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Good lesson

1. ECG Interpretation

2.  Discuss basic ECG findings.  Explain high risk findings on ECG.  Identify ECG findings.  Conditions that predispose to sudden cardiac death  Arrhythmias most commonly seen in the college population

3. I. Rate II. Rhythm III. IV. V. VI. VII. VIII. IX. X. Axis P wave PR interval PR segment QRS complex ST segment T wave QT duration U wave XI.

4. I. II. Rate Rhythm III. IV. V. VI. VII. VIII. IX. X. Axis P wave PR interval PR segment QRS complex ST segment T wave QT duration U wave XI.

5.  How to Estimate HR:  1) 30 Large Boxes = 6 seconds  HR = # QRS or P wave x 10 4x10 40/min 16x10 160/min

6.  How to Estimate HR:  2) RR Interval (# Big Boxes)  HR = 300 150 100 75 60 50 43 37 33 30 #1 #2 #3 #4 #5 #6 #7 #8 #9 #10 #7 43/min #2 150/min

7.  Normal  60-100/min  Bradycardia  <60/min  Tachycardia  >100/min

8. Calculate HR

9. I. Rate II. Rhythm Axis P wave PR interval PR segment QRS complex ST segment T wave III. IV. V. VI. VII. VIII. IX. X. QT duration U wave XI.

10. Normal Sinus rhythm P wave regular proceed each QRS R to R will be regular

11. Ecg?

12.  Atrial Fibrillation  Atrial Flutter  Junctional  SVT

13.  First Degree AV Block  Second Degree AV Block Type 1  Second Degree AV Block Type 2  Third Degree AV Block

14.  Ventricular Fibrillation  Ventricular Tachycardia  Torsade de Pointes

15. I. Rate II. Rhythm III. Axis IV. V. P wave PR interval PR segment QRS complex ST segment T wave VI. VII. VIII. IX. X. QT duration U wave XI.

16.  Normal (-30 - +100)  Lead I R+ R+  Lead AVF

17.  LAD (>-30)  RAD (>+100)  Lead I  Lead I R+ neg R+  Lead AVF neg  Lea

18. I. II. Rate Rhythm III. Axis IV. P wave V. PR interval PR segment QRS complex ST segment T wave QT duration U wave VI. VII. VIII. IX. X. XI.

19.  Atrial Contraction  Normal  <2-3 mm amplitude  <0.11 second width  Gently rounded  Upright in I, II, AVF, V4-6  Inverted in AVR  Diphasic or inverted in III  Variable in AVL, V1-2

20.  Atrial enlargement/dilatation  Increased Amplitude (>2-3mm)  Increased Width (>0.12 second)  Ectopic atria or AV junctional  Inversion  Absence  AV junctional  SA block

21. Abnormal ECG finding LAE

22. I. II. III. Rate Rhythm Axis IV. P wave V. PR interval VI. VII. VIII. IX. X. XI. PR segment QRS complex ST segment T wave QT duration U wave

23.  Beginning P wave to beginning QRS  Atria through AV junction  Normal  0.12-0.20 second

24. I. II. III. IV. V. Rate Rhythm Axis P wave PR interval VI. PR segment VII. VIII. IX. X. XI. QRS complex ST segment T wave QT duration U wave

25.  End P wave to beginning QRS  Normal  Isoelectric  Displaced  Atrial infarction  Acute pericarditis

26. I. II. III. IV. V. Rate Rhythm Axis P wave PR interval PR segment VI. VII. QRS complex VIII. IX. X. ST segment T wave QT duration U wave XI.

27.  Ventricular depolarization  Normal  Duration 0.08 - 0.10 seconds  greater of 0.12 is regarded abnormal  Q wave  Normal but Small (<0.03 second)  V5-V6, II, III, AVF

28.  SV1 + RV5 or RV6  >35mm OR  R Lead I >14mm OR  R aVL >12mm

29.  R V1 + S V5 >10.5 mm  RAD

30.  ECG Findings:  LVH  ST seg  T wav

31.  ECG Findings  Sinus Tachycardia   S1  RBBB

32.  LBBB  RBBB

33.  ECG  V1 rSR, wide R  V6 qRS, wide S  Complete: >0.12 s  Causes  Pulmonary embolism  COPD with pulmonary hypertension  RVH

34.  ECG  V1 Wide QS or rS  V6 Wide, tall R No Q  Complete: >0.12 s  Causes  Hypertensive heart disease  Valvular lesions  Cardiomyopathy  LVH

35. I. II. III. IV. V. VI. VII. Rate Rhythm Axis P wave PR interval PR segment QRS complex VIII. ST segment IX. X. XI. T wave QT duration U wave

36.  J pt (QRS takeoff) to beginning T wave  Beginning ventricular repolarization  Normal  Isoelectric  <1mm elevation limb  <2mm elevation chest  <0.5mm depression

37.  Depression  >0.5mm depression  Causes  Myocardial ischemia  Hypokalemia  Elevation  >1mm elevation limb  >2mm elevation chest  Causes  Myocardial ischemia  Acute pericarditis  Hyperkalemia 

38.  ECG Findings:  Right precordial (V1-3)  ST elevation  T wave inversi

39.  ECG Findings:  ST elevations  PR depression

40. I. II. Rate Rhythm III. IV. V. VI. VII. VIII. Axis P wave PR interval PR segment QRS complex ST segment IX. T wave X. XI. QT duration U wave

41.  Ventricular repolarization  Normal  Upright I, II, V3-V6  Inverted AVR  Variable III, AVL, AVF, V1-2  <5mm limb  <10mm chest

42.  ECG Findings:  Tall, Peaked T waves

43. I. II. Rate Rhythm Axis III. IV. V. VI. VII. VIII. IX. P wave PR interval PR segment QRS complex ST segment T wave X. QT duration XI. U wave

44.  Beginning QRS to end T wave  Total ventricular re/depolarization  Normal  QTc <0.44 sec Male  QTc <0.46 sec Female

45. I. II. Rate Rhythm III. IV. V. VI. VII. VIII. IX. X. Axis P wave PR interval PR segment QRS complex ST segment T wave QT duration XI. U wave

46.  Final phase ventricular repolarization  Normal  Small, rounded  Prominent  Hypokalemia  Drugs  Quinidine, phenothiazine  CVA  Negative  MI, LVH

47.  ECG Findings  Prolonged QT interval  Flat T wave  Prominent U  Hypokalemia

48. Interpret the following ECG

49. END