aims the ecg complex step by step interpretation rhythm disturbances axis qrs abnormalities acute...
DESCRIPTION
(diagram of ECG complex) 3TRANSCRIPT
![Page 1: Aims The ECG complex Step by step interpretation Rhythm disturbances Axis QRS abnormalities Acute and chronic ischaemia Miscellaneous ECG abnormalities](https://reader036.vdocuments.us/reader036/viewer/2022062317/5a4d1ae27f8b9ab0599778bb/html5/thumbnails/1.jpg)
Aims
• The ECG complex• Step by step
interpretation• Rhythm
disturbances• Axis• QRS abnormalities• Acute and chronic
ischaemia• Miscellaneous ECG
abnormalities
1
![Page 2: Aims The ECG complex Step by step interpretation Rhythm disturbances Axis QRS abnormalities Acute and chronic ischaemia Miscellaneous ECG abnormalities](https://reader036.vdocuments.us/reader036/viewer/2022062317/5a4d1ae27f8b9ab0599778bb/html5/thumbnails/2.jpg)
The ECG Complex
2
![Page 3: Aims The ECG complex Step by step interpretation Rhythm disturbances Axis QRS abnormalities Acute and chronic ischaemia Miscellaneous ECG abnormalities](https://reader036.vdocuments.us/reader036/viewer/2022062317/5a4d1ae27f8b9ab0599778bb/html5/thumbnails/3.jpg)
The ECG Complex• (diagram of ECG complex)
3
![Page 4: Aims The ECG complex Step by step interpretation Rhythm disturbances Axis QRS abnormalities Acute and chronic ischaemia Miscellaneous ECG abnormalities](https://reader036.vdocuments.us/reader036/viewer/2022062317/5a4d1ae27f8b9ab0599778bb/html5/thumbnails/4.jpg)
Nomenclature
• P Wave• QRS complex• T wave• U wave• PR interval• QT interval• RR interval (ventricular) heart rate
4
![Page 5: Aims The ECG complex Step by step interpretation Rhythm disturbances Axis QRS abnormalities Acute and chronic ischaemia Miscellaneous ECG abnormalities](https://reader036.vdocuments.us/reader036/viewer/2022062317/5a4d1ae27f8b9ab0599778bb/html5/thumbnails/5.jpg)
Intra-cardiac electrical conduction
• (diagram of intra cardiac electrical conduction)
5
![Page 6: Aims The ECG complex Step by step interpretation Rhythm disturbances Axis QRS abnormalities Acute and chronic ischaemia Miscellaneous ECG abnormalities](https://reader036.vdocuments.us/reader036/viewer/2022062317/5a4d1ae27f8b9ab0599778bb/html5/thumbnails/6.jpg)
Standard 12 Lead ECG
(Example of normal ECG)
6
![Page 7: Aims The ECG complex Step by step interpretation Rhythm disturbances Axis QRS abnormalities Acute and chronic ischaemia Miscellaneous ECG abnormalities](https://reader036.vdocuments.us/reader036/viewer/2022062317/5a4d1ae27f8b9ab0599778bb/html5/thumbnails/7.jpg)
Standard Times
Interval (ms)
PR 120 – 200
QTc (Corrected for heart rate)
Men: 390-450Women: 390-460
QRS <110
7
![Page 8: Aims The ECG complex Step by step interpretation Rhythm disturbances Axis QRS abnormalities Acute and chronic ischaemia Miscellaneous ECG abnormalities](https://reader036.vdocuments.us/reader036/viewer/2022062317/5a4d1ae27f8b9ab0599778bb/html5/thumbnails/8.jpg)
Step by step interpretation
8
![Page 9: Aims The ECG complex Step by step interpretation Rhythm disturbances Axis QRS abnormalities Acute and chronic ischaemia Miscellaneous ECG abnormalities](https://reader036.vdocuments.us/reader036/viewer/2022062317/5a4d1ae27f8b9ab0599778bb/html5/thumbnails/9.jpg)
Step by step interpretation
• Rate• Rhythm• Axis• QRS complex• ST segments
9
![Page 10: Aims The ECG complex Step by step interpretation Rhythm disturbances Axis QRS abnormalities Acute and chronic ischaemia Miscellaneous ECG abnormalities](https://reader036.vdocuments.us/reader036/viewer/2022062317/5a4d1ae27f8b9ab0599778bb/html5/thumbnails/10.jpg)
RATE
10
![Page 11: Aims The ECG complex Step by step interpretation Rhythm disturbances Axis QRS abnormalities Acute and chronic ischaemia Miscellaneous ECG abnormalities](https://reader036.vdocuments.us/reader036/viewer/2022062317/5a4d1ae27f8b9ab0599778bb/html5/thumbnails/11.jpg)
Rate• Normal heart rate 60-100bpm• Bradycardia < 60bpm• Tachycardia > 100bpm
• Divide tachycardia into ‘broad’ and ‘narrow complex’
• Broad = QRS > 110ms• Narrow = QRS <110ms
11
![Page 12: Aims The ECG complex Step by step interpretation Rhythm disturbances Axis QRS abnormalities Acute and chronic ischaemia Miscellaneous ECG abnormalities](https://reader036.vdocuments.us/reader036/viewer/2022062317/5a4d1ae27f8b9ab0599778bb/html5/thumbnails/12.jpg)
Rhythm
12
![Page 13: Aims The ECG complex Step by step interpretation Rhythm disturbances Axis QRS abnormalities Acute and chronic ischaemia Miscellaneous ECG abnormalities](https://reader036.vdocuments.us/reader036/viewer/2022062317/5a4d1ae27f8b9ab0599778bb/html5/thumbnails/13.jpg)
Regular or irregular?
