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The Normal & Abnormal ECG

The Normal & Abnormal ECG. دکتر تابان متخصص داخلی و فوق تخصص قلب و عروق. The Normal & Abnormal ECG. Waveforms. All Limb Leads. Lead Placement. aVF. EKG Distributions. Anteroseptal: V1, V2, V3, V4 Anterior: V1–V4 Anterolateral: V4–V6, I, aVL Lateral: I and aVL

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The Normal & Abnormal ECG

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  1. The Normal & Abnormal ECG دکتر تابانمتخصص داخلی و فوق تخصص قلب و عروق

  2. The Normal & Abnormal ECG

  3. Waveforms

  4. All Limb Leads

  5. Lead Placement aVF

  6. EKG Distributions • Anteroseptal: V1, V2, V3, V4 • Anterior: V1–V4 • Anterolateral: V4–V6, I, aVL • Lateral: I and aVL • Inferior: II, III, and aVF • Inferolateral: II, III, aVF, and V5 and V6

  7. Rhythm • Sinus • Originating from SA node • P wave before every QRS • P wave in same direction as QRS

  8. What is this rhythm? Normal sinus rhythm

  9. What is the heart rate? www.uptodate.com 300 / 6 = 50 bpm 1500 / 30 = 50

  10. The QRS Axis • Represents the overall direction of the heart’s activity • Axis of –30 to +90 degrees is normal

  11. The Quadrant Approach QRS up in I and up in aVF = Normal

  12. Normal Intervals • PR • 0.20 sec (less than one large box) • QRS • 0.08 – 0.10 sec (1-2 small boxes) • QT • 450 ms in men, 460 ms in women • Based on sex / heart rate • Half the R-R interval with normal HR

  13. RHYTHEM • HR : Bradycardia or tachycardia • Pause • Premature beat • blocks

  14. What is this rhythm?

  15. What is this rhythm?

  16. Premature Atrial Contractions Trigeminy pattern

  17. What is this rhythm?

  18. What is this rhythm?

  19. Tachyarrhythmia Regular • Narrow QRS • Wide QRS = VT or SVT +aberrancy Irregular- irregular • AF • MAT

  20. Supraventricular Tachycardia Retrograde P waves Narrow complex, regular; retrograde P waves, rate <220

  21. Ventricular Tachycardia

  22. What is this rhythm?

  23. What is this rhythm?

  24. What is this rhythm?

  25. What is this rhythm?

  26. What is this rhythm?

  27. What is this rhythm?

  28. Accelerated Idioventricular Ventricular escape rhythm, 40-110 bpm Seen in AMI, a marker of reperfusion

  29. Junctional Rhythm Rate 40-60, no p waves, narrow complex QRS

  30. AV- Blocks AV blocks First degree block PR interval fixed and > 0.2 sec Second degree block, Mobitz type 1 PR gradually lengthened, then drop QRS Second degree block, Mobitz type 2 PR fixed, but drop QRS randomly Type 3 block PR and QRS dissociated

  31. What is this rhythm? First degree AV block PR is fixed and longer than 0.2 sec

  32. What is this rhythm?

  33. First Degree Heart Block PR interval >200ms

  34. What is this rhythm? Type 1 second degree block (Wenckebach)

  35. What is this rhythm?

  36. First Degree Heart Block, Mobitz Type I (Wenckebach) PR progressively lengthens until QRS drops

  37. What is this rhythm? Type 2 second degree AV block

  38. What is this rhythm?

  39. Second Degree Heart Block, Mobitz Type II PR interval fixed, QRS dropped intermittently

  40. What is this rhythm? 3rd degree heart block (complete)

  41. What is this rhythm?

  42. Bundle branch block • RBBB • LBBB

  43. Left Bundle Branch Block Monophasic R wave in I and V6, QRS > 0.12 sec Loss of R wave in precordial leads QRS T wave discordance I, V1, V6 Consider cardiac ischemia if a new finding

  44. Right Bundle Branch Block V1: RSR prime pattern with inverted T wave V6: Wide deep slurred S wave

  45. Ischemia & MI

  46. What do you see in this EKG? ST depression II, III, aVF, V3-V6 = ischemia

  47. What is the diagnosis? Acute inferior MI with ST elevation in leads II, III, aVF

  48. Wellen’s Sign ST elevation and biphasic T wave in V2 and V3 Sign of large proximal LAD lesion

  49. Lateral MI Reciprocal changes

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