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    ELECTROCARDIOGRAM

    Uploaded by

    Mbah Gapinbissi
    This document provides an overview of electrocardiography (ECG) basics and how to interpret various normal and abnormal ECG patterns. It begins by describing the pacemakers of the heart and ECG paper format. It then covers rhythm analysis, identifying a normal sinus rhythm, and criteria for left and right atrial and ventricular hypertrophies. The document illustrates signs of coronary artery disease like subendocardial ischemia and myocardial infarction patterns. It also identifies atrial fibrillation, extrasystoles, ventricular tachycardia, and various atrioventricular blocks. Bundle branch blocks are further explained.

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    Download as PDF, TXT or read online from Scribd

    ELECTROCARDIOGRAM

    Uploaded by

    Mbah Gapinbissi
    51 views63 pages
    This document provides an overview of electrocardiography (ECG) basics and how to interpret various normal and abnormal ECG patterns. It begins by describing the pacemakers of the heart and ECG paper format. It then covers rhythm analysis, identifying a normal sinus rhythm, and criteria for left and right atrial and ventricular hypertrophies. The document illustrates signs of coronary artery disease like subendocardial ischemia and myocardial infarction patterns. It also identifies atrial fibrillation, extrasystoles, ventricular tachycardia, and various atrioventricular blocks. Bundle branch blocks are further explained.

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    lecture notes on ecg

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    This document provides an overview of electrocardiography (ECG) basics and how to interpret various normal and abnormal ECG patterns. It begins by describing the pacemakers of the heart and ECG paper format. It then covers rhythm analysis, identifying a normal sinus rhythm, and criteria for left and right atrial and ventricular hypertrophies. The document illustrates signs of coronary artery disease like subendocardial ischemia and myocardial infarction patterns. It also identifies atrial fibrillation, extrasystoles, ventricular tachycardia, and various atrioventricular blocks. Bundle branch blocks are further explained.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    51 views63 pages

    ELECTROCARDIOGRAM

    Uploaded by

    Mbah Gapinbissi
    This document provides an overview of electrocardiography (ECG) basics and how to interpret various normal and abnormal ECG patterns. It begins by describing the pacemakers of the heart and ECG paper format. It then covers rhythm analysis, identifying a normal sinus rhythm, and criteria for left and right atrial and ventricular hypertrophies. The document illustrates signs of coronary artery disease like subendocardial ischemia and myocardial infarction patterns. It also identifies atrial fibrillation, extrasystoles, ventricular tachycardia, and various atrioventricular blocks. Bundle branch blocks are further explained.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 63

    ELECTROCARDIOGRAM

    Dr. NCHINDO PIUS – MARY


    INTERNIST MD(Hons) DES.
    Objectives

    • List 3 criteria for identifying a sinus rhythm

    • Identify a normal ECG

    • Describe the main criteria for identifying ventricular hypertrophies

    • Illustrate the signs of coronary artery disease

    • Identify atrial fibrillation


    Plan
    • Normal ECG

    • Atrial and ventricular hypertrophies

    • Subepicardial ischemia, myocardial necrosis

    • Atrial fibrillation and atrial flutter

    • Extrasystoles

    • Ventricular tachycardia

    • BAV, bundle branch blocks


    ECG Basics
    Normal impulse conduction
    ECG Basics
    ECG Basics
    ECG Basics
    Pacemakers of the heart
    • SA Node - Dominant pacemaker with an intrinsic rate of 60 - 100
    beats/minute.

    • AV Node - Back-up pacemaker with an intrinsic rate of 40 - 60


    beats/minute.

    • Ventricular cells - Back-up pacemaker with an intrinsic rate of 20 - 45


    bpm.
    ECG Basics - The ECG paper
    ECG Basics - Rhythm analysis

    • Step 1: Calculate rate.


    • Step 2: Determine regularity.
    • Step 3: Assess the P waves.
    • Step 4: Determine PR interval.
    • Step 5: Determine QRS duration.
    ECG Basics - Rhythm analysis
    ECG Basics - Rhythm analysis
    ECG Basics - Rhythm analysis
    ECG Basics - Rhythm analysis
    ECG Basics - Rhythm analysis
    ECG Basics - Rhythm analysis
    ECG Basics - Rhythm analysis
    ECG Basics - Rhythm analysis
    ECG
    • Normal
    • Rhythm
    • Frequency
    • P Wave
    • P-R Interval
    • QRS Complex
    • ST Segment
    • T Wave
    Normal ECG
    • Sinus rhythm: P wave precedes each • QRS complex: duration 70 to 90 msec, axis

    QRS, PR interval ≥ 0.12 s, positive P wave • ST segment: end QRS - start T, isoelectric
    in DI DIII AVF
    • T wave: monophasic, positive and
    • Frequency: number of beats per minute asymmetric
    (bpm), 60-100 bpm, • QT interval: start QRS – end T, normal time