• Measure R-R interval between different complexes
13
![Page 14: Aims The ECG complex Step by step interpretation Rhythm disturbances Axis QRS abnormalities Acute and chronic ischaemia Miscellaneous ECG abnormalities](https://reader036.vdocuments.us/reader036/viewer/2022062317/5a4d1ae27f8b9ab0599778bb/html5/thumbnails/14.jpg)
Sinus rhythm
Rhythm14
(example showing sinus rhythm)
![Page 15: Aims The ECG complex Step by step interpretation Rhythm disturbances Axis QRS abnormalities Acute and chronic ischaemia Miscellaneous ECG abnormalities](https://reader036.vdocuments.us/reader036/viewer/2022062317/5a4d1ae27f8b9ab0599778bb/html5/thumbnails/15.jpg)
Where else may heart rhythm originate from?
• Atria – Atrial fibrillation– Atrial flutter– Atrial tachycardia
• In/around AV node– nodal ‘junctional’ rhythm– AVNRT/AVRT
• Ventricle– VT/VF
* Will be demonstrated
Rhythm15
![Page 16: Aims The ECG complex Step by step interpretation Rhythm disturbances Axis QRS abnormalities Acute and chronic ischaemia Miscellaneous ECG abnormalities](https://reader036.vdocuments.us/reader036/viewer/2022062317/5a4d1ae27f8b9ab0599778bb/html5/thumbnails/16.jpg)
Atrial Fibrillation
• Erratic atrial depolarisation• No discernible p waves• Rate varies• Irregular
(example showing atrial fibrillation)
Rhythm16
![Page 17: Aims The ECG complex Step by step interpretation Rhythm disturbances Axis QRS abnormalities Acute and chronic ischaemia Miscellaneous ECG abnormalities](https://reader036.vdocuments.us/reader036/viewer/2022062317/5a4d1ae27f8b9ab0599778bb/html5/thumbnails/17.jpg)
Atrial Flutter
• Cyclical electrical activity around right atrium
• Atrial complexes occur at approx 300/min• ‘Sawtooth’ appearance on ECG• Almost always associated with degree of
AV block(example showing atrial flutter)
Rhythm17
![Page 18: Aims The ECG complex Step by step interpretation Rhythm disturbances Axis QRS abnormalities Acute and chronic ischaemia Miscellaneous ECG abnormalities](https://reader036.vdocuments.us/reader036/viewer/2022062317/5a4d1ae27f8b9ab0599778bb/html5/thumbnails/18.jpg)
Junctional (Nodal) Rhythm
• Uncommon• Rhythm arises from around AV node• Narrow complex
(example showing junctional rhythm)
Rhythm18
![Page 19: Aims The ECG complex Step by step interpretation Rhythm disturbances Axis QRS abnormalities Acute and chronic ischaemia Miscellaneous ECG abnormalities](https://reader036.vdocuments.us/reader036/viewer/2022062317/5a4d1ae27f8b9ab0599778bb/html5/thumbnails/19.jpg)
Accelerated ‘Idioventricular’ rhythm
• Unusual• Heart rhythm controlled by ventricular
focus• Usually 60-120bpm
(example showing idioventricular rhythm)
Rhythm19
![Page 20: Aims The ECG complex Step by step interpretation Rhythm disturbances Axis QRS abnormalities Acute and chronic ischaemia Miscellaneous ECG abnormalities](https://reader036.vdocuments.us/reader036/viewer/2022062317/5a4d1ae27f8b9ab0599778bb/html5/thumbnails/20.jpg)
Ventricular tachycardia
• Wide QRS• Heart rate >120bpm• Life-threatening
• (example of VT)
Rhythm20
![Page 21: Aims The ECG complex Step by step interpretation Rhythm disturbances Axis QRS abnormalities Acute and chronic ischaemia Miscellaneous ECG abnormalities](https://reader036.vdocuments.us/reader036/viewer/2022062317/5a4d1ae27f8b9ab0599778bb/html5/thumbnails/21.jpg)
Ventricular Fibrillation
Rhythm21
• (example showing ventricular fibrillation)
![Page 22: Aims The ECG complex Step by step interpretation Rhythm disturbances Axis QRS abnormalities Acute and chronic ischaemia Miscellaneous ECG abnormalities](https://reader036.vdocuments.us/reader036/viewer/2022062317/5a4d1ae27f8b9ab0599778bb/html5/thumbnails/22.jpg)
