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ABC in
SAAD A. SHETASAAD A. SHETAMBChB, MA, MDMBChB, MA, MD
Assoc. Prof.Assoc. Prof.
MDS DepartmentMDS Department
KSUKSU
ECG
How To Read How To Read ECGECG
Rate?Rate?
QRS QRS Duration?Duration?
Stability?Stability?
Anatomy of Heart and ECG signalAnatomy of Heart and ECG signal
Normal ECG signalNormal ECG signalConducting System of Heart
MeasurementsMeasurements
Small square = 0.04 sec.Small square = 0.04 sec.
Large square = 5 small square = 0.2 sec.Large square = 5 small square = 0.2 sec.
One second = 5 large squareOne second = 5 large square
One minute = 300 large squareOne minute = 300 large square
P duration = P duration = 3 small sqs 3 small sqs = = 0.12 sec.0.12 sec.
P height = P height = 3 small sqs 3 small sqs = = 0.12 sec.0.12 sec.
QRS duration = QRS duration = 3 small sq 3 small sq = 0.12 sec.= 0.12 sec.
P-R interval = P-R interval = 5 small sqs 5 small sqs = 0.2 sec= 0.2 sec. .
Remember Remember ThisThis
3, 3, 3 and 53, 3, 3 and 5
Three Three Levels:Levels:
SAN:SAN: 60 - 60 - 100100
AVN :AVN : 40 - 6040 - 60
Bundle Branch:Bundle Branch: 20 - 20 - 4040
If regular : Divide 300/ number of large squares If regular : Divide 300/ number of large squares between 2 Rs = HRbetween 2 Rs = HR
If irregular: Count number of complexes in 6 sec. and If irregular: Count number of complexes in 6 sec. and multiply by 10multiply by 10
RATE may be:RATE may be:
Normal 60 -100Normal 60 -100
Bradycardia < 60 Bradycardia < 60
Tachycardia > Tachycardia > 100100
P P = Sinus= Sinus
No P = Non sinusNo P = Non sinus
Rate:Rate:
QRS DurationQRS Duration::
Slim lady
Obese lady
Stability:Stability:
* Stable patient: think of drug therapyStable patient: think of drug therapy * Unstable patient: think of electric * Unstable patient: think of electric
therapytherapy
Rate > 100.Rate > 100.
QRS: Narrow.QRS: Narrow.
Stable or Stable or unstableunstable
Rate < 60.Rate < 60.
QRS: Narrow.QRS: Narrow.
Stable or Stable or unstableunstable
Sinus tachycardiaSinus tachycardia
Atrial flutterAtrial flutter
Atrial Atrial fibrillationsfibrillations
PAT, PNTPAT, PNT
Sinus bradycardiaSinus bradycardia
11stst degree HB degree HB
22ndnd degree HB degree HB
Complete HBComplete HB
Supraventricular RhythmSupraventricular Rhythm
Supraventricular Rhythm: Supraventricular Rhythm: TachycardiaTachycardia
Sinus Tachycardia
Supraventricular Rhythm: Supraventricular Rhythm: TachycardiaTachycardia
Atrial FlutterAtrial Flutter
Atrial Atrial FibrillationsFibrillations
Supraventricular Rhythm: Supraventricular Rhythm: TachycardiaTachycardia
Paroxysmal Paroxysmal SVTSVT
Supraventricular Rhythm: Supraventricular Rhythm: TachycardiaTachycardia
Supraventricular Rhythm: Supraventricular Rhythm: BradycardiaBradycardia
Sinus BradycardiaSinus Bradycardia
Normal Sinus Normal Sinus RhythmRhythm
Supraventricular Rhythm: Supraventricular Rhythm: BradycardiaBradycardia
11stst Degree Degree HBHB
Supraventricular Rhythm: Supraventricular Rhythm: BradycardiaBradycardia
22ndnd Degree HB: Mobitz 1 Degree HB: Mobitz 1 Wenckebach.Wenckebach.
Progressive lengthening of the P-R interval with Progressive lengthening of the P-R interval with intermittent dropped beatintermittent dropped beat
Supraventricular Rhythm: Supraventricular Rhythm: BradycardiaBradycardia
22ndnd Degree HB: Degree HB: Mobitz 2Mobitz 2
Sudden drop of QRS without prior P-R changesSudden drop of QRS without prior P-R changes
Supraventricular Rhythm: BradycardiaSupraventricular Rhythm: Bradycardia
33rdrd Degree Degree HBHB
Ventricular RhythmVentricular Rhythm
Idioventricular Idioventricular Rhythm.Rhythm.
Ventricular RhythmVentricular Rhythm
Accelerated Idioventricular Accelerated Idioventricular RhythmRhythm.
Ventricular RhythmVentricular Rhythm
Ventricular RhythmVentricular Rhythm
Pacer Pacer RhythmRhythm
Ventricular RhythmVentricular Rhythm
TreatmentTreatment
Supraventricular Supraventricular Rhythm:Rhythm:
StableStable = = DrugsDrugs = =
AliiAliiA A denosinedenosine
L L anoxineanoxine
I I soptinsoptin
I I nderalnderal
Unstable = Unstable = ElectricElectric
DC with 25 joules, ++DC with 25 joules, ++++
TreatmentTreatment
Ventricular Rhythm:Ventricular Rhythm:
Stable Stable == Drugs Drugs = =
AlPAlPA A miodarone.miodarone.
L L idocaine.idocaine.
P P rocainamide.rocainamide.
Unstable = ElectricUnstable = Electric
DC with 200 joules, 300, DC with 200 joules, 300, 3600.3600.
Myocardial IschemiaMyocardial Ischemia
Due to lack of adequate blood flow to the myocardium
Ischemia is reversible. Changes in ECG:
T wave peakingSymmetric T wave
inversionST segment elevation
Different ECG SignalsDifferent ECG Signals
Normal SignalNormal Signal ST segment elevated signalST segment elevated signal
ECG with T wave inversionECG with T wave inversion ECG Signal with peak T wavesECG Signal with peak T waves
THANK YOUTHANK YOU