Easy ECG for generl practitioner in low hospital.ppt

Easy ECG for generl practitioner in low hospital

1. Easy ECG
ANDREAS KRISTIAN, MD

3. Epigastric pain.

5. Conduction system

7. WHAT TO READ
SINUS OR NOT?
RATE
AXIS
P WAVE (pulmonal or mitral)
PR INTERVAL (prolonged or shortened)
QRS COMPLEX (narrow or wide and height)
ST SEGMENT (depression or elevation)
T WAVE (inversion)

8. HOW TO CONCLUDE
E.g : sinus rhythm, 80x/m, normoaxis with P pulmonal, RBBB no ST-T Changes
E.g : sinus rhythm, 80x/m, RAD with ST Depression in v1-v3

10. SINUS RHYTHM
Sinus means the wave comes from SA node
Should have an upright P wave in lead II. (also in wave II, aVF, V2-V6)
Every single P wave should Always be followed by one QRS complex
The heart rate is about 60-99 bpm

11. Rate
300 : large boxes (300 dibagi jarak R ke R dalam kotak besar)
1500 : small boxes (1500 dibagi jarak R ke R dalam kotak kecik)
Hitung jumlah gelombang R selama 6 detik, dikalikan 10.
(1 detik = 5 kotak besar)

13. Axis
Look at QRS complexes at lead I and aVF
I (+) & aVF (+)  normoaxis
I (+) & aVF (-)  normo/ left axis deviation (LAD), jika aVL nya positif.
I (-) & aVF (-) look at lead III and aVR. If lead III (+)  right axis deviation. Look
at lead aVR, if aVR (+)  right axis deviation (RAD) (whatever the position of the
III wave is)
I (+) & aVL (+)  Left Axis Deviation (LAD)

17. AXIS

22. P wave
Look at the II and v1 leads!
The normal P wave is explained by activation first of the right atrium and
then of the left atrium.
Duration: < 120 ms
Amplitude: < 2.5 mm in the limb leads, < 1.5 mm in the precordial leads
Normal P wave is upright in lead II and avF, if the P wave is inverted or
downright, then the rhythm doesn’t come from SA node or the rhythm is
not sinus rhythm. It would be an ectopic rhythm or junctional rhythm (see
later).

24. P wave

28. PR Interval
The normal duration of the PR interval is three to five small squares (0.12-
0.20 s).

29. PR Interval
> 0,20 s  AV block
< 0,12 s  Junctional escape rhythm, pre-excitation syndrome.

30. PR Interval
Av block 1
st
degree

31. 2
nd
degree type 1 av block

32. Pre-excitation syndromes
WPW syndrome
LGL syndrome

34. QRS Complex
The QRS complex represents the electrical forces generated by ventricular
depolarization.
Assess The width and the height.
The duration of the QRS complex should not exceed two and a half small
squares (0.10 s).
> 0,12 s  complete bundle branch block / ventricular origin complex
The height of QRS complex, represents the width of ventricular muscle.

37. ST segment (depression or elevation)
The ST segment is the flat, isoelectric section of the ECG between the end
of the S wave and the beginning of the T wave.
Look at the ‘J’ point.

38. ST Segment

43. ST elevation
Causes ST segment elevation and Q-wave formation in contiguous leads,
either:
Septal = V1-2
Anterior = V3-4
Anteroseptal = V1-4
Anterolateral = V3-6, I + aVL
Extensive anterior  / anterolateral = V1-6, I + aVL
Inferior = II, III, aVF
Posterior = V7-9

48. ST Depression
ST depression can be either upsloping, downsloping, or horizontal.
Horizontal or downsloping ST depression ≥ 0.5 mm at the J-point in ≥
2 contiguous leads indicates myocardial ischaemia (according to the 
2007 Task Force Criteria).

50. T Wave

52. Common arrhytmhias

54. Thank you
Treat the patient, not the ECG!