The document provides information on normal ECG interpretation, including what an ECG measures, how it is recorded, the major waves and intervals of a normal ECG, and how to analyze ECGs. It describes the P wave, QRS complex, T wave, and other normal ECG components. It also outlines the normal rates, intervals, axes, and wave progression seen on ECG.
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.
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.
Review of the anatomy and physiology
Review of the conduction system
ECG:basics term,
ECG RECORDING: leads, electrodes, waveforms and intervals
Determining heart rate
ECG Analysis/Interpretation
-Normal ECG & Abnormal ECG
This presentation will enable the fresh medical/nursing and other health professionals to understand basics of ECG along with they can able to interpret in beginning.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
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2 Case Reports of Gastric Ultrasound
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Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
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.
Anti ulcer drugs and their Advance pharmacology ||
Anti-ulcer drugs are medications used to prevent and treat ulcers in the stomach and upper part of the small intestine (duodenal ulcers). These ulcers are often caused by an imbalance between stomach acid and the mucosal lining, which protects the stomach lining.
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Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
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It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
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A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
3. INTRODUCTION
• The electrocardiogram (ECG) is one of the
simplest and oldest cardiac investigations
available, yet it can provide a wealth of useful
information and remains an essential part of the
assessment of cardiac patients.
• With modern machines, surface ECGs are quick
and easy to obtain at the bedside and are based
on relatively simple electrophysiological
concepts.
4. What is an ECG?
An ECG is simply a representation of the electrical
activity of the heart muscle as it changes with
time, usually printed on paper for easier analysis.
Like other muscles, cardiac muscle contracts in
response to electrical depolarization of the muscle
cells. It is the sum of this electrical activity, when
amplified and recorded for just a few seconds that
we know as an ECG.
5. Recording the EKG
Basics:
• ECG graph:
1 mm small squares
5 mm large squares
• Paper speed
25 mm/sec standard
6. The vertical lines measure amplitude or voltage
Each small box represents 0.1 Mv
Each large block (made up of 5 small boxes)
represents 0.5 mV
The horizontal lines measure time
Each small box equals 0.04 seconds
2. Each large block (made up of 5 small boxes)
equals 0.2 seconds (multiply 0.04 x 5 = 0.2)
7.
8.
9. Major waves of a single
normal ECG pattern
• P wave: Represents Atrial depolarization,
initiated by the SA node.
Characteristics:
1.width <3 small squares (0.12 sec) and height <2.5 mm
2.Upward in leads I,II and inverted in lead aVR. This is
called sinus’ P’ wave.
3.P wave after the QRS Complex(Retrograde P wave) or
inverted P wave indicates its origin from other source.
10.
11.
12. QRS complex
It Represents ventricle depolarization This
also happens to coincide with the part of the cardiac
cycle when the myocardial cells in the atria are
repolarizing.
The impulse is slightly delayed at the AV node
before entering the ventricles through the Common
AV Bundle.
13. Characteristics
• Completely negative in lead aVR, maximum
positivity in lead II
• Normal duration between 0.08 and 0.10 sec,
not more than 0.12 sec.
• Physiological Q wave not >0.03 sec.
• In a right ventricular lead (V1) the S wave is
greater than the R wave the height of the R wave
in the left ventricular leads (V5, V6) is less than
25 mm
16. J-point
Is the end of the QRS complex and the beginning of
the ST segment.
17. Normal T wave
• It Represents Re polarization of
ventricles.
• Same direction as the preceding QRS
complex
• Height <5mm in limb leads and <10 mm in
precordial leads
• Smooth contours
• May be tall in athletes
18. The normal U Wave
It represents re polarization of purkinje fibers
and/or the ventricular septum.
The most neglected of the ECG waveforms
• U wave amplitude is usually < 1/3 T wave amplitude in
same lead.
• U wave direction is the same as T wave direction in that
lead.
• U waves are more prominent at slow heart rates and
usually best seen in the right precordial leads.
19. 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
21. Normal intervals
• PR interval: (measured from the beginning of
the P wave to the first deflection of the QRS
complex). Normally lasts 0.12 and 0.20 seconds.
(3 – 5 small squares on ECG paper).
