back to medical school ecg interpretation – made easy ! dr rob sapsford the yorkshire heart centre...
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![Page 1: Back to Medical School ECG interpretation – made easy ! Dr Rob Sapsford The Yorkshire Heart Centre Leeds General Infirmary](https://reader035.vdocuments.us/reader035/viewer/2022062314/56649f1f5503460f94c37b7e/html5/thumbnails/1.jpg)
Back to Medical SchoolECG interpretation – made easy !
Dr Rob Sapsford
The Yorkshire Heart Centre
Leeds General Infirmary
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ECG’s have become more convenient
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LV
RV
LA
RA
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Lead error
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Lead error
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Normal ECG
4 large squares
300/large squares = rate
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Machine reported as “old inferior infarct”
Pathological Q-wave
•>25% r wave
•>1 small square across
Clinical context
Be wary of overly sensitive ECG machine computer reports
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Incomplete RBBB
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RBBB
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LBBB
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1.
QT interval
QT interval
Normal up to 12 small squares (dependent rate)
(0.450s)
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QT Interval Calculation
TangentBaselin
e
QT
R-R interval
QT Interval = QT / R-R interval
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Case studies
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LVH (several criteria) simple rule:
Limb lead (I / AVL) – 12 mmHg >
Chest leads (V1 S + V5/6 R) => 35 mmHG
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Atrial fibrillation – fast ventricular response
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Sinus tachycardia
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SOB 60 yr old woman
Left Bundle Branch Block
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Intermittent palpitations at rest
Ventricular ectopy
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1st degree AV block (heart block)
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2nd degree AV block (Mobitz type II)
2:1 AV block
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Exercise intolerant 73 yr old man
3rd degree AV block (complete heart block)
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Atrial flutter with 2:1 block
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AF and complete heart block
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78 year old woman; chest pain yesterday
acute coronary syndrome- widespread ischaemia
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Chest pain - acute
Anterior septal acute coronary syndrome
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Sharp chest pain worse lying flat
Pericarditis
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Acute inferior ST elevation MI
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Palpitations
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Broad complex tachycardia
RVOT VT
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Summary
• Review of ECG interpretation• Rate, Rhythm, (Axis) • P wave, QRS and relationship• Common pitfalls
• Can be difficult– The computer is overly sensitive, but can be helpful– Someone to discuss with is reassuring