Ecg ppt

basic concept about ECG interpretation and its gives you idea for differentiation what is normal and abnormal ECG looks

1. ECG PRESENTER: REKHA MARBATE

2. Content Electric wiring of heart Normal ECG PR interval QRS complex Cardiac axis Axial Deviation How to report ECG Example

3. MODERN ECG INSTRUMENT

4. What is an EKG/ECG? • The electrocardiogram (ECG) is a representation of the electrical events of the cardiac cycle. • Each event has a distinctive waveform • the study of waveform can lead to greater insight into a patient’s cardiac patho -physiology.

5. With ECGs we can identify Arrhythmias Myocardial ischemia and infarction Pericarditis Chamber hypertrophy Electrolyte disturbances (i.e. hyperkalemia , hypokalemia ) Drug toxicity (i.e. digoxin and drugs which prolong the QT interval)

6. Depolarization • Contraction of any muscle is associated with electrical changes called depolarization • These changes can be detected by electrodes attached to the surface of the body

7. Pacemakers of the Heart • SA Node - Dominant pacemaker with an intrinsic rate of 60 - 100 beats/minute. • AV Node - Back-up pacemaker with an intrinsic rate of 40 - 60 beats/minute. • Ventricular cells - Back-up pacemaker with an intrinsic rate of 20 - 45 bpm .

8. Sinoatrial node AV node Bundle of His Bundle Branches Purkinje fibers

9. The “PQRST” • P wave – Atrial depolarization • T wave – Ventricular repolarization • QRS – Ventricular depolarization

10. Normal ECG

11. The ECG Paper • Horizontally • Vertically – One small box - 0.04 s – One large box - 0.5 cm – One large box - 0.20 s 1mv signal moves stylus by 1cm

12. Time and speed

13. PR interval If PR interval is short ,suggest excitation takes place through AV conduction or spread/ conduction is abnormally fast from atrium to ventricle

14. QRS complex Duration of QRS complex suggest the time taken for impulse to excite through ventricle. Normally= 0.12 or less, if it is more QRS complex get widen

15. EKG Leads The standard EKG has 12 leads: 3 Standard Limb Leads 3 Augmented Limb Leads 6 Precordial Leads

16. 3 Standard Limb Leads + 3 Augmented leads

17. 6 Precordial Leads

18. Recording an ECG Lat sur RT atrium

19. ECG caliberation Limited amount of information is also provided by height of P wave, QRS complex and T wave ,if machine is properly calibrated. Small complex- pericardial effusion and tall R wave indicate left ventricular hypertrophy

20. Shape of QRS Complex in limb leads

21. Cardiac axis Average direction of spread of depolarization wave through the ventricle as seen from front is called cardiac axis .

22. Axial deviation

23. Rt axial deviation:- rt ventricular hypertrophy, associated with pulmonary condition put strain on rt side of heart and with congenital heart disease. (pulmonary embolus) Lt axial deviation: lt ventricular hypertrophy, mostly problem is conduction defect rather than increase in left ventriclar muscle bulk.

24. Cardiac axis in V leads Transition point: point where R and S are equal indicate position of interventricular septum If right ventricle enlarges to Occupies more of pericardium than normal , transition point move from V3-V4 to V4-V5 or sometime V5-V6, this clockwise rotation suggestive Of chronic lung disease.

25. How to report ECG Rhythm Conduction interval Cardiac axis Descripsion of QRS complex Description of ST segment and T wave

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