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Baby Steps to ECG

Baby Steps to ECG. Dr Saqib Mahmud MRCP(UK), MRCPS(Glasg) , MRCGP. Electrical Conducting system . ECG LEADS. leads representing regions. Anatomic region of heart & associated coronary artery. Inferior MI ----------------RCA Antero-septal MI---------LAD

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Baby Steps to ECG

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  1. Baby Steps to ECG Dr Saqib Mahmud MRCP(UK), MRCPS(Glasg), MRCGP

  2. Electrical Conducting system

  3. ECG LEADS

  4. leads representing regions

  5. Anatomic region of heart & associated coronary artery • Inferior MI----------------RCA • Antero-septal MI---------LAD • Antero-lateral MI---------Circumflex • Posterior MI--------------RCA ----------------------------------------------------------- • Inferior leads-------------II, III, aVF • Antero-septal leads------V1,V2,V3&V4 • Antero-lateral leads------I,aVL,V2-V6

  6. Normal ECGPR interval0.12s-0.2s(not>1 large sq)QRS duration0.12s(not>3 small squares)PQRSTST segmentisoelectricT upright

  7. ECG reporting-systematic approach • Rate • Rhythm & P waves • Conduction intervals • Axis • QRS complexes-narrow, wide, bizarre • ST segments-elevation or depression • T waves-inverted, upright, peaked

  8. How to calculate heart rate Relationship b/w R-R interval (large squares)& heart rate ------------------------------------------------------------------ R-R interval (large squares)heart rate • 1 300 • 2 150 • 3 100 • 4 75 • 5 60 • 6 50

  9. QRS nomenclature

  10. Axis

  11. Cardiac axis • Normal axis-’’ double thumbs up’’(I&III+) • RAD--- I –ve, III +ve • LAD--- I +ve, III –ve • --------------------------------------------- • RAD-(causes): normal in children, R vent hypertrophy, PE, ASD/ VSD, antero-lateral MI • LAD-inferior MI, WpW, emphysema, conduction defects

  12. Bundle branch block • RBBB • Tall R wave V1 • QRS>0.12sec • RsR-V1 • LBBB • QS-V1,V2 • QRS>0.12

  13. LBBB

  14. RBBB+LAD

  15. Atrial flutter & fibrillation • Atrial flutter • Saw tooth appearance • Rapid & regular rhythm • Atrial fibrillation • No P waves or bizarre P waves • Always irregular rhythm • Can be slow or rate controlled

  16. ACS classification

  17. Heart block • 1st degree HB-prolonged PR>0.2sec Causes-increased vagal tone, IHD, Rh fever, dig toxicity, electrolyte imbalance,myocarditis • 2nd degree HB- • Mobitz type 1 or wenckebeck-progressively increased PR,non conducted beat,short PR (causes-inf MI, athelete, drugs-Ca & beta blockers,digoxin) • Mobitz type 2-(2:1) fixed PR, one P wave not folowed by QRS-(causes-degenerative disease of conducting system, anteroseptal MI-may herald CHB)

  18. CHB or 3rd degree HB • Atrial contraction normal-no beats conducted to ventricles • Ventricles excited by slow escape rhythm • ECG-no relationship b/w P waves and Q waves • Bizarre or wide QRS complexes • Causes-degenerative fibrosis of bundle of his, MI, drugs eg betablockers, digoxin

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