Regular • Rate — • Axis — Lt. AD • Abnormalities— Non-STEMI Note/ Pt. With STEMI Will Be +ve Cardiac Biomarkers (Troponin)
15- Pulmonary Embolism (S1 Q3 T3) • S Wave Will Be Deep In Lead I • Q Wave Will Be Deep In Lead III • T Wave Will Be Inverted In Lead III • Rhythm — Sinus & Regular • Rate — 120 bpm • Axis —Rt. AD • Abnormalities— PE • Rhythm — Sinus & Regular • Rate — 125 bpm • Axis — Rt. AD • Abnormalities— PE • Rhythm — Sinus & Regular • Rate — 90 bpm • Axis — Rt. AD • Abnormalities— Non-SEMI Note/ Often Rt. AD & Tachycardia - - - - - - - - - - - -
16- Peri-Carditis • P-R Interval Depression • S-T Elevation • Rhythm — Sinus & Regular • Rate — 63 bpm • Axis — Normal • Abnormalities— Peri-Carditis • Rhythm — Sinus & Regular • Rate — 71 bpm • Axis — Normal • Abnormalities— Peri-Carditis • Rhythm — Sinus & Regular • Rate — 88 bpm • Axis — Normal • Abnormalities— Non-SEMI Note/ In STEMI Will See S-T Segment Depression In Some Leads .. In Peri-Carditis Don’t See S-T Segment Depression Often In All Leads - R R 4 T - P B S S - - - - - - - - - -
17- Ectopic Beat • PVC (Premature Ventricular Contraction * Wide QRS Complex “In Ectopic Beat” * Usually Followed By Full Compensatory Pause Premature is The Beat That Occurs Earlier Than Would Be Expected For The Next Sinus Impulse Patterns Of PVC: 1- Bi-Geminy (1 Normal Beat : 1 PVC Beat) • Rhythm — Irregular • Rate — 60 bpm • Axis — Normal • Abnormalities— PVC (Bigeminy) 2- Tri-Geminy (2 Normal Beat : 1 PVC Beat) • Rhythm — Irregular • Rate — 60 bpm • Axis — Normal • Abnormalities— PVC (Trigeminy) 3- Quadri-Geminy (3 Normal Beat : 1 PVC Beat) • Rhythm — Irregular • Rate — 60 bpm • Axis — Normal • Abnormalities— PVC (Quadrigeminy) - - - - - - 1 PVC: / Normal Pa Wave te - - - - 2Normal: IPVC i ~ Fra i -Exc W C i - - - - - 3Normal; I PVC i ~ - I E x - - -
4- Couplet (2 Normal Beat : 2 PVC Beat) • Rhythm — Irregular • Rate — 60 bpm • Axis — Normal • Abnormalities— PVC (Quadrigeminy) PVC N N N N N N N N N PVC PVC PVC PVC PVC PVC PVC 1 2 3 4 5 6 7 8 9 - - - - 2 Normal: 2 PVC
• PAC (Premature Atrial Complex or Contraction) * Non-Sinus Rhythm * Normal QRS Complex * Post-Extra Systolic Pauses Patterns Of PAC: 1- Bi-Geminy (1 Normal Beat : 1 PAC Beat) • Rhythm — Irregular • Rate — 60 bpm • Axis — Lt. AD • Abnormalities— PAC (Bigeminy) Note/ Pauses After PAC Beat Distance Between Normal Beat Is Constant The Other Patterns Sameness To PVC - = ~ .
18- Hyper-kalaemia • Peaked T Wave • P Wave Flattening • P-R Interval Prolongation • Wide QRS Complex • Rhythm — Regular • Rate — 110 bpm • Axis — Normal • Abnormalities— Hyper-Kalaemia • Rhythm — Regular • Rate — 100 bpm • Axis — Normal • Abnormalities— Hyper-Kalaemia • Rhythm — Regular • Rate — 100 bpm • Axis — Normal • Abnormalities— Hyper-Kalaemia n - - > - - - - 3 = 100bPM - - - - 300 = 100bPM
