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ECG PRACTICAL APPROACH

ECG PRACTICAL APPROACH. Dr. Hossam Hassan Consultant Emergency Medicine. Objectives. To emphasize simplicities Practical approach Interpretation & clinical scenario are inseparable Systematic approach. Conduction System. Nomenclature. Magic numbers of Dr. Hossam. 3. 5. Rate

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ECG PRACTICAL APPROACH

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  1. ECG PRACTICAL APPROACH Dr. Hossam Hassan Consultant Emergency Medicine

  2. Objectives • To emphasize simplicities • Practical approach • Interpretation & clinical scenario are inseparable • Systematic approach

  3. Conduction System

  4. Nomenclature

  5. Magic numbers of Dr. Hossam 3 5

  6. Rate Rhythm axis P-wave PR interval QRS complex ST segment T-wave Systematic approach 3 5

  7. Rate • The interval between 2 successive R-wave • How many big squares? • Divide 300 / # big squares • Normal 60 – 100/min 5 3

  8. Rhythm Sinus Rhythm Every P=wave is followed by QRS complex P-wave is upright in lead II

  9. NSR

  10. Types of Sinus Rhythm • NSR • Sinus Tachycardia • Sinus Bradycardia • Sinus arrhythmia

  11. Sinus tachycardia

  12. Axis • Normal axis • Right axis deviation • Left axis deviation

  13. RAD

  14. LAD

  15. P-wave • Atrial depolarization • Atrial contraction is a result • Normally a dome-like structure

  16. Abnormalities of P-wave • Peaked p-pulmonle • Pulmonary HTN • PE • Pulmonary valve stenosis • M-shaped M-mitrale • Mitral valve stenosis • Left atrial hypertrophy • Inverted 2nd atrial / junctional ectopy

  17. P-pulmonale

  18. PR interval • Definition From the start of P to beginning of QRS • Represent the delay in transmission in AV node • Normally 0.12 – 0.20 msec 3 5

  19. Abnormalities of PR interval 5 • Prolonged > 1st degree HB • Short < Pre-excitation syndromes • WPW Syndrome • LGL Syndrome Junctional rhythm 3

  20. QRS Complex • Amplitute • Duration • Shape • Q-wave • R-wave 5

  21. QRS AMPLITUTE • LVH By voltage criteria • S-wave in V 1 or V 2 + R-wave in V5 or V6 35

  22. LVH & STRAIN PATTERN

  23. Causes of LVH • HTN • Aortic stenosis • HOCM • Aortic regurgitation • Mitral regurgitation

  24. QRS DURATION • Ventricular depolarization • Ventricular contraction is a result • Normally < 0.12 msec < small squares 3

  25. Causes of wide QRS • Ventricular tachycardia • BBB • Left BBB • Right BBB

  26. L BBB

  27. R BBB

  28. Shape • Upstroke & downstroke of R-wave • Delta wave

  29. Q-wave • 1st negative deflection after the P-wave • Normally 1mm wide & 2 mm deep • Lead III , V5 & V6 Pathological Q-wave Wider & deeper >1/4 of the ensuing R-wave Old MI

  30. +ve R-wave in V1

  31. Causes +ve R-wave in V I • RVH • R BBB • Posterior MI • Type A WPW

  32. ST-Segment • From the end of S-wave to the beginning of T-wave • Normally iso-electric • Abnormalities • Elevated • depressed

  33. Elevated ST segment • Acute MI • Pericarditis • Early repolarization pattern in the young

  34. Infarct localization • Inferior • Lead II , III , aVF • Septal • V I , V II • Anterior • V3 , V4

  35. Lateral • Lead I , AVL,V5 , V6 • Posterior MI - Prominent R wave in V1,V2 with depressed ST segment

  36. Acute inf MI

  37. Anteroseptal MI

  38. Anterior MI

  39. Lateral MI

  40. Depressed ST Segment • Unstable angina • Left ventricular strain pattern

  41. LVH & strain pattern

  42. T-wave • Ventricular repolarization • Dome like structure • Abnormalities • Peaked / tented t-wave • Hyperkalaemia • Subendocadial ischemia • Inverted • LV Strain pattern • Dynamic t-wave changes of ischemia

  43. DYNAMIC T-WAVE CHANGES

  44. Hay….. wake up we are done

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