ip simclip 2013 electrical ekg basics · ekg basics electrical miha kodela diagnostic andrej...
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IP SimClip 2013
EKG BASICS
Miha Kodela
Andrej Markota
Basics
● recording of heart's
electrical current
● changes in normal
electrical patterns –
diagnostic tool
● cheap and very useful
Conduction system
● spontaneous depolarisations
● synchronus contraction
Waves
+
-
Segments, intervals QRS configurations
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ECG LEADS
STANDARD ECG – 12 leads
Standard and augmented
leads
Precordial leads
SIN
Lead placement
Lead placement
Location on wall
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Vessels
LCX LAD
RCA LCX
LCX LAD
LAD
Standard settings ●Paper speed 25 mm/s
● amplitude 0,1 mV/mm
●
ANALYSIS
● rhythm
● frequency
● axis
● intervals
● QRS morphology
● ST segment , T wave
RYTHM
● P waves?
●QRS following each P wave?
● regularity?
I
aVF
II
V1
HEART RATE
● normal 60-99/min
● tahycardia > 100/min
● bradycardia < 59/min
Axis
•Direction of mean electrical vector
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INTERVALS
● PQ 0,12-0,2s (5 mm)
● QRS 0,12 s (3 mm)
● QTc 450 ms
CONDUCTION BLOCKS
● AV I
● AV II
● Mobitz I / Wenkebach
● Mobitz II
●AV III
QRS MORPHOLOGY
● pathologic Q (width > 1 mm, depth > 1/3 QRS)?
●LBB/RBB, hemiblocks
● R wave progression V1<V2<V3<V4<V5
ST segment, T waves
● normally in baseline
● can be elevated in young healthy inviduals (J point
elevation), with no other pathological changes
●All other elevations or deppresions are pathological!
Normal EKG
sinus rhythm fr. 75/min, normal axis
Case 1
sinus rhythm fr. 75/min,left axis deviation, LBB
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Case 2
sinus tachycardia fr. 130/min, normal axis
Case 3
AF , fr. 80/min, normal axis
Case 4
sinus rhythm fr. 60/min, normal axis, ST eleavtions in II, III, aVF
●Literature:
●http://www.youtube.com/user/umemergencymed
●The Only EKG Book You'll Ever Need; Malcolm
S. Thaler
● Rapid Interpretation of EKG's; Dale Dubin
● Marriott's Practical Electrocardiography; Galen
S. Wagner
HVALA!