19- ARVC (Arrhythmogenic Rt. Ventricular Cardiomyopathy) • T Wave Inverted In V1,V2 & V3 • QRS Complex Wide In V1, V2 & V3 • Epsion Wave In V1, V2 & V3 • Rhythm — Sinus & Regular • Rate — 65 bpm • Axis — Rt. AD • Abnormalities— ARVC Epsion Wave • Rhythm — Regular • Rate — 55 bpm • Axis — • Abnormalities— ARVC - - - -
20- Sinus arrhythmia • Irregular Rhythm Only • Rhythm — Sinus & Irregular • Rate — 60 bpm • Axis — Normal • Abnormalities— Sinus Arr. • Rhythm — Sinus & Irregular • Rate — 60 bpm • Axis — Normal • Abnormalities— Sinus Arr. • Rhythm — Sinus & Irregular • Rate — 100 bpm • Axis — Normal • Abnormalities— Sinus Arr. R R R 4 T T P P P S S S 5.2 5.1 4.4 3 33 - - - R ↑ , x pR+ P ↑ 44 4 3.2 2,431 3.2 3.4444 3.4 - - - e n 2.2 2.2 4.9 2132,24,2 292124.2 214 212 4.2 2,3 2,2
21- Wellen’s Syndrome • T Wave Inversion In Lead V2 & V3 • Recent History Of Angina • Normal Or Slightly Elevated Serum Cardiac Markers • Rhythm — Sinus & Regular • Rate — 79 bpm • Axis — Normal • Abnormalities— Wellen’s Syndrome • Rhythm — Sinus & Regular • Rate — 50 bpm • Axis — Lt. AD • Abnormalities— Wellen’s Syndrome Note/ Often With Lt. AD - - - - - - - -
22- WPW (Wolff-Parkinson-White Syndrome) • P-R Interval Short • Delta Wave • Rhythm — Sinus & Regular • Rate — 70 bpm • Axis — Rt. AD • Abnormalities— WOW • Rhythm — Sinus & Regular • Rate — 60 bpm • Axis — Normal or Rt. AD • Abnormalities— WOW - - - - - - - -
23- Rt. Bundle Branch Block • M Shape In R Wave In Lead V1 or V2 • May be W Shape In R Wave In Lead V5 • Rhythm — Sinus & Regular • Rate — 83 bpm • Axis — Lt. AD • Abnormalities— RBBB • Rhythm — Sinus & Regular • Rate — 54 bpm • Axis — Normal • Abnormalities— WOW ‫ﻣ‬ َ ‫ﻦ‬ ‫ﻛ‬ ُ‫ﻨ‬ ‫ﺖ‬ ُ ‫ﻣ‬ َ ‫ﻮ‬ ‫ﻻ‬ َ ‫ﻩ‬ ‫ﻓ‬ َ ‫ﻌ‬ ‫ﲇ‬ . ‫ﻣ‬ َ ‫ﻮ‬ ‫ﻻ‬ َ ‫ﻩ‬ ‫ﻣ‬ َ ‫ﻦ‬ ‫ﻛ‬ ُ‫ﻨ‬ ‫ﺖ‬ ُ ‫ﻣ‬ َ ‫ﻮ‬ ‫ﻻ‬ َ ‫ﻩ‬ ‫ﻓ‬ َ ‫ﻌ‬ ‫ﲇ‬ . ‫ﻣ‬ َ ‫ﻮ‬ ‫ﻻ‬ َ ‫ﻩ‬ .. - > - - - - ↳ msinsi
23- Lt. Bundle Branch Block • M Shape In R Wave In Lead V5 or V6 • May Be W Shape In R Wave In Lead V1 or V2 • Rhythm — Sinus & Regular • Rate — 60 bpm • Axis — Lt. AD • Abnormalities— LBBB - - - Sensiti ↳19... Exx19
‫ﰻ‬ ‫ﻛ‬ ‫ﻴ‬ ‫ﺲ‬ ‫ﳛ‬ ‫ﺘ‬ ‫ﺎ‬ ‫ج‬ ‫ﻫ‬ ‫ﺴ‬ ‫ﱰ‬ ‫ي‬ ‫و‬ ‫ا‬ ‫ﻛ‬ ‫ﺰ‬ ‫ا‬ ‫م‬ ‫ﻗ‬ ‫ﺒ‬ ‫ﻞ‬ ‫ا‬ ‫ي‬ ‫ا‬ ‫ﻧ‬ ‫ﻔ‬ ‫ﺴ‬ ‫ـ‬ ‫ﺘ‬ ‫ﻜ‬ ‫ﻴ‬ ‫ﺸ‬ ‫ﻦ‬ ‫و‬ ‫ﺑ‬ ‫ﻌ‬ ‫ﺾ‬ ‫ا‬ ‫ﻟ‬ ‫ﻜ‬ ‫ﻴ‬ ‫ﺴ‬ ‫ﺎ‬ ‫ت‬ ‫ﳓ‬ ‫ﺘ‬ ‫ﺎ‬ ‫ج‬ ‫ا‬ ‫ﻧ‬ ‫ﺴ‬ ‫ـ‬ ‫ﺘ‬ ‫ﻜ‬ ‫ﻴ‬ ‫ﺸ‬ ‫ﻦ‬ L ‫ﱐ‬ ‫ﻏ‬ ‫ﲑ‬ ‫ا‬ ‫ل‬ ECG ‫ﺣ‬ ‫ﱴ‬ ‫ﻧ‬ ‫ﻮ‬ ‫ﺻ‬ ‫ﻞ‬ ‫ﻟ‬ U ‫ا‬ ‫ﻳ‬ ‫ﻜ‬ ‫ﻨ‬ ‫ﻮ‬ ‫ﺳ‬ ‫ﺲ‬ ‫ا‬ ‫ﻟ‬ ‫ﺼ‬ ‫ﺤ‬ ‫ﯿ‬ ‫ﺢ‬ ‫ﳑ‬ ‫ﻜ‬ ‫ﻦ‬ ‫ﳓ‬ ‫ﺘ‬ ‫ﺎ‬ ‫ج‬ ‫ا‬ ‫ﻳ‬ ‫ﻜ‬ ‫ﻮ‬ ، ‫ا‬ ‫ﻧ‬ ‫ﺰ‬ ‫ﳝ‬ ‫ﺎ‬ ‫ت‬ ‫ا‬ ‫ﻟ‬ ‫ﻘ‬ ‫ﻠ‬ ‫ﺐ‬ ، ‫ا‬ ‫ﳒ‬ ‫ﯿ‬ ‫ﻮ‬ ‫ﻛ‬ ‫ﺮ‬ ‫ا‬ ‫ﰲ‬ ‫و‬ ‫ﻏ‬ ‫ﲑ‬ ‫ﻫ‬ ‫ﻦ‬ …
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  • 1. ‫ﺑ‬ ‫ﺴ‬ ‫ﻢ‬ $ ‫ا‬ ‫ﻟ‬ ‫ﺮ‬ ‫ﲪ‬ ‫ﻦ‬ ‫ا‬ ‫ﻟ‬ ‫ﺮ‬ ‫ﺣ‬ ‫ﲓ‬ ‫ﺳ‬ ‫ـ‬ ‫ﯿ‬ ‫ﺪ‬ ‫ي‬ ‫و‬ ‫ﻣ‬ ‫ﻮ‬ ‫ﻻ‬ ‫ي‬ ‫ا‬ ‫ﳞ‬ ‫ﺎ‬ 7 ‫ﻣ‬ ‫ﺎ‬ ‫م‬ ‫ا‬ ‫ﳌ‬ ‫ﻨ‬ ‫ﺘ‬ ‫ﻈ‬ ‫ﺮ‬ … ‫ﺳ‬ ‫ﻼ‬ ‫م‬ ‫ﷲ‬ ‫و‬ ‫ﻣ‬ ‫ﻼ‬ ‫ﺋ‬ ‫ﻜ‬ ‫ﺘ‬ ‫ﻪ‬ ‫ﻋ‬ ‫ﻠ‬ ‫ﯿ‬ ‫ﻚ‬ ‫و‬ ‫ﻋ‬ ‫ﲆ‬ ‫ا‬ G ‫ﺋ‬ ‫ﻚ‬ ‫ا‬ ‫ﻟ‬ ‫ﻄ‬ ‫ﺎ‬ ‫ﻫ‬ ‫ﺮ‬ ‫ﻳ‬ ‫ﻦ‬ ‫ا‬ ‫ﲚ‬ ‫ﺔ‬ ‫ا‬ ‫ﻟ‬ ‫ﻬ‬ ‫ﺪ‬ ‫ى‬ ‫و‬ ‫ﻣ‬ ‫ﺼ‬ ‫ﺎ‬ ‫ﺑ‬ ‫ﯿ‬ ‫ﺢ‬ ‫ا‬ S T … ‫ﻫ‬ ‫ﺬ‬ ‫ﻩ‬ ‫و‬ ‫ر‬ ‫ﯾ‬ ‫ﻘ‬ ‫ﺎ‬ ‫ت‬ ‫ا‬ ‫ﺿ‬ ‫ﻌ‬ ‫ﻬ‬ ‫ﺎ‬ ‫ﺑ‬ ‫ﲔ‬ ‫ﯾ‬ ‫ﺪ‬ ‫ﯾ‬ ‫ﻚ‬ ‫ﻓ‬ ‫ﺄ‬ ‫ﻧ‬ ‫ﺖ‬ ‫ا‬ ‫ﺣ‬ ‫ﻖ‬ ‫ﲠ‬ ‫ﺎ‬ ‫و‬ ‫أ‬ ‫ﻫ‬ ‫ﻠ‬ ‫ﻬ‬ ‫ﺎ‬ … ‫ﺧ‬ ‫ﻠ‬ ‫ﳱ‬ ‫ﺎ‬ ‫ﻋ‬ ‫ﲆ‬ ‫ﷲ‬ ⑲ ⑰ · !④ j. sg & ⑧ ⑮