Bradycardia
• Types– Sinus bradycardia (very rarely less than
40bpm)– Sick sinus syndrome– Slow AF/atrial flutter (usually drug related)– Atrioventricular (AV) block
22
![Page 23: Aims The ECG complex Step by step interpretation Rhythm disturbances Axis QRS abnormalities Acute and chronic ischaemia Miscellaneous ECG abnormalities](https://reader036.vdocuments.us/reader036/viewer/2022062317/5a4d1ae27f8b9ab0599778bb/html5/thumbnails/23.jpg)
Sinus Bradycardia
• (example showing sinus bradycardia)
Rhythm23
![Page 24: Aims The ECG complex Step by step interpretation Rhythm disturbances Axis QRS abnormalities Acute and chronic ischaemia Miscellaneous ECG abnormalities](https://reader036.vdocuments.us/reader036/viewer/2022062317/5a4d1ae27f8b9ab0599778bb/html5/thumbnails/24.jpg)
Sick Sinus Syndrome
• Sinus arrest
• (example of sinus arrest)
Rhythm24
![Page 25: Aims The ECG complex Step by step interpretation Rhythm disturbances Axis QRS abnormalities Acute and chronic ischaemia Miscellaneous ECG abnormalities](https://reader036.vdocuments.us/reader036/viewer/2022062317/5a4d1ae27f8b9ab0599778bb/html5/thumbnails/25.jpg)
AV block
• 1st degree (prolonged PR interval)
• (example of 1st degree AV block)
Rhythm25
![Page 26: Aims The ECG complex Step by step interpretation Rhythm disturbances Axis QRS abnormalities Acute and chronic ischaemia Miscellaneous ECG abnormalities](https://reader036.vdocuments.us/reader036/viewer/2022062317/5a4d1ae27f8b9ab0599778bb/html5/thumbnails/26.jpg)
2nd Degree AV block
• Mobitz type 1 (Wenckebach)
• (Example showing 2nd degree mobitz type 1 block)
Rhythm26
![Page 27: Aims The ECG complex Step by step interpretation Rhythm disturbances Axis QRS abnormalities Acute and chronic ischaemia Miscellaneous ECG abnormalities](https://reader036.vdocuments.us/reader036/viewer/2022062317/5a4d1ae27f8b9ab0599778bb/html5/thumbnails/27.jpg)
2nd Degree AV block
• Mobitz type 2• (Example showing Mobitz type 2 2:1 AV
block)
Rhythm27
![Page 28: Aims The ECG complex Step by step interpretation Rhythm disturbances Axis QRS abnormalities Acute and chronic ischaemia Miscellaneous ECG abnormalities](https://reader036.vdocuments.us/reader036/viewer/2022062317/5a4d1ae27f8b9ab0599778bb/html5/thumbnails/28.jpg)
AV Block
• 3rd degree (complete heart block)
• (Example of complete heart block)
Rhythm28
![Page 29: Aims The ECG complex Step by step interpretation Rhythm disturbances Axis QRS abnormalities Acute and chronic ischaemia Miscellaneous ECG abnormalities](https://reader036.vdocuments.us/reader036/viewer/2022062317/5a4d1ae27f8b9ab0599778bb/html5/thumbnails/29.jpg)
Axis
29
![Page 30: Aims The ECG complex Step by step interpretation Rhythm disturbances Axis QRS abnormalities Acute and chronic ischaemia Miscellaneous ECG abnormalities](https://reader036.vdocuments.us/reader036/viewer/2022062317/5a4d1ae27f8b9ab0599778bb/html5/thumbnails/30.jpg)
Axis
• ‘Mean frontal plane axis’• Determined by vector of dominant
(maximal QRS deflection)• Normal: -30 to 90 degrees• Left deviation -90 to -30 degrees• Right deviation 90 to 180 degrees
Axis30
![Page 31: Aims The ECG complex Step by step interpretation Rhythm disturbances Axis QRS abnormalities Acute and chronic ischaemia Miscellaneous ECG abnormalities](https://reader036.vdocuments.us/reader036/viewer/2022062317/5a4d1ae27f8b9ab0599778bb/html5/thumbnails/31.jpg)
Axis
31
• (diagram explaining axis alongside normal ECG)
