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ECGs (again!)

ECGs (again!). Mary L. Dohrmann, MD Professor of Clinical Medicine Division of Cardiovascular Medicine. ECG Interpretation. Practice! Practice! Practice!. http://ecg.bidmc.harvard.edu/maven/mavenmain.asp. What is ECG Wave-Maven?

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ECGs (again!)

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  1. ECGs (again!) Mary L. Dohrmann, MD Professor of Clinical Medicine Division of Cardiovascular Medicine

  2. ECG Interpretation Practice! Practice! Practice!

  3. http://ecg.bidmc.harvard.edu/maven/mavenmain.asp What is ECG Wave-Maven? Proficiency in electrocardiogram (ECG) interpretation is an essential skill for medical students, housestaff, and clinicians. However, medical school and postgraduate resources to develop and upgrade the necessary high level of "ECG literacy" are severely limited. Further, current textbook and classroom instructional materials do not adequately integrate ECG interpretation into specific contexts where waveform findings must be correlated with other clinical data. We have begun to address the limitations in traditional approaches to ECG pedagogy by creating the infrastructure for a unique web-based tutorial.

  4. ECG Interpretation Observation Conclusion Clinical context/significance

  5. Rhythm Sinus Not sinus Morphology Supravent. Ventricular

  6. Morphology Hierarchy WPW > LBBB > LVH > MI

  7. The Normal ECG

  8. The Normal ECG Sinus rhythm (P before @ QRS) Rate 50 – 100 bpm Axis +90o to –30o Intervals: PR .12-.21 sec QRS <.10 sec QTc<.46 sec (observed QT⁄ √ (RR) interval)

  9. 51 y/o male with chest pain100% occlusion of a diagonal (also had 3 vessel disease, normal LVEF)

  10. 29 y/o with chest painDiffuse ST elevation c/w pericarditis, ?PR segment depression

  11. 47 y/o male with chest painAcute inferior MI – culprit vessel RCA

  12. 41 y/o male with severe SOBExtensive anterior/anterolateral MI

  13. 54 y/o male with exertional chest painAMI, indeterminate age; RBBB and left axis

  14. 60 y/o comatose s/p MVALow voltage Simple cifferential of low voltage: air, fat, fluid, no muscle

  15. 60 y/o with chest painLVH with LAD, ST-T abn, & LAE In patient with angina and LVH, always think of aortic stenosis and hypertrophic cardiomyopathy in differential diagnosis

  16. 40 y/o with chest pain & palpitationsshort PR/delta wave c/w preexcitation (WPW) – note pseudo-Qs inferiorly

  17. 70 y/o with exertional chest painLBBB If need stress test in this patient, use pharmacologic stress with adenosine combined with imaging modality (sestamibi or cardiac MRI)

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