ecg interpretation - eastern illinois universitycfje/5250/12b-interptret… · ppt file · web...
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ECG Interpretation
Chapter 22
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ECG Interpretation
1. Rate
a. Atrial rate: PP interval
b. Ventricular rate: RR interval
2. Rhythm
a. P wave
b. PR interval
c. QRS
i. voltage (height)
ii. width
3. Axis
4. Hypertrophy
5. Blocks
6. Infarct
7. Ischemia
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Standardization
Standardization mark10 mm vertical deflection = 1 mVolt
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Rate
Ventricular rate (heart rate)RR interval
Atrial ratePP interval
3rd degree AV block
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Heart Rate Calculation
1500 divided by the number of small boxes between two R waves
•most accurate•take time to calculate•only use with regular rhythms
1 lg sq = 300 bpm2 lg sq = 150 bpm3 lg sq = 100 bpm4 lg sq = 75bpm5 lg sq = 60 bpm6 lg sq = 50 bpm
300 divided by the number of large boxes between two R waves
•quick•not too accurate•only use with regular rhythm
10 multiplied by the number of R waves in 6 seconds
•less precise•use with irregular rhythms•very quick
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Rhythm
Sinus rhythm - consistent P wavesAtrial rhythm - irregular P wavesJunctional/Nodal rhythm - no P waves, late P waves, or inverted P wavesVentricular rhythm - no P waves, wide QRS
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AV Junctional Rhythms
Retrograde P waves immediately preceding the QRS complexes in aVR and II.Retrograde P waves immediately following the QRS complexesAbsent P waves
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ECG Waves
P waveatrial depolarization
≤ 2.5 mm in amplitude< 0.12 sec in width
PR interval (0.12 - 0.20 sec.)time of stimulus through atria and AV node
prolonged interval = first-degree heart block
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P wave
Tall = RAEWide = LAE
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PR Interval
Long PR interval = first degree AV blockShort PR interval = WPWShort PR interval with inverted P waves = ectopic atrial or junctional pacemaker
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Classification of AV Heart Blocks
Degree AV Conduction Pattern
1St Degree Block Uniformly prolonged PR interval
2nd Degree, Mobitz Type I Progressive PR interval prolongation
2nd Degree, Mobitz Type II Sudden conduction failure
3rd Degree Block No AV conduction
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Wolff-White-Parkinson
Wide QRSdue to early depolarization not due to a delay in depolarization
Shortened PR intervalUpstroke QRS complex is slurred; delta wave
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ECG Waves
QRSwidth 0.12 second or less
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Normal QRS
V1? V1?
V6? V6?
Fig. 4-6
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Normal Q waves
• Septal r wave
• Septal q wave
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Q WavesAbnormal if wider than 0.04 sec
Leads I, II, III, aVf or leads V3 - V6.Greater than 25% of the R waveNote: Not all Q waves are abnormal, Not all Q waves are the result of MI.
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QRS Width
WideRBBB or LBBBPremature ventricular beatsWPW
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QRS Voltage
RVHLVH
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Mean QRS Axis
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Axis Deviation
LEAD ILEAD aVF
(or Lead II or III)
LEAD aVR
Normal Positive Positive
LAD Positive Negative
RAD Negative Positive Positive (or Negative)
Intermediate axis Negative Negative
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R Wave Progression
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Transmural MI
Ischemia Tall T waves (and/or reciprocal T wave inversion)
InjuryST segment elevation.T wave inversion of the previously tall T waves
InfarctPathalogical Q waves
(at least one small box wide or 11/3 the entire QRS height)
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Overview
LEAD AREA OF THE HEART
V1-V2 Anterior/Septum
V3-V4 Anterior Wall
V5-V6 Anterior/Lateral
II, III, aVF Inferior
I and aVL Lateral
V1-V2 Posterior (reciprocal)
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ST SegmentsJ point:
end of QRS wavebeginning of ST segment
ST segmentbeginning of ventricular repolarizationnormally isoelectric (flat)changes, elevation or depression, may indicate pathological condition
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Subendocardial Ischemia
ST segment depression criteria1 mm or morehorizontal or downwardlasts 0.08 secondsdepression of only the J point with rapid upward sloping are considered normal.