1 / 51

ECG Interpretation Criteria Review

ECG Interpretation Criteria Review. Left. Right. Axis Deviation. RAD = If R wave in III > R wave in II LAD = If R wave in aV L > I; and deep S wave in III. Axis Deviation Criteria. Axis Deviation. LAD = possible left anterior fasicular block RAD = possible left posterior fasicular block.

cato
Download Presentation

ECG Interpretation Criteria Review

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. ECG Interpretation Criteria Review

  2. Left Right Axis Deviation • RAD = If R wave in III > R wave in II • LAD = If R wave in aVL > I; and deep S wave in III

  3. Axis Deviation Criteria

  4. Axis Deviation • LAD = possible left anterior fasicular block • RAD = possible left posterior fasicular block

  5. Right Atrial Abnormality Criteria • Tall P waves in lead II • (or III, aVF and sometimes V1)

  6. Left Atrial Abnormality • Lead II (and I) show wide P waves • (second hump due to delayed depolarization of the left atrium) • (P mitrale: mitral valve disease) • V1 may show a bi-phasic P wave • 1 box wide, 1 box deep • (biphasic since right atria is anterior to the left atria)

  7. Right Ventricular Hypertrophy Criteria • In V1, R wave is greater than the S wave - or - R in V1 greater than 7 mm • Right axis deviation • In V1, T wave inversion (reason unknown)

  8. Left Ventricular Hypertrophy Criteria • If S wave in V1 or V2 + R wave in V5 or V6 ≥ 35 mm... • ...or, R wave > 11 (or 13) mm in aVL or I... • ...or, R in I + S in III > 25 mm. • Also • LVH is more likely with a “strain pattern” or ST segment changes • Left axis deviation • Left atrial abnormality

  9. Right Bundle Branch Block Criteria • V1 or V2 = rSR’ - “M” or rabbit ear shape • V5 or V6 = qRS • Large R waves • Right chest leads: T wave inversion (“secondary changes” since they reflect a delay in depolarization not an actual change in depolarization). • Complete RBBB: QRS > 0.12 sec. • Incomplete RBBB: QRS = 0.10 to 0.12 sec.

  10. Left Bundle Branch Block Criteria • Wide QRS complex • V1 = QS (or rS) and may have a “W” shape to it. • V6 = R or notched R and may show a “M” shape or rabbit ears • Secondary T wave inversion • Secondary if in lead with tall R waves • Primary if in right precordial leads

  11. Incomplete Bundle Branch Blocks • RBBB or LBBB where QRS is between .10 and .12 with same QRS features

  12. Left Anterior Fascicular Block • Limb leads • QRS less width less than 0.12 sec. • QRS axis = Left axis deviation (-45° or more) • if S wave in aVF is greater than R wave in lead I • small Q wave in lead I, aVL, or V6

  13. Left Posterior Fascicular Block • Right axis deviation (QRS axis +120° or more) • S wave in lead I and a Q wave in lead III (S1Q3) • Rare

  14. Bifascicular Block • Two of the three fascicles are blocked. • Most common is RBBB with left anterior fascicular block.

  15. Subendocardial Ischemia Partial occlusion Transmural Infarction (MI) Complete occlusion

  16. A. Normal ECG prior to MI • B. Hyperacute T wave changes - increased T wave amplitude and width; may also see ST elevation • C. Marked ST elevation with hyperacute T wave changes (transmural injury) • D. Pathologic Q waves, less ST elevation, terminal T wave inversion (necrosis)  • E. Pathologic Q waves, T wave inversion (necrosis and fibrosis) • F. Pathologic Q waves, upright T waves (fibrosis)

  17. Infarction

  18. Anterior Infarctions • Abnormal Q waves in chest leads • Anterior MI can show loss of R wave progression in the chest leads

  19. Inferior Infarctions • Abnormal Q waves in leads II, III, and aVF

  20. Lateral • Lateral - V5 and V6 • High lateral when ST elevation and Q waves localized to leads I and aVL

  21. Posterior MI • Tall R waves in V1,V2 • R/S ratio > 1 in V1, V2 • The tall, anterior R waves are mirror images of a pathological, posterior Q waves. • Absences of right axis deviation (found with RVH) • ST segment depression in V1-V3 • Often seen with inferior MI

  22. Infarctions or BBB • RBBB & LBBB • T wave inversion and ST segment depression in V1 & V2 (RBBB) and V5 & V6 (LBBB) • MI • T wave inversion and ST segment depression in additional leads • Likely loss of R wave progression

  23. Infarctions and BBB • RBBB and MI • usual ECG changes in leads other than V1 and V2 • septal MI - upright T waves in V1 and V2 • with just RBBB the T waves should be inverted so upright T waves w/ RBBB are “abnormal” and indicated septal MI

  24. Infarctions and LBBB • Infarctions often damage the left bundle branch leading to a new or recent LBBB • expect to see upright T waves in left chest leads • septal MI are very difficult to assess with LBBB

  25. Subendocardial Ischemia • ST Segment depression • Anterior leads (I, aVl and V1-V6) • Inferior leads (II, III, and aVf) • may see ST segment elevation in aVr • T wave inversion • Poor R wave progression

  26. Subendocardial Infarction • No Q waves (non-Q wave infarction) • Persistent ST segment depression • T wave inversion

  27. Sinus Bradycardia • HR less than 60 bpm

  28. Sinus Tachycardia • HR > 100 bpm

  29. Premature Atrial Complexes (PAC) • Normal conduction • Conducted with aberration • a fascicles or bundle branch is refractory • wide QRS • Non-conducted • the AV node was still refractory; P wave will be close to the T wave • no QRS complex

  30. Atrial Tachycardia

  31. Figure 14-6 AV Nodal Reentrant Tachycardia • Rapid recirculating impluse in the AV node area (140-250 beats/min) • No P waves (hidden in QRS complex) or may be just before or after the QRS complex • Negative P waves in lead II

  32. Atrial Flutter • Sawtooth; F waves (easiest seen in II, III, & aVF) • Atrial rate of about 300 bpm • Ventricular rate150, 100 or 75 beats/min • 2:1, 3:1 and 4:1

  33. Atrial Fibrillation • No organized depolarization in atria. • Irregular “f waves” can range from looking almost like P waves to a flat line. • Atrial rate is about 600 bpm • Normal QRS w/ ventricular rate ~110-180 but random & irregular

  34. Junctional Rhythm

  35. Accelerated Junctional Rhythm

  36. WPW

  37. First Degree AV Block

  38. 2nd Degree AV Block, Type 1

  39. 2nd Degree AV Block, Type 2

  40. 2rd Degree AV Block

  41. Premature Ventricular Contractions • Characteristics • Premature and occur before the next normal beat • Wide (> 0.12 ms) and the T wave is usually opposite of the QRS • Bizarre looking • PVCs usually precede a P wave. • A nonsinus P wave may follow the PVC

  42. PVC • Unifocal (monomorphic) PVCs • same appearance in the same lead • small focus • normal and diseased hearts

  43. PVC • Polymorphic (multifocal and multiform) PVCs • different appearance in the same lead • multiform = different coupling intervals • multifocal = same coupling intervals • usually diseased hearts Multiform

  44. Idioventricular Rhythm

  45. Couplet

  46. Triplet

  47. Bigeminy and Trigeminy

  48. Ventricular Tachycardia ...more than three PVCs

  49. Torsades de Pointes

More Related