BASICS OF ECG INTERPRETATION

NORMAL E C G

RATE: 60 100/ mts MECHANISM: SINUS (P wave precedes QRS) RHYTHM: REGULAR HEART RATE: 300/ NO OF LARGE BOXES BETWEEN TWO SUCCESSIVE QRS COMPLEXES OR 1500/ NO OF SMALL SQUARES BETWEEN TWO SUCCESSIVE QRS COMPLEXES

E C G: NORMAL WAVES AND INTERVALS

P WAVE:ATRIAL DEP QRS COMPLEX: VENTRICULAR DEP T WAVE: VENTRICULAR REP U WAVE PR INTERVAL QT INTERVAL

E C G: DURATION OF NORMAL WAVES AND INTERVALS

P WAVE:<0.12s WIDTH / HEIGHT PR INTERVAL:0.12s TO 0.2s QRS COMPLEX:<0.12s QT INTERVAL:0.35-0.43s VAT :<0.04s

E C G: DURATION OF NORMAL WAVES AND INTERVALS

Q-T INTERVAL Measured In A Lead With Initial q Wave. Measured From Beginning Of q Wave To End Of T Wave. Shortens With Tachycardia And Lengthens With Bradycardia. Q-T Interval Is Corrected For Rate Of 60, Using Bazetts Formula.

E C G: AXIS
DEF : DIRECTION OF MAXIMUM DEP FRONT NORMAL AXIS: -30 to +110 LEFT AXIS: -30 to -90 RIGHT AXIS: +110 to -1 NORTH WEST AXIS: -90 to -180

HOW TO LOOK FOR AXIS?

METHOD 1: SELECT A LEAD WITH MAXIMUM QRS , AXIS WILL BE TOWARDS THIS LEAD. METHOD 2: SELECT A LEAD WITH EQUIPHASIC QRS, AXIS WILL BE AT 90 TO THIS LEAD. METHOD 3: IF TWO LEADS HAVE QRS OF SAME HEIGHT, AXIS WILL BE BETWEEN TWO SUCH LEADS.

E C G : CHAMBER ENLARGEMENT

E C G: CHAMBER ENLARGEMENT
RT ATRIAL ENLARGEMENT: `P`pulmonale P wave height>2.5mm LT ATRIAL ENLARGEMENT: `P`mitrale -P wave width >2.5mm Notched P wave BIATRIAL ENLARGEMENT: Biphasic P wave in V1 Morris index :P wave depth >2 mm and duration >0.04 s of terminal deflection, suggests LT atrial enlargement

E C G: CHAMBER ENLARGEMENT
ATRIAL ENLARGEMENT

E C G: CHAMBER ENLARGEMENT
ATRIAL ENLARGEMENT

E C G: CHAMBER ENLARGEMENT

RT VENTRICULAR ENLARGEMENT: R wave >7mm in V1 , R/S ratio in V1>1 R in V1+ S in V6 >11mm LT VENTRICULAR ENLARGEMENT: R in V6= R in V5 ; R in V6>20mm S in V1>30mm ; R in V6+ S in V1>35mm Romhilt -Estes Score >5

E C G: CHAMBER ENLARGEMENT
VENTRICULAR ENLARGEMENT

E C G: CHAMBER ENLARGEMENT
RT & LT VENTRICULAR ENLARGEMENT

E C G : HEART BLOCKS

E C G:HEART BLOCKS
TYPES: S A BLOCK A V BLOCK:1 A V BLOCK 2 A V BLOCK (Wenckebach,Mobitz ,2:1 block ) 3A V BLOCK( complete block) BUNDLE BRANCH BLOCK ( Rt and Lt ) FASCICULAR BLOCK (Rt and Lt )

E C G: HEART BLOCKS
A V BLOCK: 1HEART BLOCK

E C G: HEART BLOCKS
A V BLOCK:2HEART BLOCK ( Wenckebach Type)

E C G: HEART BLOCKS
A V BLOCK: 2HEART BLOCK (Mobitz Type)

E C G:HEART BLOCKS
A V BLOCK:2HEART BLOCK (2:1Block)

E C G: HEART BLOCKS
A V BLOCK: 3HEART BLOCK (Complete Heart Block)

E C G: HEART BLOCKS
RT BUNDLE BRANCH BLOCK

E C G: HEART BLOCKS
RT BUNDLE BRANCH BLOCK

E C G: HEART BLOCKS
LT BUNDLE BRANCH BLOCK

E C G: HEART BLOCKS
LT BUNDLE BRANCH BLOCK

E C G: HEART BLOCKS
RT & LT BUNDLE BRANCH BLOCK

E C G : ISCHEMIC HEART DISEASE

E C G: ISCHEMIC HEART DISEASE

TYPES OF CHANGES: ISCHEMIA

INJURY NECROSIS

E C G: ISCHEMIC HEART DISEASE

E C G: ISCHEMIC HEART DISEASE

LEAD GROUPS Anterior: V1- V6 Septal: V3 V4 Lateral: I, aVL, V5 , V6 High Lateral: I, aVL Inferior: II, III, aVF Posterior: Mirror Image In V1 , V2

I H D: ISCHEMIA
ANGINA

I H D: MI(SUB ENDOCARDIAL)

I H D: MI( INFERIOR )

I H D:MI(ANTERIOR)

E C G : EXTRASYSTOLES

ECTOPICS : SUPRAVENTRICULAR

ECTOPICS:VENTRICULAR

E C G: TACHYARRHYTHMIAS

E C G:TACHY ARRHYTHMIAS

TYPES BASED ON ORIGIN: Supra Ventricular Tachycardia, Ventricular Tachycardia BASED ON MORPHOLOGY: Narrow QRS Tachycardia, Broad QRS Tachycardia BASED ON RHYTHM: Regular Tachycardia , Irregular Tachycardia BASED ON MECHANISM: Reentry, Non Reentry, Pre excitation

E C G:TACHY ARRHYTHMIAS

E C G:TACHY ARRHYTHMIAS

A : AV Nodal Reentry B : AV Reentry C : Atrial Tachycardia

E C G: TACHY ARRHYTHMIAS
JUNCTIONAL TACHYCARDIA

E C G:TACHY ARRHYTHMIAS
ATRIAL FIBRILLATION

E C G: TACHY ARRHYTHMIAS
ATRIAL FLUTTER

E C G: TACHY ARRHYTHMIAS
MULTIFOCAL ATRIAL TACHYCARDIA

E C G:TACHY ARRHYTHMIAS

VENTRICULAR TACHYCARDIA NEGATIVE QRS IN V1-V6 AV DISSOCIATION QR COMPLEXES IN V4-V6 LT / NORTH WEST AXIS CAPTURE BEATS NARROW R WITH SLURRED DELAYED S QRS > 0.12s

E C G:TACHY ARRHYTHMIAS
VENTRICULAR TACHYCARDIA

E C G:TACHY ARRHYTHMIAS
TORSADES DE POINTES

E C G:TACHY ARRHYTHMIAS
VENTRICULAR FIBRILLATION

E C G: BRADY ARRYHTHMIAS

E C G:BRADY ARRYHTHMIAS
JUNCTIONAL(A V NODAL) RHYTHM

E C G:BRADY ARRHYTHMIAS
IDIOVENTRICULAR RHYTHM

E C G : OTHER COMMON CHANGES

PERICARDITIS

PERICARDIAL EFFUSION

HYPERTENSIVE HEART DISEASE

PULMONARY EMBOLISM

E C G:K+ABNORMALITY
HYPOKALEMIA

HYPERKALEMIA