![Page 32: Aims The ECG complex Step by step interpretation Rhythm disturbances Axis QRS abnormalities Acute and chronic ischaemia Miscellaneous ECG abnormalities](https://reader036.vdocuments.us/reader036/viewer/2022062317/5a4d1ae27f8b9ab0599778bb/html5/thumbnails/32.jpg)
Axis
• Check leads I and II• If the complexes are both positive: normal• If the complexes ‘Leave’ each other: Left• If the complexes ’Reach’ each other: Right
Axis32
![Page 33: Aims The ECG complex Step by step interpretation Rhythm disturbances Axis QRS abnormalities Acute and chronic ischaemia Miscellaneous ECG abnormalities](https://reader036.vdocuments.us/reader036/viewer/2022062317/5a4d1ae27f8b9ab0599778bb/html5/thumbnails/33.jpg)
QRS abnormalities
33
![Page 34: Aims The ECG complex Step by step interpretation Rhythm disturbances Axis QRS abnormalities Acute and chronic ischaemia Miscellaneous ECG abnormalities](https://reader036.vdocuments.us/reader036/viewer/2022062317/5a4d1ae27f8b9ab0599778bb/html5/thumbnails/34.jpg)
QRS complexes
• Wide? (> 110ms) – Suggests either rhythm arising below AV node or– Conduction delay down bundle of his
QRS abnormalities34
![Page 35: Aims The ECG complex Step by step interpretation Rhythm disturbances Axis QRS abnormalities Acute and chronic ischaemia Miscellaneous ECG abnormalities](https://reader036.vdocuments.us/reader036/viewer/2022062317/5a4d1ae27f8b9ab0599778bb/html5/thumbnails/35.jpg)
Left bundle branch block
QRS abnormalities35
• (diagrams of LBBB and diagram of leads V1 and V6)
![Page 36: Aims The ECG complex Step by step interpretation Rhythm disturbances Axis QRS abnormalities Acute and chronic ischaemia Miscellaneous ECG abnormalities](https://reader036.vdocuments.us/reader036/viewer/2022062317/5a4d1ae27f8b9ab0599778bb/html5/thumbnails/36.jpg)
Right bundle branch block
QRS abnormalities36
• (diagrams of LBBB and diagram of leads V1 and V6)
![Page 37: Aims The ECG complex Step by step interpretation Rhythm disturbances Axis QRS abnormalities Acute and chronic ischaemia Miscellaneous ECG abnormalities](https://reader036.vdocuments.us/reader036/viewer/2022062317/5a4d1ae27f8b9ab0599778bb/html5/thumbnails/37.jpg)
Left/right bundle
WiliaM
MarroW
QRS abnormalities37
• (diagrams of leads V1 and V6)
![Page 38: Aims The ECG complex Step by step interpretation Rhythm disturbances Axis QRS abnormalities Acute and chronic ischaemia Miscellaneous ECG abnormalities](https://reader036.vdocuments.us/reader036/viewer/2022062317/5a4d1ae27f8b9ab0599778bb/html5/thumbnails/38.jpg)
LVH/RVH
• LVH Criteria:– S wave in V1 + tallest R wave in V5 >35mm– Many other criteria – Caution when LBBB present
• RVH criteria:– Dominant R wave (>6mm) V1– Deep S wave >10mm V5 or >3mm V6
38
![Page 39: Aims The ECG complex Step by step interpretation Rhythm disturbances Axis QRS abnormalities Acute and chronic ischaemia Miscellaneous ECG abnormalities](https://reader036.vdocuments.us/reader036/viewer/2022062317/5a4d1ae27f8b9ab0599778bb/html5/thumbnails/39.jpg)
Ischaemia
39
![Page 40: Aims The ECG complex Step by step interpretation Rhythm disturbances Axis QRS abnormalities Acute and chronic ischaemia Miscellaneous ECG abnormalities](https://reader036.vdocuments.us/reader036/viewer/2022062317/5a4d1ae27f8b9ab0599778bb/html5/thumbnails/40.jpg)
Ischaemic territories
Ischaemia40
(Illustrated example showing ischaemic territories)
![Page 41: Aims The ECG complex Step by step interpretation Rhythm disturbances Axis QRS abnormalities Acute and chronic ischaemia Miscellaneous ECG abnormalities](https://reader036.vdocuments.us/reader036/viewer/2022062317/5a4d1ae27f8b9ab0599778bb/html5/thumbnails/41.jpg)