  • 2. : basics of ECG Limb Leads: • I —> From Right Arm (-) To Left Arm (+) • II —> From Right Arm (-) To Left Leg (+) • III —> From Left Arm (-) To Left Leg (+) Chest leads: • V1 —> 4th Right ICS (Intercostal Space) • V2 —> 4th Left ICS • V3 —> Between (V2 - V4) • V4 —> 5th Left ICS & Mid Clavicular Line (Apex) • V5 —> 5th Left ICS & Anterior Axillary Line • V6 —> 5th Left ICS & Axillary Line Normal values • Heart rate (60 - 100 bpm) • PR interval (0.12 - 0.20 s) or (3-5 SS) • QRS interval ≤ 0.12 s or 3 SS • QT interval < half RR interval (males < 0.40 s; females < 0.44 s) • P wave amplitude (in lead II) ≤ 3 mV (mm) or 3 SS • Q wave < 0.04 s (1 mm) and < 1/3 of R wave amplitude in the same lead Intervals and segments • PR Interval: From the start of the P wave to the start of the QRS complex • PR Segment: from the end of the P wave to the start of the QRS complex • J Point: The junction between the QRS complex and the ST segment • QT Interval: From the start of the QRS complex to the end of the T wave • QRS Interval: From the start to the end of the QRS complex • ST Segment: From the end of the QRS complex (J point) to the start of the T wave RA LA RL LL LL RL RA LA ... i
  • 3. : Abc for reading ECG 1- Rhythm • Sinus Rhythm or Non-Sinus Rhythm * If We Find +ve (Up) P Wave And Followed By QRS Complex In Lead I, II ; This Mean Sinus Rhythm; If Opposite This Mean Non-Sinus Rhythm • Regular or Irregular Rhythm * If Interval Between R-R Constant This Mean Regular Rhythm; But If R-R Changes This Mean Irregular Rhythm 2- Heart Rate (This Calculate According to Rhythm) • Regular Rhythm (300 / Numbers of LS Between R-R) • Irregular Rhythm (Numbers of R Wave In 15 LS x 20) * Normal Heart Rate (60 - 100 b/min) * Tachycardia > 100 b/min * Bradycardia < 60 b/min method For Identify Types of Rhythms 17 SS 17SS 17SS 17SS … 1 Large Square = 5 Small Square 1SS = 1 mm = 40 ms 17 SS= 17/5 = 3.4 LS Heart Rate = 300/3.4 = 88 b/min 1 2 3 4 5 6 7 8 9 1 2 3 4 5 Heart Rate = 5 x 20 = 100 b/min P R T P R T S S 3 + 5 + 3+31 + 5 + 5 + S I + i + 5 + 1 - 16 -16 -16 ⑧ 8 ·6
  • 4. 3- Axis (This Depends On R Wave & S Wave In I,II, III, aVF Lead) • Normal Axis * R Wave > S Wave In Lead I, II, III, aVF • Left Axis Deviation * R Wave > S Wave In Lead I * S Wave > R Wave In II, III, aVF • Rt. Ax. Dev. * R Wave > S Wave In Lead II, III, aVF * S Wave > R Wave In Lead I • Extreme Rt. Ax. Dev. (ERAD) • S Wave > R Wave In Lead I, II, III, aVF aVR I (0°) II III aVF (90°) aVL R R R R - S S S S R R ? " -S S R R 2 - Q R R R R R > R R R R R => S S 3 S S R R R R R R R R R - # S 3 - S S S S S - -> R R R R S 3 S S = R R R R * R R R R R R R R S S S S * Signin
