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    ECGforinterns

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    usmleusmle86
    This document provides guidance on interpreting electrocardiograms (ECGs) for internal medicine interns. It reviews the essential steps for ECG interpretation, including evaluating rate, rhythm, axis, hypertrophy, intervals, P waves, QRS complexes, and ST segments/T waves. Five clinical cases are presented and their ECGs reviewed. Additional resources for further ECG learning include recommended websites, apps, and books. The goal is to establish a consistent approach to ECG interpretation and review essential cases for new interns.

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    ECGforinterns

    Uploaded by

    usmleusmle86
    34 views25 pages
    This document provides guidance on interpreting electrocardiograms (ECGs) for internal medicine interns. It reviews the essential steps for ECG interpretation, including evaluating rate, rhythm, axis, hypertrophy, intervals, P waves, QRS complexes, and ST segments/T waves. Five clinical cases are presented and their ECGs reviewed. Additional resources for further ECG learning include recommended websites, apps, and books. The goal is to establish a consistent approach to ECG interpretation and review essential cases for new interns.

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    ECGforinterns (1)

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    This document provides guidance on interpreting electrocardiograms (ECGs) for internal medicine interns. It reviews the essential steps for ECG interpretation, including evaluating rate, rhythm, axis, hypertrophy, intervals, P waves, QRS complexes, and ST segments/T waves. Five clinical cases are presented and their ECGs reviewed. Additional resources for further ECG learning include recommended websites, apps, and books. The goal is to establish a consistent approach to ECG interpretation and review essential cases for new interns.

    Copyright:

    © All Rights Reserved
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    34 views25 pages

    ECGforinterns

    Uploaded by

    usmleusmle86
    This document provides guidance on interpreting electrocardiograms (ECGs) for internal medicine interns. It reviews the essential steps for ECG interpretation, including evaluating rate, rhythm, axis, hypertrophy, intervals, P waves, QRS complexes, and ST segments/T waves. Five clinical cases are presented and their ECGs reviewed. Additional resources for further ECG learning include recommended websites, apps, and books. The goal is to establish a consistent approach to ECG interpretation and review essential cases for new interns.

    Copyright:

    © All Rights Reserved
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    of 25

    ECG for Interns

    UCI Internal Medicine Mini-Lecture


    Learning Objectives

    • Establish Consistent Approach to Interpreting ECGs

    • Review Essential Cases for New Interns

    • Provide Additional Resources for Future Learning


    ECG Interpretation

    What is your approach to reading an ECG?


    •Rate
    •Rhythm
    •Axis
    •Hypertrophy
    •Intervals
    •P wave
    •QRS complex
    •ST segment – T wave
    Rate
    Square Counting: 300-150-100-75-60-50-42A

    Count QRS in 10 second rhythm strip x 6


    Rhythm
    • Are P waves present? 

    • Is there a P wave before every QRS complex and a QRS


    complex after every P wave?

    • Are the P waves and QRS complexes regular?

    • Is the PR interval constant?


    Axis
    Left or right axis deviation?
    Look at limb leads I and aVF.
    •Normal: I +, aVF +
    •LAD: I +, aVF –
    •RAD: I -, aVF +
    Hypertrophy

    LVH: S in V1 or V2 + R in V5 or V6 ≥ 35 mm.

    RVH: V1 R/S ratio >1 or V6 S/R ratio >1.


    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 – 1st 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.


    P Waves
    Evaluate the shape, height and width of P waves.
    •Multiple morphologies  Wandering pacemaker or
    Multifocal atrial tachycardia

    •Notched (M-shaped) P-wave in I and II, > 0.12 s  P-


    mitrale seen in severe left atrial enlargement
    QRS complex
    Poor R Wave Progression in V1 to V6: suggests prior anterior MI

    Pathologic Q wave: previous MI. Q wave amplitude 25% or more


    of the subsequent R wave, OR > 0.04 s in width + > 2 mm in
    amplitude in more than one lead
    ST segment & T wave
    Case #1

    70 year old male with history of diabetes mellitus and


    hypertension occasionally feels lightheaded. He recently
    fainted while standing.
    Case #1 ECG
    Case #2
    58 year old female with no significant past medical
    history presents with fatigue, lightheadedness and
    shortness of breath.
    Case #2 ECG
    Case #3

    78 year old female with history of HTN, DM, HL, CAD


    admitted for syncope complains of palpitations and
    lightheadedness.
    Case #3 ECG
    Case #4

    67 year old male with history of diabetes, hypertension,


    COPD presents with chest pain.
    Case #4 ECG
    Case #5

    38 year old female with history of DM, HTN, CKD


    presents with 2 days of nausea and abdominal pain.
    Case #5 ECG
    Case #6

    60 year-old man with history of HTN, HL, CAD presents


    with nausea, shortness of breath and chest pain.
    Case #6 ECG
    Additional Resources
    Websites:
    •http://en.ecgpedia.org/
    •http://ecg.utah.edu
    •http://ecg.bidmc.harvard.edu/maven/

    Apps:
    •ECG Guide by QxMD (iPad and iPhone)
    •ECG Interpret (iPhone)

    Books:
    •12-Lead ECG: The Art of Interpretation, Tomas Garcia (perhaps the best
    book on ECGs with detailed explanations and physiology.)
    •Arrhythmia Recognition, Tomas Garcia
    Summary

    • Always keep a consistent approach.

    • Do not rely upon machine reads.

    • Practice makes perfect.

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