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ECGs For Beginners

This document provides an overview of key concepts for interpreting electrocardiograms (ECGs), including how to assess the rate, rhythm, axis, signs of hypertrophy, evidence of infarction or ischemia, and fatal ECG patterns. It explains how to calculate the heart rate based on the rhythm and use of the ECG grid. Common rhythms like atrial fibrillation, supraventricular tachycardia, ventricular tachycardia are demonstrated. Features of left or right axis deviation, left or right ventricular hypertrophy, and locations of myocardial infarction are outlined. Tracings show examples of subendocardial ischemia, inferior or anterior MIs, non-ST elevation MIs, and old MIs

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Yair Myat Hane
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59 views89 pages

ECGs For Beginners

This document provides an overview of key concepts for interpreting electrocardiograms (ECGs), including how to assess the rate, rhythm, axis, signs of hypertrophy, evidence of infarction or ischemia, and fatal ECG patterns. It explains how to calculate the heart rate based on the rhythm and use of the ECG grid. Common rhythms like atrial fibrillation, supraventricular tachycardia, ventricular tachycardia are demonstrated. Features of left or right axis deviation, left or right ventricular hypertrophy, and locations of myocardial infarction are outlined. Tracings show examples of subendocardial ischemia, inferior or anterior MIs, non-ST elevation MIs, and old MIs

Uploaded by

Yair Myat Hane
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as PDF, TXT or read online on Scribd
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ECGs for Beginners

Soe Chan Myae


Rate
Rhythm
Axis
Hypertrophy
Infarct & ischaemia
Fatal ECGs
RATE
If regular
300/RR in large squares.
If irregular or bradycardia
Cycles/6 sec. strip X 10
1 sec = 1 cycle = 5 large squares
No. of R in 30 large squares × 10
RHYTHM
P before QRS

PR internal for AV blocks. Normal 120 -200


ms
R- R interval equal
If (-) P wave look QRS complex
 Narrow QRS ( atrial rhythm,supraventricular
rhythm) ,
Wide QRS( (ventricular rhythm, atrial rhythm
with heart block)
AF
AF
SVT
VT
AXIS
Normal axis
Upward in I & avF
LAD
Upward in I & downward in avF
Cause – IHD ,LVH
RAD
Downward in I & Upward in avF
Causes Mitral stenosis,Chronic lung
disease ,RVH
Extreme axis
Downward in I & avF
LAD
HYPERTROHY
Atrial
P wave
Ventircle
QRS complex
Left atrial enlargement

 The P wave in lead II is broad and substantially


notched, while V1 reveals a deeply inverted
(negative) P wave.
Right atrial enlargement

Delayed activation of an enlarged right atrium


leads to simultaneous activation of the right
and left atria; this results in a relatively
narrow P wave which is of increased amplitude.
Left ventricular hypertrophy

 This electrocardiogram demonstrates several features


of left ventricular hypertrophy: the QRS complex is
slightly widened due to an intraventricular
conduction delay; there is left axis deviation; there
is ST depression and inverted T waves noted in
several leads; several voltage criteria are met,
including an R wave in aVL which is greater than 18
Right ventricular hypertrophy

 The right ventricular forces become predominant in


patients with right ventricular hypertrophy (RVH),
producing tall R waves in the right precordial leads (V1
and V2), and deep S waves in the left precordial leads
(V5 and V6); a R:S ratio >1 in V1 and V2 is suggestive of
RVH. Other features in this case include right axis
deviation and RV1 >7 mm.
INFARCT & ISCHAEMIA
Diffuse subendocardial
ischemia

Diffuse subendocardial ischemia manifested by prominent ST


depressions in leads I, II, aVL, aVF, and V2 to V6, with ST elevation
in aVR. A prolonged PR interval (0.28 sec) is also present.
ventricular myocardial
infarction

Electrocardiogram shows Q waves and prominent doming ST segment


elevation in II, III, and aVF, findings which are characteristic of an acute inferior
myocardial infarction. ST elevation in the right precordial leads - V4R, V5R,
and V6R Ñ indicates right ventricular involvement as well (arrows). The ST
depressions in leads I and aVL represent reciprocal changes.
Inferior MI with anterior
ischemia

Electrocardiogram showing ischemic changes in two areas of the


myocardium: inferior myocardial infarction (Q waves and ST elevations in
leads II, III, and aVF); and anterior ischemia (ST depressions in leads V2
and V3).
Inferior MI
Persistent ST segment
elevation post-MI

The presence of an anterior wall aneurysm following an acute myocardial


infarction is suspected because of persistent ST elevation in leads V2 to V4.
Inverted T waves are evidence of the old infarct.
Anterior MI
NSTEMI
Days old MI
Fatal ECGs
Electroytes changes
PE
Hyperkalemia
Hypokalemia
Hypocalcemial long QT
interval
PE
Thank You

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