  • 5. 1- Sinus Tachycardia • Normal ECG, But Rate More Than 100 bpm • Rhythm — Sinus & Regular • Rate — 97 bpm • Axis — Normal • Abnormalities— Normal • Rhythm — Sinus & Regular • Rate — 131 bpm • Axis — Normal • Abnormalities— Sinus Tachy. • Rhythm — Sinus & Regular • Rate — 143 bpm • Axis — Normal • Abnormalities— Sinus Tachy. Abnormalities of ECG - pR + qR T 3 S R 3.1 3.1 3.1 3,1 - T P Q - - p = , S S - R 12 P T P T a s 9 S & - - 2,3 213 2,3 pi = = - - - - 2.1 2,12,1
  • 6. 2- SA Node Block • Non-Sinus & Irregular Irregular • Normal Axis • Normal Heart Rate or Bradycardia In ECG • Absent One Beat Between R-R Interval • Abnormal R-R Interval = 2 Normal R-R • Rhythm — Non-Sinus & Irregular • Rate — 60 bpm • Axis — Normal • Abnormalities— SA Node Block 38 SS 19 SS 19 SS 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 • Rhythm — Non-Sinus & Irregular • Rate — 40 bpm • Axis — Normal • Abnormalities— SA Node Block 46 SS 23 SS 23 SS • Rhythm — Non-Sinus & Irregular • Rate — 45 bpm • Axis — Normal • Abnormalities— SA Node Block 54 SS 27 SS 27 SS Note/ Often Bradycardia A - > - > - -> - > - - - - i R R P T P T - S S - - i - - - - > i - - > -
  • 7. 3- SA Node Arrest • Non-Sinus Rhythm & Irregular • Normal Axis • Normal or Bradycardia In ECG • Absent One Beat or More Between R-R Interval • Abnormal R-R Interval = 2 Normal R-R • Rhythm — Non-Sinus & Irregular • Rate — 30 bpm • Axis — Normal • Abnormalities— SA Node Arrest 43 SS 95 SS 43 SS 92 SS 41 SS 41 SS 41 SS 92 SS 92 SS 92 SS • Rhythm — Non-Sinus & Irregular • Rate — 20 bpm • Axis — Normal • Abnormalities— SA Node Arrest Note/ Often Bradycardia ‫ر‬ ‫ﰊ‬ ‫إ‬ ‫ﱐ‬ ‫ا‬ ‫ﺣ‬ ‫ﺎ‬ ‫و‬ ‫ل‬ ‫ﻓ‬ ‫ﺄ‬ ‫ﻋ‬ ‫ﲏ‬ >I ↳ ⑲ - A - - ⑤ - - - - -
  • 8. 4- sa node bradycardia or sinus bradycardia • Normal ECG, But Rate Less Than 60 bpm • Rhythm — Sinus & Regular • Rate — 46 bpm • Axis — Normal • Abnormalities— Sinus Brady. • Rhythm — Sinus & Regular • Rate — 45 bpm • Axis — Normal • Abnormalities— Sinus Brady. 33 SS 33 SS • Rhythm — Sinus & Regular • Rate — 50 bpm • Axis — Normal • Abnormalities— Sinus Brady. - R T P S S R R - P 4 P T Q ① - - R R P < P 4 PR T a, ① S 2, l I S - 11 ... R T - S - - S - - - -
  • 9. 5- Rt. AH (Right atrial hypertrophy) • May Be Rt. Axis Deviation • Heart Rate Normal or Tachycardia • Amplitude P Wave > 2.5 SS In II, III & aVF • Rhythm — Sinus & Regular • Rate — 100 bpm • Axis — Right • Abnormalities— Rt. AH • Rhythm — Sinus & Regular • Rate — 100 bpm • Axis — Right • Abnormalities— Rt. AH Note/ Often Tachycardia & Rt. AD • Rhythm — Sinus & Regular • Rate — 96 bpm • Axis — Right • Abnormalities— Rt. AH - - - > - - - - - pR pR T T Q Q - > -
