This document provides an overview of electrocardiograms (EKGs), including:
1) How EKGs work by placing electrodes on the limbs and chest to detect electrical signals from the heart and display them on a graph.
2) The components of the EKG like waves, complexes, intervals and how to read them.
3) How to interpret EKGs including identifying abnormal rhythms, conduction defects, hypertrophy, infarction locations and related coronary arteries.
Copyright:
Attribution Non-Commercial (BY-NC)
Available Formats
Download as PPT, PDF, TXT or read online from Scribd
This document provides an overview of electrocardiograms (EKGs), including:
1) How EKGs work by placing electrodes on the limbs and chest to detect electrical signals from the heart and display them on a graph.
2) The components of the EKG like waves, complexes, intervals and how to read them.
3) How to interpret EKGs including identifying abnormal rhythms, conduction defects, hypertrophy, infarction locations and related coronary arteries.
This document provides an overview of electrocardiograms (EKGs), including:
1) How EKGs work by placing electrodes on the limbs and chest to detect electrical signals from the heart and display them on a graph.
2) The components of the EKG like waves, complexes, intervals and how to read them.
3) How to interpret EKGs including identifying abnormal rhythms, conduction defects, hypertrophy, infarction locations and related coronary arteries.
Copyright:
Attribution Non-Commercial (BY-NC)
Available Formats
Download as PPT, PDF, TXT or read online from Scribd
This document provides an overview of electrocardiograms (EKGs), including:
1) How EKGs work by placing electrodes on the limbs and chest to detect electrical signals from the heart and display them on a graph.
2) The components of the EKG like waves, complexes, intervals and how to read them.
3) How to interpret EKGs including identifying abnormal rhythms, conduction defects, hypertrophy, infarction locations and related coronary arteries.
Copyright:
Attribution Non-Commercial (BY-NC)
Available Formats
Download as PPT, PDF, TXT or read online from Scribd
Download as ppt, pdf, or txt
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Electrocardiograms
Cindy Chan, MD
Electrocardiograms (EKGs or ECGs) display the electrical activity of the heart
One electrode is placed on each arm One electrode is placed on a leg (sometimes, one on each leg) Six electrodes are placed across the chest wall (from right sternal border to left midaxillary line)
Each lead has its own an axis (or direction) Each lead then reads the electrical current relative to its axis Imagine that youre standing at the receiving end of the axis, watching the current If the current is coming toward you, the EKG deflection is upward (ie. positive) If the current is going away from you, the EKG deflection is downward (ie. negative)
So, if there is no deflection on the EKG, there are two explanations:
No current The current is perpendicular to the lead axis
Precordium
Up Right arm
Left arm
Down
avR
avL
avF
avR
avL
avF
Inferior leads
avR
avL
1 Lateral leads
avF
Rate 0.04 sec (or 40 msec) = small box 0.2 sec = (small box) X 5 = large box 0.2 sec = 1/300th of minute So, if QRSs are 1 large box apart, rate is 300 If QRSs are 2 large boxes apart, rate is 150 (300/2) If QRSs are 3 large boxes apart, rate is 100 (300/3), etc.
Rhythm 1. Sinus arrhythmia - varies with respiration 2. Wandering pacemaker - varying P waves 3. Multifocal atrial tachycardia - varying P waves + rate > 100 4. Atrial fibrillation - no P waves + irregular ventricular rhythm 5. Escape beats - from automaticity focus after pause (atrial, junctional, ventricular, all can lead to escape rhythm) 6. Premature beats - from irritable automaticity focus (atrial, junctional, ventricular)
Rhythm Tachyarrhythmias: 1. Sinus Tach 2. Supraventricular tachycardia (SVT) (paroxysmal atrial, junctional, or ventricular tachycardia; with or without block) - rate 150-250 3. Atrial flutter - "saw-tooth", from single atrial focus, rate 250-350 4. Ventricular flutter - "sine waves", rate 250-350 5. Atrial fibrillation with rapid ventricular rate (RVR) - from multiple atrial foci, no P waves + irregular ventricular rhythm, rate 350-450 6. Ventricular Fibrillation - from multiple ventricular foci, erratic rhythm, rate 350-450
Rhythm Bradyarrhythmias: 1. Sick sinus syndrome - with pauses 2. 1 AVB - prolonged PR interval 3. 2 AVB - ie. Wenckeback, Mobitz Type I, gradual lengthening of PR until dropped QRS 4. 2 AVB - ie. Mobitz Type II, sporadic dropped QRS 5. 3 AVB - ie. Complete HB, complete disassociation of P and QRS
Rhythm Bundle branch blocks: RBBB: Prolonged QRS upright in V1 LBBB: Prolonged QRS downwards in V1 L anterior hemiblock: LAD, R1S3 (large R wave in lead I, large S wave in lead III) L posterior hemiblock: RAD, S1R3 (large S wave in lead I, large R wave in lead III)
Axis Normal axis is -30 to +105 degrees Normal axis if upright in leads I and aVF I downwards, aVF upright: RAD I downwards, aVF downwards: extreme RAD I upright, aVF downards: LAD
LAD: left axis deviation RAD: right axis deviation
avR Extreme RAD LAD
avL
1 0 RAD Normal axis
avF 90
Intervals Lead II tends to be the easiest/clearest to read..
QRS ST T
P P wave
Normal
QRS ST T
P PR interval
Normal
QRS ST T
P QRS complex
Normal
QRS ST T
P QT interval
Normal
Intervals P wave: <0.10 sec PR interval: 0.12-0.2 sec QRS: 0.05-0.10 sec QT interval: depends on the rate, but generally <0.5 sec
Intervals quick method
P wave: less than 2.5 small boxes PR interval: 3-5 small boxes QRS: 1-2.5 small boxes QT interval: <1/2 RR interval Corrected QT: QT/RR
Hypertrophy 1. R atrial hypertrophy: P height > 2.5 mm (right high) 2. L atrial hypertrophy: P length >0.12 sec (left long) 3. R Ventricular Hypertrophy (RVH) criteria: RAD with widened QRS Persistent S wave in V5, V6 R > S in V1, but progressively smaller from V1-V6
4. L Ventricular Hypertrophy (LVH) criteria:
LAD with widened QRS S in V1 + R in V5 = >35 mm R in aVL > 11 mm
Infarction Q waves: 1 mm wide, 1/3 amplitude of QRS Inverted T waves: ischemia ST segment elevation: infarct Anterior leads: V1, V2, V3, V4, V5 Lateral: 1, aVL, V6 Inferior: II, III, aVF
QRS ST T
P ST segment
Normal
Anterior
Right
Left
Posterior
RV
LV
Anterior Anterioseptum
RV Inferioseptum
Lateral
LV
Inferio-Posterior
Anterioseptum
Anterior
RV Inferoseptum Inferioseptum
Lateral
LV
Inferio-Posterior
LAD
RCA
LCx
LATERAL WALL
Circumflex ANTERIOR WALL
LAD POSTERIOR WALL
RCA
Frontal plane avR avL
LATERAL 1 WALL
Circumflex 2 avF
ANTERIOR 3 WALL
inferior Dead tissue
Leads 2, 3 and avF ST POSTERIOR WALL and then Q waves
RCA
LAD
Inferior MI
Significant Q waves Occlusion of RCA in 2,3 and avF
