ecg abnormalities for MBBS student made easy

All ECG abnormalities in one ppt

1. ECG Abnormalities Group C (67-100) Presented by Roll no :85, 91

2. Ischemia Obstruction of blood flow to heart muscle There are 2 types of Ischemia takes place Transmural Ischemia Subendocardial Ischemia

3. Transmural Ischemia ECG changes go through certain phases: Hyperacute Acute Evolving Fully evolved Healed

4. Hyperacute Phase Due to Initial blockage of coronary vessel Tall, peaked and symmetrical T waves in affected lead.

5. Acute phas e ST segment elevation > 1mm above the borderline (one small box) It should be 2 or more contiguous lead

6. Evolving Phase T wave elevation converted into T Wave inversion Till this period ischemia is going on

7. Fully evolved phase Here Infarction occurs which is seen by deep Q waves Also called as pathological Q waves What counts as a deep Q waves is that - > 0.04 secs or > 1 small box If >⅓ Rd of the R wave

8. Healed phase Pathology Q Wave will persist even all other ECG Changes have Reversed to the normal position

9. Localization of MI on ECG

10. Comment: Anterior lateral wall MI with septal involvement

11. Subendocardial ischemia ( NSTEMI) Classical hallmark is ST segment depression

12. T wave inversion It also shows subendocardial Ischemia Initial phase when Ischemia is developing before st segment depression there is T wave inversion Is should be elevated in >2 continuous leads except lead 3, aVR and v1

13. ECG Changes in Electrolyte Imbalances

14. Hyperkale mia

15. Hypokalemia

16. Hypocalcemia Decreases myocardial contractility Lengthens the phase 2 of action potential

17. Hypercalcemia Increase of myocardial contractility Shortens Phase 2 action potential

18. ECG Changes in Hypertrophy Right Atrial Enlargement (RAE) 1. Tall P waves – especially in leads II, III, and aVF 2. Peaked P wave (P-pulomanle) Left Atrial Enlargement (LAE) 1. Broad, notched ("M"-shaped) P wave in lead I 2. Biphasic P wave in lead V1 (P mitrale)

19. Left Ventricular Hypertrophy (LVH) : 1. Increased QRS Voltage Lead V5 and V6 → Prominent R wave. Lead V1 and V2 → Deep S wave. 2. Left Axis Deviation (LAD) 3. Left Ventricular Strain Pattern ST segment depression and T wave inversion in lateral leads 4. Prolonged QRS Duration

20. Right Ventricular Hypertrophy (RVH) 1. Right Axis Deviation (RAD) 2. Dominant R Wave in Lead V1 Tall R wave in V1 or R/S ratio > 1. 3. Deep S Wave in Lateral Leads (V5–V6) 4. Narrow QRS Complex

21. ECG Changes in Arrhythmias Arrhythmias are broadly classified into: Tachyarrhythmias (fast rhythms) Bradyarrhythmias (slow rhythms)

22. I. Sinus Tachycardia Rate: 100–160bpm P wave: Normal, upright in leadII QRS: Normal, narrow

23. 1.Atrial Tachycardia (AT) Narrow QRS Rhythm:Regular P wave:Uniform,Abnormal Morphology RP:Long,PR:Short II. Atrial Tachyarrhythmias

24. 2 . Atrial Fibrillation (AF) Rhythm: Irregularly irregular P waves: Absent; replaced by fibrillatory (f) waves QRS: Normal, narrow Ventricular rate: Variable

25. 3 . Atrial Flutter Rhythm: Regular or irregular Atrial rate: ~300 bpm Flutter waves: “Saw-tooth” appearance, best in II, III, aVF AV block: Commonly 2:1 → ventricular rate ~150 bpm

26. III. Ventricular Tachyarrhythmias 1. Ventricular Tachycardia (VT) Rate: 100–250 bpm P waves: Absent or AV dissociation QRS: Wide (> 120 ms), bizarre morphology Monomorphic (uniform QRS) or Polymorphic (varied QRS)

27. 2. Torsades de Pointes(TdP) Form of polymorphic VT QRS: Varies in amplitude and axis (twisting pattern) QT interval: Prolonged preceding the episode Associated with: Hypokalemia, hypomagnesemia, drugs

28. 3. Ventricular Fibrillation (VF) ECG: Chaotic, irregular, no identifiable P, QRS, or T waves Heart is not pumping — Cardiac Arrest Immediate defibrillation required

29. Bradyarrhythmias 1.SA Node dysfunction(Sick sinus syndrome) Absent P wave Sinus bdaycardia Sinus Pause /arrest Suno -atrial exit Tachy-brady syndrome

30. 2.Idioventricular Rhythm Rate:15-40 bpm Wide QRS complex Absent P wave Rhythm: Regular/Irregular

31. ECG CHANGES IN CONDUCTION BLOCKS 1.AV Blocks:1st degree 2nd degree(Mobitz type 1 & 2) 3rd degree 2.Bundle Branch Block:Right & Left

32. I. Atrioventricular (AV) Block 1. First-Degree AV Block: Delayed conduction through AV node. Prolonged PR interval > 0.20 sec Every P wave is followed by a QRS complex

33. 2. Second-Degree AV Block (a) Mobitz Type I (Wenckebach) Progressive lengthening of PR interval Followed by a dropped QRS complex Grouped beating (cycles of increasing PR followed by dropped beat) Block site:AV Node

34. (b) Mobitz Type II Constant PR interval with intermittent non-conducted P waves Dropped QRS occurs suddenly, without prior PR prolongation Block Site: Below AV node (His-Purkinje system)

35. 3. Third-Degree (Complete) AV Block No relation between P waves and QRS complexes Atria and ventricles beat independently (AV dissociation) Escape rhythm seen (narrow or wide QRS depending on level) Block Site: AV node or below

36. II. Bundle Branch Blocks (BBB) 1. Right Bundle Branch Block (RBBB) QRS duration ≥ 0.12 sec RSR' pattern in V1 (“M-shaped” complex) Wide S wave in leads I and V6

37. 2 . Left Bundle Branch Block (LBBB) QRS duration ≥ 0.12 sec Absent Q wave in I, V5, V6 Broad, notched (M-shaped) R wave in V6, I ST-T changes (discordant T wave inversions)

38. Wolff-Parkinson-White(WPW) syndrome Short PR interval Delta waves Wide QRS complex

39. Thank you