  • 10. 6- Lt. ah • Duration P Wave > 3 SS In Lead II • In V1 P Wave Inverted (Down) • Rhythm — Sinus & Regular • Rate — 80 bpm • Axis — Left • Abnormalities— Lt. AH • Rhythm — Sinus & Regular • Rate — 107 bpm • Axis — Normal • Abnormalities— Lt. AH • Rhythm — Sinus & Regular • Rate — 79 bpm • Axis — Normal • Abnormalities— Lt. AH R R P ↑I R T R P P S S - P P - - - - > i - - - - - - - - - - - - -
  • 11. 7- Rt. Ventricle Hypertrophy (Rt. Vh) • R Wave Dominant In Lead V1 • S Wave Dominant In Lead V6 • Rt. Axis Deviation • Rhythm — Sinus & Regular • Rate — 107 bpm • Axis — • Abnormalities— Lt. AH • Rhythm — Sinus & Regular • Rate — 93 bpm • Axis — Rt. • Abnormalities— Rt. VH ‫ﻻ‬ ‫ﺗ‬ ‫ﻜ‬ ُ ‫ﻦ‬ ‫ﻋ‬ ‫ﻨ‬ ‫ﴫ‬ q ً ‫و‬ ‫أ‬ ‫ﻛ‬ ‫ﺮ‬ ‫ﻩ‬ ‫ا‬ ‫ﶺ‬ ‫ﯿ‬ ‫ﻊ‬ -> > > > * ⑮ I -> > > > °. )>@. M R R R P P P P Q Q ① S T S T T T S S R R T P P Q S S - - Si - - - - - - p R T pR + p R 5 - - - - - - - - - -
  • 12. 8- Lt. Vh • Amplitude Of R Wave In Lead V5 + Amplitude Of S Wave In Lead V2 > 35 SS • Rhythm — Sinus & Regular • Rate — 50 bpm • Axis — Normal • Abnormalities— Lt. VH 33 SS 40 SS • Rhythm — Sinus & Regular • Rate — 75 bpm • Axis — Normal • Abnormalities— Lt. VH • Rhythm — Sinus & Regular • Rate — 66 bpm • Axis — Normal • Abnormalities— Lt. VH > - - - - - S - - - -
  • 13. 9- Atrial Fibrillation (AF) • Non-Sinus & Irregular Rhythm • Absent P Wave • Rhythm — Non- Sinus & Irregular • Rate — 60 bpm • Axis — Lt. AD • Abnormalities— Atrial Fibrillation • Rhythm — Non- Sinus & Irregular • Rate — 120 bpm • Axis — Lt. AD • Abnormalities— Atrial Fibrillation • Rhythm — Non- Sinus & Irregular • Rate — 80 bpm • Axis — Normal • Abnormalities— Atrial Fibrillation R R R 9 9 T - > ° > as as a s - - - - - - - R R R R 4 T 4 9 S S S S - - - -
  • 14. 10- Atrial Flutter • Sinus & Irregular Rhythm • Every QRS Complex Prior By More Than P Wave • Loss Of The Iso-Electric Baseline • Saw-Tooth In Lead II, III & aVF • Rhythm — Sinus & Irregular • Rate — 40 bpm • Axis — Normal • Abnormalities— Atrial Flutter • Rhythm — Sinus & Irregular • Rate — 80 bpm • Axis — Normal or Lt. AD • Abnormalities— Atrial Flutter • Rhythm — Sinus & Irregular • Rate — 80 bpm • Axis — Normal • Abnormalities— Atrial Flutter - - - - > R R R R P < ppp + p,4 + 4Pa,P44P Q Q - - - -
  • 15. 11-av node block • First Degree Av Block (1st AVB) * P-R Interval More Than (5 SS) * Every P Wave Following By QRS Complex • Rhythm — Sinus & Regular • Rate — 60 bpm • Axis — Normal • Abnormalities— 1st AVB • Rhythm — Sinus & Regular • Rate — 88 bpm • Axis — Normal • Abnormalities— 1st AVB • Rhythm — Sinus & Regular • Rate — 75 bpm • Axis — Normal • Abnormalities— 1st AVB ‫ﯾ‬ ‫ﻮ‬ ‫ﻣ‬ ‫ﺎ‬ً ‫ﻣ‬ ‫ﺎ‬ ‫ﺳ‬ ‫ﺘ‬ ‫ﺒ‬ ‫ﺘ‬ ‫ﺴ‬ ‫ﻢ‬ ‫و‬ ‫ﺗ‬ ‫ﻘ‬ ‫ﻮ‬ ‫ل‬ q ‫ﷲ‬ ‫ﻫ‬ ‫ﺬ‬ ‫ا‬ ‫أ‬ ‫ﻛ‬ ‫ﱶ‬ ‫ﳑ‬ ‫ﺎ‬ ‫د‬ ‫ﻋ‬ ‫ﻮ‬ ‫ت‬ ‫إ‬ ‫ﻟ‬ ‫ﯿ‬ ‫ﻪ‬ A ⑱ . . . . . . . . . . . - ⑮ - R R T P T - S Ess S R T P R 4 P R - - S - - - P R = p R + pR + p R Es => s - - > - R R P =" T - R R R 7 P P Q Q ⑦ - - - - - - -
