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Interpretation
Cardiology and Vascular Medicine
Laboratory
Faculty of Medicine
University of Brawijaya
Objectives
The Basics
Interpretation
Clinical Pearls
Practice
Recognition
Lead Placement
aVF
Precordial Leads
EKG Distributions
Waveforms
Introduction
ECG Interpretation
ECG
Rates
Determination heart rate
(normal paper speed 25
mm/s):
300 / Count number of large
square (bold boxes in one R R
interval)
1500 / Count number of small
square in one R R intervals
Number of QRS complex in 6
seconds, multiply by 10
Rate
Differential Diagnosis of
Tachycardia
Tachycardi Narrow
a
Complex
ST
Regular
SVT
Atrial flutter
Wide Complex
ST w/
aberrancy
SVT w/
aberrancy
VT
Irregular
A-fib
A-flutter w/
variable
A-fib w/
aberrancy
A-fib w/ WPW
www.uptodate.com
(300 / 6) = 50 bpm
ECG
Rates ?
ECG
RHYTHYM
SA Node
Normal Impulse
60 100 x / minute
AV Node
40 -60 x / minute
Ventrikel
<40 x / minnute
Rhythm
Sinus (SA node)
Originating from
SA node
P wave before
every QRS
P wave in same
direction as QRS
Negative P wave
in aVR and
positive di II
Atrial Fibrillation
-No visible P waves
-Irregular R R interval
Normal Intervals
PR
QRS
QT
Prolonged QT
Normal
Corrected QT (QTc)
Men 450ms
Women 460ms
QTm/(R-R)
Causes
Blocks
AV blocks
Type 3 block
Superior
Axes
- 180 s/d
-90
LAD
- 90 s/d 30
aV
R
aV
L
I
RAD
+ 90 s/d +
180
II
I
aV
F
II
Normal
Axes
- 30 s/d +
90
Hypertrophy
Ischemia
36
37
WANDERIN BASELINE
38
SOMATIC TREMOR
39
ELECTRICAL
INTERFERANCE
40
Lets Practice
Mattu, 2003
PR interval >200ms
Accelerated Idioventricular
Junctional Rhythm
Hyperkalemia
Wellens Sign
Brugada Syndrome
Brugada Syndrome
Premature Atrial
Contractions
Trigeminy pattern
Sawtooth waves
Typically at HR of 150
Torsades de Pointes
Digitalis
Lateral MI
Reciprocal changes
Inferolateral MI
Anterolateral / Inferior
Ischemia
59
Supraventricular
Tachycardia
Retrograde P waves
Ventricular Tachycardia
Prolonged QT
QT > 450 ms
Inferior and anterolateral ischemia
Left Ventricular
Hypertrophy
Normal
Left Ventricular
Hypertrophy
LVH
ECHOcardiogram
Left Ventricular
Hypertrophy
Acute Pulmonary
Embolism
SIQIIITIII in 10-15%
T-wave inversions, especially occurring in
inferior and anteroseptal simultaneously
RAD
Wolff-Parkinson-White
Syndrome
Hypokalemia
U waves
Can also see PVCs, ST depression, small T waves
09/09/13
73
Thank You
Any Questions?