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EKG Pocket Guide

1. The EKG provides information on heart rate, rhythm, intervals, axis, hypertrophy, and signs of ischemia, injury, or infarction. 2. Key intervals include the PR (<0.20 sec), QRS (~0.12 sec), and QT intervals. Abnormal intervals can indicate conditions like WPW or conduction blocks. 3. The axis is used to locate the side of myocardial infarction - RAD indicates right axis deviation while LAD signifies left axis deviation. Diffusely low amplitudes may signal severe coronary artery disease.

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Fabian Ramirez Hincapié
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584 views2 pages

EKG Pocket Guide

1. The EKG provides information on heart rate, rhythm, intervals, axis, hypertrophy, and signs of ischemia, injury, or infarction. 2. Key intervals include the PR (<0.20 sec), QRS (~0.12 sec), and QT intervals. Abnormal intervals can indicate conditions like WPW or conduction blocks. 3. The axis is used to locate the side of myocardial infarction - RAD indicates right axis deviation while LAD signifies left axis deviation. Diffusely low amplitudes may signal severe coronary artery disease.

Uploaded by

Fabian Ramirez Hincapié
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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EKG Interpretation

EKG Interpre
1.) Make sure theres no lead reversal P wave should be + in lead II and in AVR
2.) Calculate rate (300, 100, 150, 75, 60, 50)
3.) What is the rhythm?
Leads V1 and V2 are the most revealing leads to look at!
-Regular or irregular?
1 big box = 0.20 sec, 1 small box = 0.04 sec
-Are P waves present?
-Calculate intervals
-PR interval should be 0.20 sec
-Short in WPW
-QRS complex should be ~0.12 sec (3 small boxes)
-Narrow if 0.10 sec
-Wide if > 0.12 sec
-RBBB: wide in V1 with + end deflection, V6 with end
deflection, RAD with notched R waves in V1 and V2,
2/2 chronic pulm dz
-LBBB: opposite findings of RBBB, ?AMI
-QT interval should be R R interval
4.) Determine axis
-Normal: + QRS in lead I and AVF with transition to half upright in V3 + V4
-RAD: Lead I is and AVF is + with early transition (seen in V1 and V2)
-LAD: Lead I is + and AVF is with late transition (not as upright in V3 + V4)
-Pathologic LAD if lead II is also
-Diffusely low amplitude QRS indicates severe CAD, pericardial effusion, or
hypothyroid
5.) Check for hypertrophy
-Atrial P waves: check V1
-Tall peaked or largest component first = RA enlargement 2/2 pulm HTN
-Broad notched or largest component second = LA enlargement 2/2 mitral
dz
-Ventricular:
-RVH: check V1, normal QRS is mostly , RVH causes a more + R wave
-LVH: V1 with S and V5 with more + R; adding S in V1 + R in V5 > 35 mm
-Can also see ventricular strain = ST with middle hump
-Occurs in V1 for RV strain and in V5 for LV strain
6.) Look for ischemia, injury, and infarction
-Ischemia: ST depression (differential: digoxin, LV strain, subendocardial ischemia,
BBB, reciprocal of AMI, hyperventilation, physiologic J point depression with
tachycardia), T wave peaking inversion
-Injury: ST elevation (differential: LV aneurysm, early repolarization, Prinzmetals,
pericarditis, BBB, MI, Brugada, hyperK, benign early repolarization- will have initial
concave)
-Infarction: significant Q waves ( 0.03 s) in at least 2 contiguous leads (differential:
LBBB, WPW, ventricular enlargement)
-R waves should from V1 through V5, if not its poor R wave progression and
can indicate anterior MI

Leads
II, III, AVF
I, AVL

Artery
RCA > LCX
LCX
LAD or
branch
LCX > RCA

None

None

Wall
Inferior LV
Lateral LV (usually
in combination
with V5 + V6)
Septal/anteroseptal
LV
Posterior (rare)

V3, V4
V5, V6

Anterior LV
Anterolateral LV

None
II, III, AVF

V4, V5, V6 as
placed on the RV

RV wall

LAD
LCX >
LAD/branch
RCA

V1, V2

I, AVL
II, III, AVF

Reciprocal Leads

V1, V2, V3, V4 (mirror image will show


early R wave transition and ST depression)

P/w
massive MI
& SCD

P/w
bradycardia,
Wenkeboch

P/w Mobitz II,


LBBB

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