  • 16. • Second Degree AV Block 1- Type One Or Mobitz One * Progressively Increase Duration Of P-R Interval * Drop Or Absent QRS Complex, But P Wave Should Be Present * Then Return This Cycle * Sinus & Irregular Rhythm • Rhythm — Sinus & Irregular • Rate — 60 bpm • Axis — Lt. AD • Abnormalities— 2nd AVB Mob 1 • Rhythm — Sinus & Irregular • Rate — 80 bpm • Axis — Normal • Abnormalities— 2nd AVB Mob 1 - R R 4 P P S - - > P R R 1 YRS 9 R = Msios - - - - - as a3 - - - - R R R P ↑ p + p = bQRS ↓ QRS - P -as - - - 45 7
  • 17. 2- Type Two Or Mobitz Two * Normal P-R Interval (3-5 SS) * Drop Or Absent QRS Complex, But P Wave Should Be Present * Sinus & Irregular Rhythm • Rhythm — Sinus & Irregular • Rate — 80 bpm • Axis — Lt. AD • Abnormalities— 2nd AVB Mob 1 • Rhythm — Sinus & Irregular • Rate — 80 bpm • Axis — Lt. AD • Abnormalities— 2nd AVB Mob 1 MEETING YOU WAS A NICE ACCIDENT !" - - - - 9 R+ RpRspRsPye Rsp - - - yes,I ~
  • 18. • Third Degree AV Block * Wide QRS Complex * Bradycardia * Sinus & Irregular Rhythm * Atrial & Ventricles Are Depolarizing Independently “No Association Between Atria & Ventricles” • Rhythm — Sinus & Irregular • Rate — 20 bpm • Axis — Lt. AD • Abnormalities— 3rd AVB • Rhythm — Sinus & Irregular • Rate — 40 bpm • Axis — Lt. AD • Abnormalities— 3rd AVB Note/ May Be Often Lt. AD - - - - See sites is sis
  • 19. 12- svt (supra-ventricular tachycardia) • Narrow QRS Complex • Tachycardia • Often Non-Visible P Wave • Rhythm — Regular • Rate — 270 bpm • Axis — Normal • Abnormalities— SVT • Rhythm — Regular • Rate — 200 bpm • Axis — Normal • Abnormalities— SVT • Rhythm — Regular • Rate — 270 bpm • Axis — Normal • Abnormalities— SVT
  • 20. 13- vt (ventricular tachycardia) • Wide QRS Complex • Tachycardia • Often Rt. Bundle Branch Block • Often Non-Visible P Wave • Rhythm — Regular • Rate — 187 bpm • Axis — • Abnormalities— VT • Rhythm — Regular • Rate — 250 bpm • Axis — • Abnormalities— VT • Rhythm — Regular • Rate — 170 bpm • Axis — Normal • Abnormalities— VT pattern of vt
  • 21. 14- Ischemic heart disease (ihd) • STEMI (ST-Elevation Myocardial Infarction) * S-T Segment Elevation * May Be T Wave Inversion # Septal MI (STE In V1-V2) —> Lt. Anterior Descending Artery (LAD) # Apical MI (STE In V3-V4) —> Distal LAD # Anterio-Lateral MI (STE In V5-V6) —> LAD + Lt. Circumflex Artery (LCX) # Lateral MI (STE In I, aVL) —> Proximal LCX # Inferior MI (STE In II, III, aVF) —> Rt. Coronary Artery + Distal LCX • Rhythm — Sinus & Regular • Rate — 78 bpm • Axis — Lt. AD • Abnormalities— Septal MI • Rhythm — Sinus & Regular • Rate — 83 bpm • Axis — Lt. AD • Abnormalities— Anterio-lateral MI • Rhythm — Sinus & Regular • Rate — 83 bpm • Axis — Normal • Abnormalities— Inferior & Antero-Lateral MI - - - - - - I ↓ 2i aV I I - > - - - - -
