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ECG Diagnosis

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Medical Physiology Prelab

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Page 1: ECG Diagnosis
Page 2: ECG Diagnosis

10 ECG rules ECG signs of M.I. Evolution of changes in M.I. Classical Appearences

Page 3: ECG Diagnosis

R r qR qRs Qrs QS

Qr Rs rS qs rSr’ rSR’

Page 4: ECG Diagnosis

I II III aVR aVL aVF V1 V2 V3 V4 V5 V6

.2

Page 5: ECG Diagnosis

PRinterval

Mill

ivo

lts

Milliseconds

0 200 400 600

-0.5

0

0.5

1.0

P

R

T

Q

S

PR interval should be 120 to 200 milliseconds or 3 to 5 little squares

Page 6: ECG Diagnosis

Mill

ivo

lts

Milliseconds

0 200 400 600

-0.5

0

0.5

1.0

QRS

P

R

T

Q

S

The width of the QRS complex should not exceed 110 ms, less than 3 little squares

Page 7: ECG Diagnosis

I II III aVR aVL aVF

The QRS complex should be dominantly upright in leads I and II

Page 8: ECG Diagnosis

I II III aVR aVL aVF

QRS and T waves tend to have the same general direction in the limb leads

Page 9: ECG Diagnosis

P

Q

T

S

All waves are negative in lead aVR

Page 10: ECG Diagnosis

V1

V2

V3

V4

V5V6

The R wave in the precordial leads must grow from V1 to at least V4

Page 11: ECG Diagnosis

I II III aVR aVL aVF V1 V2 V3 V4 V5 V6

The ST segment should start isoelectric except in V1 and V2 where it may be elevated

Page 12: ECG Diagnosis

I II III aVR aVL aVF V1 V2 V3 V4 V5 V6

The P waves should be upright in I, II, and V2 to V6

Page 13: ECG Diagnosis

I II III aVR aVL aVF V1 V2 V3 V4 V5 V6

There should be no Q wave or only a small q less than 0.04 seconds in width in I, II, V2 to V6

Page 14: ECG Diagnosis

I II III aVR aVL aVF V1 V2 V3 V4 V5 V6

The T wave must be upright in I, II, V2 to V6

Page 15: ECG Diagnosis

ST segment elevation over area of damage ST depression in leads opposite infarction Pathological Q waves Reduced R waves Inverted T waves

Page 16: ECG Diagnosis

R

P

Q

ST

• Occurs in the early stages

• Occurs in the leads facing the infarction

• Slight ST elevation may be normal in V1 or V2

Page 17: ECG Diagnosis

R

P

Q

T

ST

• Only diagnostic change of myocardial infarction

• At least 0.04 seconds in duration

• Depth of more than 25% of ensuing R wave

Page 18: ECG Diagnosis

R

P

Q

T

ST

• Late change

• Occurs as ST elevation is returning to normal

• Apparent in many leads

Page 19: ECG Diagnosis

I II III aVR aVL aVF V1 V2 V3 V4 V5 V6 I II III aVR aVL aVF V1 V2 V3 V4 V5 V6

Anterior wall MI Left bundle branch block

Page 20: ECG Diagnosis

1 minute after onset 1 hour or so after onset A few hours after onset

A day or so after onset Later changes A few months after AMI

Q

R

P

QT

STR

P

Q

ST

P

QT

ST

R

P

S

T

P

QT

ST

R

P

Q

T

Page 21: ECG Diagnosis

Anterior infarction

I II III aVR aVL aVF V1 V2 V3 V4 V5 V6

Left coronary artery

Page 22: ECG Diagnosis

Inferior infarction

I II III aVR aVL aVF V1 V2 V3 V4 V5 V6

Right coronary artery

Page 23: ECG Diagnosis

Lateral infarction

I II III aVR aVL aVF V1 V2 V3 V4 V5 V6

Left circumflexcoronary artery

Page 24: ECG Diagnosis

aVR V1 V4I

II

III

LATERAL

INFERIOR

ANTPOST ANT

SEPTAL

ANT

LAT

aVL

aVF

V2

V3

V5

V6

Page 25: ECG Diagnosis

• Q wave duration of more than 0.04 seconds

• Q wave depth of more than 25% of ensuing r wave

• ST elevation in leads facing infarct (or depression in opposite leads)

• Deep T wave inversion overlying and adjacent to infarct

• Cardiac arrhythmias