Chronic ischaemia/ Q waves
• Normal in aVR/V1• > ½ small square wide and 1 small square
tall
(example of q wave)
Ischaemia41
![Page 42: Aims The ECG complex Step by step interpretation Rhythm disturbances Axis QRS abnormalities Acute and chronic ischaemia Miscellaneous ECG abnormalities](https://reader036.vdocuments.us/reader036/viewer/2022062317/5a4d1ae27f8b9ab0599778bb/html5/thumbnails/42.jpg)
Acute ischaemia
• T wave inversion
(example of t wave inversion)
Ischaemia42
![Page 43: Aims The ECG complex Step by step interpretation Rhythm disturbances Axis QRS abnormalities Acute and chronic ischaemia Miscellaneous ECG abnormalities](https://reader036.vdocuments.us/reader036/viewer/2022062317/5a4d1ae27f8b9ab0599778bb/html5/thumbnails/43.jpg)
ST depression/elevation
• Describe how far J point is depressed/elevated from isoelectric line
• (diagram of j point)
Ischaemia43
![Page 44: Aims The ECG complex Step by step interpretation Rhythm disturbances Axis QRS abnormalities Acute and chronic ischaemia Miscellaneous ECG abnormalities](https://reader036.vdocuments.us/reader036/viewer/2022062317/5a4d1ae27f8b9ab0599778bb/html5/thumbnails/44.jpg)
Acute ischaemia
• ST depression(example of ST depression)
Ischaemia44
![Page 45: Aims The ECG complex Step by step interpretation Rhythm disturbances Axis QRS abnormalities Acute and chronic ischaemia Miscellaneous ECG abnormalities](https://reader036.vdocuments.us/reader036/viewer/2022062317/5a4d1ae27f8b9ab0599778bb/html5/thumbnails/45.jpg)
Acute ST elevation
Ischaemia45
• (example of acute ST elevation)
![Page 46: Aims The ECG complex Step by step interpretation Rhythm disturbances Axis QRS abnormalities Acute and chronic ischaemia Miscellaneous ECG abnormalities](https://reader036.vdocuments.us/reader036/viewer/2022062317/5a4d1ae27f8b9ab0599778bb/html5/thumbnails/46.jpg)
Miscellaneous Abnormalities
46
![Page 47: Aims The ECG complex Step by step interpretation Rhythm disturbances Axis QRS abnormalities Acute and chronic ischaemia Miscellaneous ECG abnormalities](https://reader036.vdocuments.us/reader036/viewer/2022062317/5a4d1ae27f8b9ab0599778bb/html5/thumbnails/47.jpg)
Digoxin effect
Miscellaneous abnormalities47
• (example of digoxin effect)
![Page 48: Aims The ECG complex Step by step interpretation Rhythm disturbances Axis QRS abnormalities Acute and chronic ischaemia Miscellaneous ECG abnormalities](https://reader036.vdocuments.us/reader036/viewer/2022062317/5a4d1ae27f8b9ab0599778bb/html5/thumbnails/48.jpg)
QT prolongation
• May be acquired or inherited• (ECG of QT prolongation)
Miscellaneous abnormalities48
![Page 49: Aims The ECG complex Step by step interpretation Rhythm disturbances Axis QRS abnormalities Acute and chronic ischaemia Miscellaneous ECG abnormalities](https://reader036.vdocuments.us/reader036/viewer/2022062317/5a4d1ae27f8b9ab0599778bb/html5/thumbnails/49.jpg)
Hypokalaemia
Miscellaneous abnormalities49
• (example of hypokalaemia)
![Page 50: Aims The ECG complex Step by step interpretation Rhythm disturbances Axis QRS abnormalities Acute and chronic ischaemia Miscellaneous ECG abnormalities](https://reader036.vdocuments.us/reader036/viewer/2022062317/5a4d1ae27f8b9ab0599778bb/html5/thumbnails/50.jpg)
Hyperkalaemia
Miscellaneous abnormalities50
• (example of hyperkalaemia)
![Page 51: Aims The ECG complex Step by step interpretation Rhythm disturbances Axis QRS abnormalities Acute and chronic ischaemia Miscellaneous ECG abnormalities](https://reader036.vdocuments.us/reader036/viewer/2022062317/5a4d1ae27f8b9ab0599778bb/html5/thumbnails/51.jpg)
End of session
51