  • 22. • Non- STEMI (Angina) * S-T Segment Depression • Rhythm — Sinus & Regular • Rate — 83 bpm • Axis — Normal • Abnormalities— Non-SEMI • Rhythm — Sinus & Regular • Rate — 88 bpm • Axis — Normal • Abnormalities— Non-SEMI • Rhythm — Sinus & Regular • Rate — • Axis — Lt. AD • Abnormalities— Non-STEMI Note/ Pt. With STEMI Will Be +ve Cardiac Biomarkers (Troponin)
  • 23. 15- Pulmonary Embolism (S1 Q3 T3) • S Wave Will Be Deep In Lead I • Q Wave Will Be Deep In Lead III • T Wave Will Be Inverted In Lead III • Rhythm — Sinus & Regular • Rate — 120 bpm • Axis —Rt. AD • Abnormalities— PE • Rhythm — Sinus & Regular • Rate — 125 bpm • Axis — Rt. AD • Abnormalities— PE • Rhythm — Sinus & Regular • Rate — 90 bpm • Axis — Rt. AD • Abnormalities— Non-SEMI Note/ Often Rt. AD & Tachycardia - - - - - - - - - - - -
  • 24. 16- Peri-Carditis • P-R Interval Depression • S-T Elevation • Rhythm — Sinus & Regular • Rate — 63 bpm • Axis — Normal • Abnormalities— Peri-Carditis • Rhythm — Sinus & Regular • Rate — 71 bpm • Axis — Normal • Abnormalities— Peri-Carditis • Rhythm — Sinus & Regular • Rate — 88 bpm • Axis — Normal • Abnormalities— Non-SEMI Note/ In STEMI Will See S-T Segment Depression In Some Leads .. In Peri-Carditis Don’t See S-T Segment Depression Often In All Leads - R R 4 T - P B S S - - - - - - - - - -
  • 25. 17- Ectopic Beat • PVC (Premature Ventricular Contraction * Wide QRS Complex “In Ectopic Beat” * Usually Followed By Full Compensatory Pause Premature is The Beat That Occurs Earlier Than Would Be Expected For The Next Sinus Impulse Patterns Of PVC: 1- Bi-Geminy (1 Normal Beat : 1 PVC Beat) • Rhythm — Irregular • Rate — 60 bpm • Axis — Normal • Abnormalities— PVC (Bigeminy) 2- Tri-Geminy (2 Normal Beat : 1 PVC Beat) • Rhythm — Irregular • Rate — 60 bpm • Axis — Normal • Abnormalities— PVC (Trigeminy) 3- Quadri-Geminy (3 Normal Beat : 1 PVC Beat) • Rhythm — Irregular • Rate — 60 bpm • Axis — Normal • Abnormalities— PVC (Quadrigeminy) - - - - - - 1 PVC: / Normal Pa Wave te - - - - 2Normal: IPVC i ~ Fra i -Exc W C i - - - - - 3Normal; I PVC i ~ - I E x - - -
  • 26. 4- Couplet (2 Normal Beat : 2 PVC Beat) • Rhythm — Irregular • Rate — 60 bpm • Axis — Normal • Abnormalities— PVC (Quadrigeminy) PVC N N N N N N N N N PVC PVC PVC PVC PVC PVC PVC 1 2 3 4 5 6 7 8 9 - - - - 2 Normal: 2 PVC
  • 27. • PAC (Premature Atrial Complex or Contraction) * Non-Sinus Rhythm * Normal QRS Complex * Post-Extra Systolic Pauses Patterns Of PAC: 1- Bi-Geminy (1 Normal Beat : 1 PAC Beat) • Rhythm — Irregular • Rate — 60 bpm • Axis — Lt. AD • Abnormalities— PAC (Bigeminy) Note/ Pauses After PAC Beat Distance Between Normal Beat Is Constant The Other Patterns Sameness To PVC - = ~ .
  • 28. 18- Hyper-kalaemia • Peaked T Wave • P Wave Flattening • P-R Interval Prolongation • Wide QRS Complex • Rhythm — Regular • Rate — 110 bpm • Axis — Normal • Abnormalities— Hyper-Kalaemia • Rhythm — Regular • Rate — 100 bpm • Axis — Normal • Abnormalities— Hyper-Kalaemia • Rhythm — Regular • Rate — 100 bpm • Axis — Normal • Abnormalities— Hyper-Kalaemia n - - > - - - - 3 = 100bPM - - - - 300 = 100bPM
