Documenti di Didattica
Documenti di Professioni
Documenti di Cultura
Objectives
The Basics
Interpretation
Clinical Pearls
Practice
Recognition
Lead Placement
aVF
Precordial Leads
EKG Distributions
Waveforms
Interpretation
Rate
Rhythm (including intervals and blocks)
Axis
Ischemia
Hypertrophy
Electrolyte imbalance
Other abnormalities
ECG Interpretation
What is your approach to reading an ECG?
Rate
Rhythm
Axis
Hypertrophy
Intervals
P wave
QRS complex
ST segment T wave
Rate
Rate
300
150
100
75
60
50
Rate
www.uptodate.com
(300 / 6) = 50 bpm
Rhythm
Sinus
Originating
from SA node
P wave before
every QRS
P wave in same
direction as
QRS
Intervals
What is the normal PR interval?
0.12 to 0.20 s (3 - 5 small squares). Short PR Look
for Wolff-Parkinson-White. Long PR 1 st Degree AV block
What is the normal QRS?
< 0.12 s duration (3 small squares). Long QRS - look
for bundle branch block, ventricular pre-excitation,
ventricular pacing or ventricular tachycardia
What is the normal QTc (QT/square root of RR)?
< 0.42 s. Long QTc can lead to torsades to pointes.
Normal Intervals
PR
QRS
QT
P wave
Always positive in lead I and
II
Always negative in lead aVR
< 3 small squares in duration
< 2.5 small squares in
amplitude
Commonly biphasic in lead
V1
P Waves
Evaluate the shape, height and width of P
waves.
Multiple morphologies Wandering pacemaker
or Multifocal atrial tachycardia
P Pulmonale
P
Mitrale
Blocks
AV blocks
Type 3 block
Ischemia
Lateral MI
Reciprocal changes
Inferolateral MI
Anterolateral / Inferior
Ischemia
Hypertrophy
Hyperkalemia
Hypokalemia
U waves
Can also see PVCs, ST depression, small T waves
Wolff-Parkinson-White
Syndrome
Brugada Syndrome
Brugada Syndrome
Arrythmias
Tachycardia
Bradycardia
Sawtooth waves
Typically at HR of 150
Torsades de Pointes
Supraventricular
Tachycardia
Retrograde P waves
Ventricular Tachycardia
Thank You
Any Questions?