fatima ryalat, md research and teaching assistant physiology department
TRANSCRIPT
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ECG Interpretation
Fatima Ryalat, MDResearch and Teaching Assistant
Physiology Department
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We diagnose PATIENTS not ECG
Always stick to your own methodology analyzing ECG so as
not to miss anything.
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MethodologyCheck for:ID, date, timeRhythmRateAxisWaves, intervals, segments
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Normal ECG
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Normal Sinus Rhythm:
Regular R-R intervals( card method).
every QRS complex is preceded by a P wave.
Normal P-R intervals
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Heart Rate
If the heart rate is regular (equal distances between Rs) :
HR= 300/ no. Of large squares within R-R interval
orHR= 1500/ no. Of small squares
within R-R interval
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Normal Heart Rate60- 100 bpm
if < 60 : sinus Bradycardiaif >100 :sinus Tachycardia
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Normal Axis
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Normal Axis
We look at limb leads only.if leads (I and II) +ve, then normal cardiac axis.
RULE OF THUMBS
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Normal P wave
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Normal P-R interval3- 5 ss (120- 200 ms)
Normal QRS complex<3 ss (120 ms)
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Normal QT interval
QT c= QT /sq root (R-R)<=0.44 s
or< 50% of R-R interval
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Normal ST segmentisoelectric ( in comparison to
the T –P segment)
T waveNormally inverted in aVR ,V1,
v2 +/- v3, III.
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Abnormalities in ECG
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How to calculate Heart Rate in irregular rhythm?
Count the Rs in 30 large squares then multiply by 10
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Axis deviation
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LAD
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RAD
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P wave
Present
Normal Morpholog
y
Abnormal Morpholog
y
Abscent
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P wave
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P PulmonalePeaked P wave in RA hypertrophy
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P MitraleBifid P wave in LA hypertrophy
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P-R INTERVAL•12
0 – 200 ms ( 3-5 ss)
Normal
•Heart Block
•> 5 ss
Prolonged
•< 3 ss
•WPW
Shortened
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wide QRS( >3 ss) = ventricular abnormality
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ST segment
Iso electric(normal)
Elevated(MI or
Pericarditis)
Depressed(Ischemia)
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NL T wave Inverted
Hyper acute(MI)
Peaked(hyperkalem
ia)
Flat(hypokalemi
a)
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Abnormal Rhythm
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Atrial Rhythm
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Ventricular RhythmVentricular Tachycardia and
Ventricular Fibrillation
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Atrioventricular Rhythms(Conduction Blocks)
Heart Block( 3 degrees)
Bundle Branch Block
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LBBB
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RBBB
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GOOD LUCK