    • P-wave: round, duration ≤ 0.12 s, = 380 to 420 msec,

    amplitude ≤ 2.5 mm, axis: 0 to 90° • QTc = QT/√RR < 440 msec

    • PR interval: between 120 and 200 msec


    Normal ECG values
    Left atrial hypertrophy
    • Left atrial overload or left atrial hypertrophy
    • Occurs in mitral stenosis, hypertension, HF
    • It results in an increase in the duration of the P wave in DII ≥ 120 ms
    with often a bifid appearance
    • In V1 there is a predominance of the terminal negative component of
    P
    • LAH Moritz criteria: 2 out of 3 criteria are sufficient
    Left atrial hypertrophy
    Left atrial hypertrophy
    • In DII and V1
    • Axis < 30°
    • Duration > 120 msec
    • Bifid in DII
    • Negative
    Right atrial hypertrophy

    • Atrial overload or right atrial hypertrophy (HAD)

    • Etiologies – COPD, chronic cor pulmonale, acute cor pulmonale

    • Increased P-wave amplitude > 2.5 mm in DII

    • Predominance of the positive initial part of the P wave in V1


    Right atrial hypertrophy
    Right atrial hypertrophy
    • In DII and V1
    • Right axis deviation,
    • Pointed P-wave in DII and
    Amplitude> 2.5 mm
    Left ventricular hypertrophy
    • Sokolow – Lyon criteria
    RV5 + SV1 > 35 mm
    • Cornell index
    RaVL + SV3 > 28mm (♂)
    and > 20 mm (♀)
    Left ventricular hypertrophy
    Right ventricular hypertrophy
    • R/S > 1, V1 V2
    • S ample V5 V6
    • Right axis deviation
    Sub endocardial ischemia
    Sub epicardial necrosis
    • ST-segment elevation = myocardial infarction
    Topographic terminologies
    • Anterior ischemia or necrosis : V1 to V6

    • Antero-septal ischemia or necrosis : V1 to V3

    • Apical Ischemia or necrosis: V4 and V5

    • Anterolateral ischemia or necrosis: V4 to V6

    • inferior ischemia or necrosis: D2, D3, aVF

    • Reciprocal changes
    Extensive anterior Myocardial Infarction
    Anterior myocardial infarction
    Inferior myocardial infarction

    Sus-décalage ST en DII, DIII, aVF avec miroir en DI, aVL


    Possible extension au ventricule droit 36
    Posterior myocardial infarction
    Myocardial infarction
    electrical chronology
    Atrial fibrillation
    Atrial flutter
    Atrial extra systoles
    Ventricular extra systoles
    bigerminy, trigerminy
    Ventricular extra systoles
    duplet
    Ventricular tachycardia
    Atrioventricular blocks
    • These are conduction disorders located at the level of the atrioventricular
    junction

    • either at the level of the atrioventricular node: nodal or "suprahisian"


    block,

    • or at the level of the trunk of the bundle of his: truncular or "intra-hisian"


    AVB, or

    • at the level of the dividing branches: infra-hisian AVB

    • The AVB can be of very variable degree, ranging from a simple slowing
    down of conduction to its complete interruption
    First degree AV Block
    • First-degree BAV: most
    often NODAL
    • A-V conduction slowing
    is expressed by a
    prolongation of the PR
    interval beyond 0.20 s
    AVB II, Mobitz Type I, with Wenckebach Period
    • Gradual lengthening of the PR interval, until a blocked P wave occurs
    and the cycle begins again
    2nd degree AVB: Mobitz type II
    • Unexpected occurrence of a blocked P wave without prior
    prolongation of the PR interval.
    AVB 3: 3rd degree block or complete AVB
    block
    • No P waves are conducted to the ventricles Blocking all P waves Total
    dissociation between atria and ventricles
    AVB 3: 3rd degree block or complete AVB
    block
    Right bundle branch block
    • Interruption of conduction on the right branch of the HIS fibres

    • Aspect rSR' or rsr' or rsR' in V1,V2.

    • Sometimes qRR' in V1

    • Deep and serated S wave in V5,V6; DI,aVL

    • QRS Widening: Complet RBB if QRS ≥ 120 ms; Incomplete RBB if QRS
    [100-120[
    Right bundle branch block
    Left bundle branch block

    • Interruption of conduction on the left branch of the HIS fibres

    • Broad, crocheted R-wave or RR' aspect in V5,V6; DI,aVL

    • Disappearance of the septal q wave in V5,V6; DI,aVL

    • Large S-wave or QS aspect from V1 to V3 QRS

    • Enlargement: complete LBB if QRS ≥ 120 ms; Incomplete LBB if QRS


    [100-120[
    Left bundle branch block

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