Upload
muazrizvi
View
220
Download
0
Embed Size (px)
Citation preview
8/12/2019 Student EKG Lecture 1
1/29
EKG Basics
S. Parvez Quadri
Chief ResidentAdvocate Christ Medical Center
8/12/2019 Student EKG Lecture 1
2/29
White on Right, Smoke over Fire
8/12/2019 Student EKG Lecture 1
3/29
I
IIaVF
III
aVLaVR
8/12/2019 Student EKG Lecture 1
4/29
One small box = 0.04 s
One large box = 0.2 s
8/12/2019 Student EKG Lecture 1
5/29
8/12/2019 Student EKG Lecture 1
6/29
8/12/2019 Student EKG Lecture 1
7/29
Systematic Approach!
Rate
Rhythm
Axis Intervals
Hypertrophy
Ischemia/Infarction
8/12/2019 Student EKG Lecture 1
8/29
Rate
Normal = 60100 beats/min
Tachycardia > 100 beats/min
Bradycardia < 60 beats/min
Count the number of QRS complexes in a 6 second interval and multiple by 10
You MUST memorize these numbers!
Or rate = 300/number of large boxes
8/12/2019 Student EKG Lecture 1
9/29
Rhythm
Sinus Rhythm
P before every QRS
QRS after every P Upright P in lead II
If your EKG does not
meet these criteria, itis not sinus rhythm
8/12/2019 Student EKG Lecture 1
10/29
Axis
Normal axis =
-30 to 90 degrees
Is it positive in I and aVF?
Where is the QRS biphasic?
I
IIaVFIII
aVLaVR
8/12/2019 Student EKG Lecture 1
11/29
Segments and Intervals
PR < 0.2 s (< 5 small
boxes)
QRS < 0.12 s (< 3 small
boxesQTeyeball to make
sure < RR
QTc < 0.45s
Why do we need to correct the QT interval?
8/12/2019 Student EKG Lecture 1
12/29
Atrial Hypertrophy
Lead II characteristics
Prolonged P wave > 120s = LAEPeaked P wave > 0.25 mV = RAE
V1
II
8/12/2019 Student EKG Lecture 1
13/29
Ventricular Hypertrophy
Right ventricular enlargement
R > S in V1
Left ventricular enlargement
many criteria
Bigger of S in V1 or V2 + R
in V5 or V6 > 35 mV
R in aVL > 11 mV
8/12/2019 Student EKG Lecture 1
14/29
8/12/2019 Student EKG Lecture 1
15/29
Ischemia/Infarction
ST abnormalities
ST elevation or
depression
T wave abnormalities
Q waves
8/12/2019 Student EKG Lecture 1
16/29
8/12/2019 Student EKG Lecture 1
17/29
8/12/2019 Student EKG Lecture 1
18/29
Sinus tachycardia-PE, anemia, pain
Rate = 110
Rhythm = nl sinus
Axis = normal (around 60) Intervals = nl
Hypertrophy = none
Ischemia/Infarction = none
8/12/2019 Student EKG Lecture 1
19/29
8/12/2019 Student EKG Lecture 1
20/29
8/12/2019 Student EKG Lecture 1
21/29
8/12/2019 Student EKG Lecture 1
22/29
Left atrial abnormality, LVH
Rate = 80
rhythm = nl sinus
axis = almost left axis (-30)
intervals = nl (QRS = 110, upper limit of normal) hypertrophy = LVH (V2 + V5 > 35, aVL > 11)
Ischemia/Infarction = non-specific ST-T abnormalities)
Pt had cardiomyopathy secondary to anthracycline chemotherapy for her history of breast
cancer
8/12/2019 Student EKG Lecture 1
23/29
8/12/2019 Student EKG Lecture 1
24/29
A fib with RVR
Rate = 110
Rhythm = atrial fibrillation with RVR
Axis = nl, 30 Intervals = nl
Hypertrophy = nl
Ischemia/infarction= non-specific ST-Tchanges in II, III, aVF
8/12/2019 Student EKG Lecture 1
25/29
8/12/2019 Student EKG Lecture 1
26/29
8/12/2019 Student EKG Lecture 1
27/29
8/12/2019 Student EKG Lecture 1
28/29
NSR with repolarization
abnormality ( normal)
Rate = 90
Rhythm = nl sinus
Axis = normal (around 60) intervals = nl (PR = 120, QRS = 80, QT = nl)
Hypertrophy = none
Ischemia/Infarction = none
8/12/2019 Student EKG Lecture 1
29/29