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
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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
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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
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-
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S S S S
-
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S 3 S S
=
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R R R R
R R R R
S S S S
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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
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a s
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-
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pi =
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-
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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
-
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R R
P T
P
T
-
S S
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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
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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.
-
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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
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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
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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
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R R
9
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s
-
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R R
4 T 4
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S S
S
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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
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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 =
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-
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-
-
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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
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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
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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
-
=
~
.
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
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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