• QRS Interval: (measured from first deflection of
QRS complex to end of QRS complex at
isoelectric line). Interval usually lasts between
0.08 and 0.12 seconds. (3 small squares on
ECG paper).
22.
23. R-R interval - The RR interval represents the
amount of time between heart beats. Thus, the
RR interval is heart rate dependent.
In fact, most of our methods for determining
heart rate from the EKG are dependent on
measuring the RR interval. For example if there
is 0.6 seconds between beats, and there are 60
seconds per minute, then the heart rate would be
100 beats per minute [(60 sec/minute / (0.6
sec/beat)].
24. • QT interval (measured from first deflection of
QRS complex to end of T wave at isoelectric
line). it is usually about 0.35 seconds in duration,
but the duration of the QT interval is very heart
rate dependent.
• ST segment - Is the segment between the J
point (the end of the QRS complex) and the
beginning of the T wave.
25. ECG Interpretation
What is your approach to reading an ECG?
•Rate
•Rhythm
•Axis
•Wave morphology
•Intervals and
•Segment analysis
26.
27. The rule of 300
No of big
boxes
Rate (apprx)
1 300
2 150
3 100
4 75
5 60
6 50
28. 10 second rule
• As most ECG record 10 seconds of rhythm per
page, one can simply count the number of beats
present on the ECG and multiply by 6 to get the
number of beats per seconds.
• Rate: (Number of waves in 10 second
strips)x6
• This method works well for irregular rhythm
29. Count QRS in 10 second rhythm strip x 6 use this
method to determine rate when rhythm is irregular
(e.g., atrial fibrillation)
30. Rhythm
Look at the rhythm strip below and answer the
questions
• Are P waves present?
• yes
• Is there a P wave before every QRS complex and a QRS
complex after every P wave?
• yes
• Are the P waves and QRS complexes regular?
• yes
• Is the PR interval constant?
• yes
Yes to all these
questions, so this is
normal sinus rhythm!
31. Normal Sinus Rhythm
ECG rhythm characterized by a usual rate
of anywhere between 60 and 100 beats per
min.
Every P wave must be followed by a QRS
And every QRS is preceded by P wave.
Normal duration of PR interval is 3-5 small
squares
• The P wave is upright in leads I and II.
32. Axis
Axis is the general flow of electricity as it
passes through the heart
The QRS axis represents the net overall
direction of the heart’s electrical activity.
35. The Quadrant Approach
• Examine the QRS complex in Leads I and aVF to
determine if they are predominantly positive or
predominantly negative.
• The combination should place the axis into one of the 4
quadrants below.
I AVF Axis
+ + Normal
+ - LAD
- + RAD
36.
37.
38. • To determine cardiac axis look at QRS complexes
of lead II ,III.
AXIS LEAD II LEADIII
Normal Positive Positive/negativ
e
Right axis
deviation
Positive Positive
Left axis
deviation
Negative Negative
45. CONCLUSION
ECG NORMAL VALUES:
Heart rate 60 - 100 bpm
PR interval 0.12 - 0.20 s
QRS interval ≤ 0.12 s
QT interval < half RR interval (males < 0.40 s;
females < 0.44 s) .
P wave amplitude (in lead II) ≤ 3 mV (mm)
P wave terminal negative deflection (in lead V1) ≤ 1
mV (mm)Q wave < 0.04 s (1 mm) and < 1/3 of R
wave amplitude in the same lead.
Editor's Notes
SLIDE STARTS WITH QUESTION ONLY
Ask interns about their method for interpreting an ECG.
Emphasize the importance of interpreting an ECG always in the same order so that nothing is missed.
Question will appear first in presentation, then answers.
Rate — Ask interns to define normal rate, bradycardia and tachycardia. Square counting: 300-150-100-75-60-42 or count number of QRS complexes in rhythm strip and multiply by 6 (especially for atrial fibrillation).
1st Example: Normal sinus rhythm
2nd Example: Third degree heart block
No P waves – atrial fibrillation
Left Axis Deviation (LAD)
Right Axis Deviation (RAD)
The cardiac axis refers to the mean direction of the wave of ventricular depolarization in the frontal plane, measured from a zero reference point. Normal is anywhere from -30 degrees to +90 degrees