  • 29. 19- ARVC (Arrhythmogenic Rt. Ventricular Cardiomyopathy) • T Wave Inverted In V1,V2 & V3 • QRS Complex Wide In V1, V2 & V3 • Epsion Wave In V1, V2 & V3 • Rhythm — Sinus & Regular • Rate — 65 bpm • Axis — Rt. AD • Abnormalities— ARVC Epsion Wave • Rhythm — Regular • Rate — 55 bpm • Axis — • Abnormalities— ARVC - - - -
  • 30. 20- Sinus arrhythmia • Irregular Rhythm Only • Rhythm — Sinus & Irregular • Rate — 60 bpm • Axis — Normal • Abnormalities— Sinus Arr. • Rhythm — Sinus & Irregular • Rate — 60 bpm • Axis — Normal • Abnormalities— Sinus Arr. • Rhythm — Sinus & Irregular • Rate — 100 bpm • Axis — Normal • Abnormalities— Sinus Arr. R R R 4 T T P P P S S S 5.2 5.1 4.4 3 33 - - - R ↑ , x pR+ P ↑ 44 4 3.2 2,431 3.2 3.4444 3.4 - - - e n 2.2 2.2 4.9 2132,24,2 292124.2 214 212 4.2 2,3 2,2
  • 31. 21- Wellen’s Syndrome • T Wave Inversion In Lead V2 & V3 • Recent History Of Angina • Normal Or Slightly Elevated Serum Cardiac Markers • Rhythm — Sinus & Regular • Rate — 79 bpm • Axis — Normal • Abnormalities— Wellen’s Syndrome • Rhythm — Sinus & Regular • Rate — 50 bpm • Axis — Lt. AD • Abnormalities— Wellen’s Syndrome Note/ Often With Lt. AD - - - - - - - -
  • 32. 22- WPW (Wolff-Parkinson-White Syndrome) • P-R Interval Short • Delta Wave • Rhythm — Sinus & Regular • Rate — 70 bpm • Axis — Rt. AD • Abnormalities— WOW • Rhythm — Sinus & Regular • Rate — 60 bpm • Axis — Normal or Rt. AD • Abnormalities— WOW - - - - - - - -
  • 33. 23- Rt. Bundle Branch Block • M Shape In R Wave In Lead V1 or V2 • May be W Shape In R Wave In Lead V5 • Rhythm — Sinus & Regular • Rate — 83 bpm • Axis — Lt. AD • Abnormalities— RBBB • Rhythm — Sinus & Regular • Rate — 54 bpm • Axis — Normal • Abnormalities— WOW ‫ﻣ‬ َ ‫ﻦ‬ ‫ﻛ‬ ُ‫ﻨ‬ ‫ﺖ‬ ُ ‫ﻣ‬ َ ‫ﻮ‬ ‫ﻻ‬ َ ‫ﻩ‬ ‫ﻓ‬ َ ‫ﻌ‬ ‫ﲇ‬ . ‫ﻣ‬ َ ‫ﻮ‬ ‫ﻻ‬ َ ‫ﻩ‬ ‫ﻣ‬ َ ‫ﻦ‬ ‫ﻛ‬ ُ‫ﻨ‬ ‫ﺖ‬ ُ ‫ﻣ‬ َ ‫ﻮ‬ ‫ﻻ‬ َ ‫ﻩ‬ ‫ﻓ‬ َ ‫ﻌ‬ ‫ﲇ‬ . ‫ﻣ‬ َ ‫ﻮ‬ ‫ﻻ‬ َ ‫ﻩ‬ .. - > - - - - ↳ msinsi
  • 34. 23- Lt. Bundle Branch Block • M Shape In R Wave In Lead V5 or V6 • May Be W Shape In R Wave In Lead V1 or V2 • Rhythm — Sinus & Regular • Rate — 60 bpm • Axis — Lt. AD • Abnormalities— LBBB - - - Sensiti ↳19... Exx19
  • 35. ‫ﰻ‬ ‫ﻛ‬ ‫ﻴ‬ ‫ﺲ‬ ‫ﳛ‬ ‫ﺘ‬ ‫ﺎ‬ ‫ج‬ ‫ﻫ‬ ‫ﺴ‬ ‫ﱰ‬ ‫ي‬ ‫و‬ ‫ا‬ ‫ﻛ‬ ‫ﺰ‬ ‫ا‬ ‫م‬ ‫ﻗ‬ ‫ﺒ‬ ‫ﻞ‬ ‫ا‬ ‫ي‬ ‫ا‬ ‫ﻧ‬ ‫ﻔ‬ ‫ﺴ‬ ‫ـ‬ ‫ﺘ‬ ‫ﻜ‬ ‫ﻴ‬ ‫ﺸ‬ ‫ﻦ‬ ‫و‬ ‫ﺑ‬ ‫ﻌ‬ ‫ﺾ‬ ‫ا‬ ‫ﻟ‬ ‫ﻜ‬ ‫ﻴ‬ ‫ﺴ‬ ‫ﺎ‬ ‫ت‬ ‫ﳓ‬ ‫ﺘ‬ ‫ﺎ‬ ‫ج‬ ‫ا‬ ‫ﻧ‬ ‫ﺴ‬ ‫ـ‬ ‫ﺘ‬ ‫ﻜ‬ ‫ﻴ‬ ‫ﺸ‬ ‫ﻦ‬ L ‫ﱐ‬ ‫ﻏ‬ ‫ﲑ‬ ‫ا‬ ‫ل‬ ECG ‫ﺣ‬ ‫ﱴ‬ ‫ﻧ‬ ‫ﻮ‬ ‫ﺻ‬ ‫ﻞ‬ ‫ﻟ‬ U ‫ا‬ ‫ﻳ‬ ‫ﻜ‬ ‫ﻨ‬ ‫ﻮ‬ ‫ﺳ‬ ‫ﺲ‬ ‫ا‬ ‫ﻟ‬ ‫ﺼ‬ ‫ﺤ‬ ‫ﯿ‬ ‫ﺢ‬ ‫ﳑ‬ ‫ﻜ‬ ‫ﻦ‬ ‫ﳓ‬ ‫ﺘ‬ ‫ﺎ‬ ‫ج‬ ‫ا‬ ‫ﻳ‬ ‫ﻜ‬ ‫ﻮ‬ ، ‫ا‬ ‫ﻧ‬ ‫ﺰ‬ ‫ﳝ‬ ‫ﺎ‬ ‫ت‬ ‫ا‬ ‫ﻟ‬ ‫ﻘ‬ ‫ﻠ‬ ‫ﺐ‬ ، ‫ا‬ ‫ﳒ‬ ‫ﯿ‬ ‫ﻮ‬ ‫ﻛ‬ ‫ﺮ‬ ‫ا‬ ‫ﰲ‬ ‫و‬ ‫ﻏ‬ ‫ﲑ‬ ‫ﻫ‬ ‫ﻦ‬ …
  • 36. For Other Cause Or Note
  • 37. For Other Cause Or Note
  • 38. For Other Cause Or Note
  • 39. For Other Cause Or Note