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The normal ECG

The normal ECG. Normal sinus rhythm Each p wave followed by a QRS Normal P waves P wave rate 60-100bpm. Sinus bradycardia. Sinus tachycardia. QRS axis. P waves. Height <2.5mm in lead II Width < 11msec in lead II. Right atrial hypertrophy. M shaped p wave in II

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The normal ECG

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  1. The normal ECG

  2. Normal sinus rhythm • Each p wave followed by a QRS • Normal P waves • P wave rate 60-100bpm

  3. Sinus bradycardia

  4. Sinus tachycardia

  5. QRS axis

  6. P waves • Height <2.5mm in lead II • Width < 11msec in lead II

  7. Right atrial hypertrophy

  8. M shaped p wave in II Prominent negative component in V1

  9. Left atrial hypertrophy M shaped p wave in II Prominent negative component in V1

  10. PR interval • 0.12to 0.2 sec (3-5 small squares)

  11. 2nd degree AV block divided into two types by Mobitz

  12. 2nd degree AV block divided into two types by Mobitz

  13. 2nd degree AV block divided into two types by Mobitz Alias “Wenkebach”

  14. QRS duration • <012sec • If wider then BBB • LBBB (WiLLiaM) • s wave in V1-V3 • rsr pattern in V5-V6 • RBBB (MaRRoW) • rsr in V1

  15. QTc interval (normal 0.42sec) • ST segment • T wave • U wave

  16. Hyperkalaemia

  17. Breathlessness increasing over years ... Difficult

  18. Right ventricular hypertrophy Dominant R in V1 Right axis …… = Mitral stenosis + pulmonary hypertension! + Left atrial abnormality

  19. What now?

  20. Atrial fibrillation with pre-excitation DC Cardioversion or iv procainamide NOT digoxin, verapamil, beta blockers, adenosine...

  21. Inferior myocardial infarction & 4:3 Wenkebach block (i.e. at node)

  22. Trifascicular block Lateral Q’s (A.S.H.) Voltage criteria for LVH HOCM!

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