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Introduction to EKG

Introduction to EKG. And then a little more. To get an accurate EKG, leads must be properly applied:. aVR: RA(-) to [LA & LL(+)] aVL: LA(+) to [RA & LL(+)] aVF: LL(+) to [RA & LA(-)]. I: RA(-) to LA(+) II RA(-) to LL(+) III:LA(-) to LL(+). Precordial lead is +. Normal activation.

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Introduction to EKG

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  1. Introduction to EKG And then a little more

  2. To get an accurate EKG, leads must be properly applied: aVR: RA(-) to [LA & LL(+)] aVL: LA(+) to [RA & LL(+)] aVF: LL(+) to [RA & LA(-)] I: RA(-) to LA(+) II RA(-) to LL(+) III:LA(-) to LL(+) Precordial lead is +

  3. Normal activation

  4. Interpretation: • Rhythm: look for P waves, regularity, reproducible intervals, PR interval, shape • Rate • Axis • Intervals: PR, QRS, QTc • Conduction • R wave progression • ST segments and T waves • Ectopic beats • Q waves: where they should and should not be • Other stuff

  5. Some general guidelines: • P waves • Best seen in lead II • Upright or biphasic (neg component smaller) in V1-V2, upright in V4-V6 • QRS complex • V1 shows rS, V6 shows qR • Size of r wave progressively increases, transition V3-V4 • QRS duration < .120 sec • One R wave in precordial leads should be > 8mm • No R wave in precordial leads > 27mm • Sum of tallest R in left leads and S in right leads should be < 35-40mm • Precordial q waves should not exceed .04 sec nor have a depth greater than ¼ the height of the R wave following • R wave in aVL <12-13mm • ST segment • Should not be more than 1mm above or below baseline. Normal minor elevation in leads with large S waves ( V1-V3) and normal configuration is concave up.

  6. T waves • Often inverted in V1. May be inverted in V2 if already inverted in V1. • Always upright in leads I, II, V3-V6 • Always inverted aVL • U waves • Amplitude usually < 1/3 T wave height in same lead • Direction is same as T wave in that lead

  7. Axis • Frontal plane lead with the sum of r wave and s wave most closely approximates 0. • Look at QRS in the lead perpendicular to original lead • If QRS id positive, axis along that direction. If negative, axis in opposite direction.

  8. Normal axis • Axis- cont Left axis Right axis

  9. Heart block • Normal PR interval < .2 sec • 1st degree AV block- prolonged PR

  10. Heart Block • 2nd degree AV block- Wenchebach- Mobitz 1 • Prolonged PR until dropped QRS • 1st PR interval always the shortest • 1 dropped QRS only • RR intervals shorten

  11. 2nd Degree- 2 to 1 block

  12. 2nd degree type 2- mobitz 2

  13. Complete heart block

  14. Bundle branch block • QRS > .120 sec • RBBB- R-R’ in V1-V2, s wave in lead 1 & V6

  15. LBBB • QRS >.120 sec • Neg QRS in V1 • Lack of small q in lead 1, V5-V6

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