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ECGcheatsheet5 PDF

This document provides guidance on interpreting an electrocardiogram (ECG). It outlines normal and abnormal findings including: - Common rates and rhythms seen on ECG as well as how to analyze axis, hypertrophy, and waves/intervals. - Characteristics of a sharp or diffuse J point as well as signs of atrial and ventricular enlargement. - Patterns associated with different types of myocardial infarction and how STEMI evolves over time. - Abnormal findings indicative of conditions like ischemia, hyperkalemia, left and right bundle branch blocks, and more.

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Miko Ramoso
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© © All Rights Reserved
Available Formats
Download as PDF, TXT or read online on Scribd
247 views

ECGcheatsheet5 PDF

This document provides guidance on interpreting an electrocardiogram (ECG). It outlines normal and abnormal findings including: - Common rates and rhythms seen on ECG as well as how to analyze axis, hypertrophy, and waves/intervals. - Characteristics of a sharp or diffuse J point as well as signs of atrial and ventricular enlargement. - Patterns associated with different types of myocardial infarction and how STEMI evolves over time. - Abnormal findings indicative of conditions like ischemia, hyperkalemia, left and right bundle branch blocks, and more.

Uploaded by

Miko Ramoso
Copyright
© © All Rights Reserved
Available Formats
Download as PDF, TXT or read online on Scribd
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RATE

300 150 100

75

60

50

SHARP J POINT
ST seg. & T wave well demarcated, not merged as in STE
J point elevation is normal in young, healthy athletes
DIFFUSE J POINT
ST slowly curving with only an area J point can be found

43

- Count number of complexes x 6 (standard ECG = 10sec)


RHYTHM
Locate the P wave (rate, axis, morphology)
What is the relationship between the P wave and QRS?
Analyze QRS morphology
AXIS DEVIATION
Normal (-30 to 90)
Left
Right

Lead I QRS
+
+
-

Lead II/aVF QRS


+
+

HYPERTROPHY
LEFT ATRIAL ENLARGEMENT (P mitrale)
P wave > 0.12sec and bifid in lead II
RIGHT ATRIAL ENLARGEMENT (P pulmonale)
P wave > 0.25mV in lead II
LVH
R wave in V5 or V6 >25mm
S wave in V1 or V2 >25mm
Sum of R wave in V5 or V6 + S wave in V1 >35mm
RVH
R wave > S wave in V1

LAE

RAE

5mm=0.2sec(200ms)
ST segment

0.12s<PR<0.2s

Q S
QRS<0.12s
QT<(1/2)RR
QTc=QT/sqr(RR)

1mm
=0.1mV

LVH

RVH

QTc interval
W
<0.45
>0.47

NORMAL Q WAVES
Small (septal) q waves normal in leads aVL, I, II, V5, V6
Can be normal on expiration in lead III
PATHOLOGICAL Q WAVES (PRIOR MI)
>1-2 small squares deep (or >25% of R wave)
>1 small square wide (or 30ms)
More likely diagnostic if with inverted T wave
DOMINANT R WAVE
In lead V1: normal in young children; seen in RVH, RBB, HCM, posterior MI
In lead aVR: TCA poisoning, dextrocardia, VT
POOR R WAVE PROGRESSION
Prior anteroseptal MI, cardiomyopathy, LVH, RVH/COPD, LBBB

PATTERNS
Anterior MI (LAD) = V1-V4
Lateral MI (LCx) = I, aVL, V5-V6
Anterolateral MI (LAD) = I, aVL, V1-V6
Inferior MI (RCA, LCx) = II, III, aVF
Inferolateral MI (RCA, LCx) = I, aVL, V5-V6, II, III, aVF
Acute posterior MI (RCA or LCx):
Dominant R waves in leads V1-V3
ST depression in V1-V3
Upright, tall T waves
STEMI EVOLUTION
Hyperacute T waves (tall, peaked,
symmetric)
STE in contiguous leads (concave
convex, merging with T wave)
Development of Q wave and T wave
inversions as ST returns to baseline

1mm=
0.04sec(40ms)

1-15yo
M
Normal
0.44 <0.43
Prolonged >0.46 >0.45
(upper 1%)

NORMAL ECG

(Known LBBB and pacing make ECG less diagnostic for ACS)

WAVES, INTERVALS, & SEGMENTS

ANTERIOR ST DEP.
ST SEGMENT ELEVATION
POSTERIOR MI
WITH ANGINA
(New STE at the J point)
In all leads (except V2-V3), significant STE =
In two contiguous leads
0.1mV
In leads V2-V3, significant STE =
0.15mV in women
0.2mV in men 40yo
0.25mV in men 40yo
ST SEGMENT DEPRESSION
(New horizontal or down-sloping STD)
Significant STD =
In two contiguous leads
0.05mV
and/or
T-wave inversion 0.1mV in two contiguous leads with
Prominent R wave or R/S ratio>1

HYPERKALEMIA
NORMAL INVERTED T WAVES
Normal in leads aVR, V1
Can be normal in lead V2 in young pts,
lead V3 in black pts, lead III during
expiration
INVERTED T WAVES IN ISCHEMIA
0.1mV in two contiguous leads
TALL T WAVES
<1/2 preceding QRS
LVH LV STRAIN PATTERN TWI in leads I, aVL, V5-6
RVH RV STRAIN PATTERN TWI in leads II, III, aVF

BBB

ANTERIOR MI WITH TALL T WAVES

V1: M
V6: W

V1: W
V6: M

SOURCES: ECG tutorials on UpToDate (Basic principles of ECG analysis, Myocardial ischemia and infarction),
Making Sense of the ECG by Houghton, Pocket Medicine by Sabatine; Third Universal Definition of Myocardial
Infarction by Thygesen et al; lifeinthefastlane.com; compiled by Henry Del Rosario

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