This document summarizes an ECG conference that reviewed basic ECG principles and interpretation methodology. It presented several patient cases to demonstrate sinus rhythm, atrial arrhythmias, STEMI patterns, ischemia, wide complex tachycardia, conduction blocks, axis deviations, AV nodal reentrant tachycardia, Brugada syndrome, digoxin toxicity, and more. The conference emphasized analyzing the ECG in terms of rhythm, axis, waveforms, and overall clinical picture.

1. 
ECG ConferenceECG Conference
Henry Tran, MDHenry Tran, MD
January 13, 2016January 13, 2016

2. Goals
 Review basic principles of EKG
 RHYTHM: Identify sinus vs atrial arrhythmias
 Recognize patterns of STEMI
 Recognize patterns of ischemia
 Distinguish Wide Complex Tachycardia: Ventricular
Tachycardia vs. Aberrant Conduction

3. Conduction System

4. ECG

5. Positioning Precordial Leads

6. 12 Lead ECG

7. Axis

8. ECG Interpretation Methodology
 #1 Rhythm: what rhythm governs the atria
 Sinus or Not sinus
 AV Block
 Bundle Branch Conduction
 #2 Axis:
 Look for LAFB or Right Axis
 #3 Waveform Analysis
 #4 The Big Picture

9. Pt #1 Bruce Stage 2

10. P Waves: ? Sinus or Ectopic
SINUS P WAVE IS UPRIGHT IN LEAD I and LEAD II

11. Pt #1 Resting ECG prior to regular exercise stress test

12. Pt #1 Bruce Stage 1, 2:45 min

13. Pt 2

14. Pt 3

15. Typical Atrial Flutter

16. ECG Interpretation Methodology
 #1 Rhythm: what rhythm governs the atria
 Sinus or Not sinus
 AV Block
 Bundle Branch Conduction
 #2 Axis:
 Look for LAFB or Right Axis
 #3 Waveform Analysis
 #4 The Big Picture

18. Mobitz I Wenckebach
• Although it is possible to syncopize due
to Mobitz I, it is generally considered
benign and a normal variant
• If you see it at night during sleep, not an
emergency

20. Mobitz 2

21. Where’s the block?
Mobitz I
Mobitz II

22. Pt 3

23. Don’t miss this…

24. Conduction in AVRT
Orthodromic Antidromic

26. Vi / Vt

27. Bundle Branch Blocks

28. LAFP
•Axis >45o
•qR in I, AVL
LPFP
•Very rare
• >100o

29. V TACH!!!
Axis Deviation: Causes
NORMAL
Northwest LEFT
RIGHT
Lead
I
Lead aVF
•normal finding in children
and tall thin adults
•RVH
•COPD
•ASD/VSD
•PE
•Anterolateral MI
•left posterior hemiblock (>125 degree)
•left anterior hemiblock (>-45o
)
•Q waves of inferior MI
•WPW-Right Pathway
LVH DOES NOT CAUSE LEFT AXIS

31. Pt 6

32. WPW

33. Pt 7

34. Pt 8: 43 yo female complains of chest tightness

35. 55 yo male POD #1 s/p laminectomy, remains
intubated

36. Don’t Miss This…
Don’t Miss These…

37. 27 yo asian male complains of malignant syncope
NO TERMINAL S WAVE AS IN RBBB

38. Brugada Syndrome
• Channelopathy: Na+ SCN5A, L-Type calcium
• Increase epicardial dispersion of repolarization in the RV

39. 44 yo male with schizophrenia and HCV complains of chest pain:

40. 83 yo male hx of afib on coumadin brought to ER due to poor PO intake:

41. Accelerated junctional rhythms

44. 33 yo male with no PMHX complains of chest pain x 3 hrs. Do you give kayexalate?

45. 25 yo female complains of palpitations and dizziness. What imaging modality should
be ordered next?

46. Digoxin Toxicity LBBBLVH
GUESS THE REPOLARIZATION ABNORMALITY!

47. Summary
 What’s the rhythm?????

48. Thanks!