1 / 320

LBBB BY DR BASHIR ASSOCIATE PROF MEDICINE SOPORE KASHMIR

ECG MADE EASY FOR MEDICAL STUDENTS AND DOCTORS

drbashir
Download Presentation

LBBB BY DR BASHIR ASSOCIATE PROF MEDICINE SOPORE KASHMIR

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 BASICS By Dr Bashir Ahmed DarChinkipora Sopore KashmirAssociate Professor MedicineEmail drbashir123@gmail.com

  2. From Right to Left • Dr.Smitha associate prof gynae • Dr Bashir associate professor Medicine • Dr Udaman neurologist • Dr Patnaik HOD ortho • Dr Tin swe aye paeds

  3. From RT to Lt • Professor Dr Datuk rajagopal N • Dr Bashir associate professor medicine • Dr Urala HOD gynae • Dr Nagi reddy tamma HOD-opthomology • Dr Setharamarao Prof ortho

  4. ELECTROGRAPHY MADE EASY • ULTIMATE AIM TO HELP PATIENTS

  5. ECG machine

  6. Limb and chest leads • When an ECG is taken we put 4 limb leads or electrodes with different colour codes on upper and lower limbs one each at wrists and ankles by applying some jelly for close contact. • We also put six chest leads at specific areas over the chest • So in reality we see only 10 chest leads.

  7. Position of limb and chest leads Four limb leads Six chest leads V1- 4th intercostal space to the right of sternum V2- 4th intercostal space to the left of sternum V3- halfway between V2 and V4 V4- 5th intercostal space in the left mid-clavicular line V5- 5th intercostal space in the left anterior axillary line V6- 5th intercostal space in the left mid axillary line

  8. LA LV RA RV V4 V1 V2 V2 V3 V3 V5 V5 V6 V6 V1 V4 Horizontal plane - the six chest leads 6.5

  9. Colour codes given by AHA

  10. ECG Paper: Dimensions 5 mm 1 mm Voltage ~Mass 0.1 mV 0.04 sec 0.2 sec Speed = rate

  11. ECG paper and timing • ECG paper speed = 25mm/sec • Voltage calibration 1 mV = 1cm • ECG paper - standard calibrations • each small square = 1mm • each large square = 5mm • Timings • 1 small square = 0.04sec • 1 large square = 0.2sec • 25 small squares = 1sec • 5 large squares = 1sec

  12. After applying these leads on different positions then these leads are connected to a connector and then to ECG machine. • The speed of machine kept usually 25mm/second.calibration or standardization done while machine is switched on.

  13. ECG paper 1 Small square = 0.04 second 1 Large square = 0.2 second 5 Large squares = 1 second Time 2 Large squares = 1 cm 6.1

  14. The first step while reading ECG is to look for standardization is properly done. • Look for this mark and see that this mark exactly covers two big squares on graph.

  15. STANDARDISATION ECG amplitude scale Normal amplitude 10 mm/mV Half amplitude 5 mm/mV Double amplitude 20 mm/mV

  16. ECG WAVES • You will see then base line or isoelectric line that is in line with P-Q interval and beginning of S-T segment. • From this line first positive deflection will arise as P wave then other waves as shown in next slide. • Small negative deflections Q wave and S wave also arise from this line.

  17. ECG WAVES

  18. The Normal ECG Normal Intervals: PR 0.12-0.20s QRS duration <0.12s QTc 0.33-0.43s

  19. Simplified normal Position of leads on ECG graph • Lead 1# upward PQRS • Lead 2# upward PQRS • Lead 3# upward PQRS • Lead AVR#downward or negative PQRS • Lead AVL# upward PQRS • Lead AVF# upwards PQRS

  20. Simplified normal Position of leads on ECG graph • Chest lead V1# negative or downward PQRS • Chest leads V2-V3-V4-V5-V6 all are upright from base line .The R wave slowly increasing in height from V1 to V6. • So in normal ECG you see only AVR and V1 as negative or downward defelections as shown in next slide.

  21. Normal ECG Slide 13

  22. NSR

  23. P-wave • Normal P wave length from beginning of P wave to end of P wave is 2 and a half small square. • Height of P wave from base line or isoelectric line is also 2 and a half small square.

  24. Normal values up in all leads except AVR. Duration. < 2.5 mm. Amplitude. < 2.5 mm. Abnormalities 1. Inverted P-wave Junctional rhythm. 2.Wide P-wave(P- mitrale) LAE 3.Peaked P-wave (P-pulmonale) RAE 4. Saw-tooth appearance Atrial flutter 5. Absent normal P wave Atrial fibrillation P-wave

  25. P wave height 2 and half small squares ,width also 2 and half small square

  26. Shape of P wave • The upward limb and downward limbs of P wave are equal. • Summit or apex of P wave is slightly rounded.

  27. P pulmonale & P mitrale • P pulmonale-Summit or apex of P wave becomes arrow like pointed or pyramid shape,the height also becomes more than two small squares from base line. • P waves best seen in lead 2 and V1.

  28. P pulmonale & P mitrale • P mitrale- the apex or summit of p wave may become notched .the notch should be at least more than one small square. • Duration of P becomes more than two and a half small squares.

  29. Slide 14

  30. Slide 16

  31. Left Atrial Enlargement Criteria P wave duration in II >than 2 and half small squares with notched p wave or Negative component of biphasic P wave in V1≥ 1 “small box” in area

  32. Right Atrial Enlargement Criteria P wave height in II >2 and half small squares and are also tall and peaked. or Positive component of biphasic P wave in V1 > 1 “small box” in area

  33. Slide 15

  34. Atrial fibrillation • P waves thrown into number of small abnormal P waves before each QRS complex • The duration of R-R interval varies • The amplitude of R-R varies • Abnormal P waves don’t resemble one another.

  35. Slide 41

  36. Atrial flutter • The P waves thrown into number of abnormal P waves before each QRS complex. • But these abnormal P waves almost resemble one another and are more prominent like saw tooth appearance.

  37. Slide 40

  38. Junctional rhythm • In Junctional rhythm the P waves may be absent or inverted.in next slide u can see these inverted P waves.

  39. Slide 43

  40. Paroxysmal atrial tachycardia • The P and T waves you cant make out separately • The P and T waves are merged in one • The R-R intervals do not vary but remain constant and same. • The heart rate being very high around 150 and higher.

  41. Slide 39

  42. NORMAL P-R INTERVAL • PR interval time 0.12 seconds to 0.2 seconds. • That is three small squares to five small squares.

  43. Definition: the time interval between beginning of P-wave to beginning of QRS complex. Normal PR interval 3-5mm or 3-5 small squares on ECG graph (0.12-0.2 sec) Abnormalities 1. Short PR interval WPW syndrome 2. Long PR interval First degree heart block PR interval

  44. Short P-R interval • Short P-R interval seen in WPW syndrome or pre- excitation syndrome or LG syndrome • P-R interval is less than three small squares. • The beginning of R wave slopes gradually up and is slightly widened called Delta wave. • There may be S-T changes also like ST depression and T wave inversion.

  45. Slide 17

  46. Lengthening of P-R interval • Occurs in first degree heart block. • The P-R interval is more than 5 small squares or > than 0.2 seconds. • This you will see in all leads and is same fixed lengthening .

  47. Slide 44

  48. Q WAVES • Q waves <0.04 second. • That’s is less than one small square duration. • Height <25% or < 1/4 of R wave height.

  49. Normal Q wave

More Related