ECG INTERPRETATION:ECG INTERPRETATION
ECG INTERPRETATION:the basicsDamrong Sukitpunyaroj,Sukitpunyaroj MDPerfect Heart Institue, Piyavate Hospital
Overview Conduction Pathways Systematic Interpretation Common abnormalities in Critical Care– Supraventricular arrhythmias– VentricularVentric lar arrharrhythmiasthmias
Conduction Pathways
Conduction PathwaysP wave atrial depolarisation.PR Interval impulse from atriato ventricles.ventriclesQRS complex ventriculardepolarisation.ST segment isoelectric - partof repolarisation.T wave usually same directionas QRS - ventricularrepolarisation.QT Interval This intervalspans the onset ofdepolarisation to thecompletion of repolarizationof the ventricles.ventricles
Interpretation
Interpretation1.Rate Number of P’s (atrial) R’s (ventricular) perminute (6 second [30 squares] X 10 minute rate).P rate: 8 x 10 802.R rate: 8 x 10 80Rhythm Regular or irregular. Map P-P and R-Rintervals.intervals
Interpretation3 P wave present,3.t 1 per QRS,QRS shape,hdduration,tivoltage.lt4. P-R interval length (0.12 - 0.2 sec 1 big square), isoelectric.
Interpretation5. QRS duration (0.06 - 0.10 ), voltage, q or Q waves6. ST Segment shape, isoelectric with PR segment
Interpretation7. T wave shape, direction8. QT interval length (R-R/2 or QTc 0.40 sec)
Abnormalities:Supraventricular arrhythmias Atrial Fibrillation Atrial Flutter Supraventricular Tachycardia (SVT)Abnormalities:V t i l arrhythmiasVentricularh th i Premature Ventricular Complexes (PVCs) Ventricular tachycardia (VT)
Conduction PathwaysSupraventricularNarrow QRS complexVentricularVti lWide QRS complex
Abnormalities:atrial fibrillationRhythm: IrregularRate: A: 350 – 650; V: variesP: poorly definedP-R: N/AQRS: narrow complexS-T: normalT: normalQ-T: normal
Abnormalities:atrial flutterRhythm: Regular / IrregularRate: A: 220 – 430; V: 300 (2:1, 3:1 or sometimes 4:1)P: Saw toothed appearanceP-R: N/AQRS: narrow complexS-T: normalT: normalQ-T: normal
Abnormalities:supraventricular tachycardia (SVT)Rhythm: RegularRate: 100P: not visibleP-R: not definedQRS: narrow complexS-T: depression (sometimes)T: normalQ-T: prolonged (sometimes)
Abnormalities:premature ventricular complexes
Examples
Examples
ECG INTERPRETATION:12 Lead
Overview Lead Placement Axis Common abnormalities in Critical Care– Heart block– BundleB ndle branch blocks– Life threatening arrhythmias
Lead PlacementV1 4th ICS righti ht sternumtV2 4th ICS left sternumV3 midway between V2and V4V4 5th ICS midclavicularV5 between V4 and V6anterior auxiliary lineV6 midauxillary linelateral to V4 and V5
Lead Placement Electrical activity towards Electrical activity away
Lead Placement
Axis The direction of an ECGwaveform in the frontalplane measured indegrees Representspthe flow ofthe majority of electricalactivity NormallyNll theh QRScomplex is measured
Axis Each lead has its own axis
Lead PlacementStandard Leads (bipolar) I - lateral wall II - inferior wall III - inferior wallAugmented leads (unipolar) aVR - no mans land aVL - lateral wall aVF - inferior wallChestt LChLeadsd (unipolar) V1 - septal wall V2 - septal wall V3 - anterior wall V4 - anterior wall V5 - lateral wall V6 - lateral wall
Lead PlacementNo-mans land, inferior, lateral, anterior, septal,
Abnormalities:bundle branch blocks QRS widened, greater than 0.12 secs Change in axis Difficult to interpret ECG Right or Left Normal P wave Followed by a T wave
Abnormalities:right bundle branch blocks Indicates conductionproblems in the right side ofthe heart May be normal in healthypeople R wave in V1, ie two R wavesin V1 Q wave in V6 Lead V1 cats ears
Abnormalities:left bundle branch blocks Always indicates heartdisease, usually of the leftside of the heart Hard to interpret an ECG withLBBB Lead V1 Q wave and an Swave Lead V6 an R wave followedbyy another R wave Lead V6 Rabbit ears
Abnormalities:heart block SA block (exit block) 1st degree AV block 2nd degree AV block– Wenckeback (type I)– MobitzMobit (type(t pe II) 3rd degree AV block
Abnormalities:heart block – SA block
Abnormalities:heart block – 1st degree AV
Abnormalities:heart block – 2nd degree AVW k b kWenkebackMobitz
Abnormalities:heart block – 3rd degree AV
Abnormalities:life threatening arrhythmias Ventricular Tachycardia Ventricular Fibrillation Asystole
Abnormalities:life threatening arrhythmias - VT
Abnormalities:life threatening arrhythmias - VF
Abnormalities:life threatening arrhythmias – Asystole
Examples
Examples
Difficult to interpret ECG Right or Left Normal P wave Followed by a T wave. Abnormalities: right bundle branch blocks Indicates conduction problems in the right side of the heartthe heart May be normal i
a 12-lead ECG Recording a high-quality ECG is essential to ensure that interpretation of the ECG is correct. Errors that can occur in ECG recording include poor electrode contact and incorrect electrode positioning, which can lead to misinterpretation of the ECG and misdiagnosis. This guide to performing a standard 12-lead ECG recording
Electrocardiography (ECG) Handout Thanks to everyone who has looked at the EmergencyPedia page since we started in April 2013. Since the start we've been keen to include a FOAM ECG page to share our ECG collection and ideas. We have started by presenting an ECG checklist, OSCE station and more than 20 original ECG cases on this page (see below).
the ECG wave simultaneously. Jyoti Gupta et al. (2015), proposed use of MATLAB to process the ECG signals acquired from an online ECG database. MATLAB was used for processing the ECG signals. Dijkstra's Algorithm was used to send the processed ECG data from a wireless node to a remote location using a shortest path.
A good basic ECG interpretation may rely on the ability to combine clinical skills with basic ECG interpretation. ECG is an important tool used for the diagnosis and treatment of various cardiac and other related diseases. The recorded traces of ECG waveform produced by heart can tell you basic information about patient's condition.
Diagnostic ECG Three steps to performing a basic ECG investigation - Get a good clean tracing - Make rapid reliable measurements - Interpretation based on the trace and clinical observation. Getting a good clean ECG Trace . Microsoft PowerPoint - PRACTICAL ECG.ppt Author:
Instructional Method - Topic #1: Demonstrating 12 Lead ECG Interpretation Skills Topic Description: This session will identify individual interpretation competencies and any limitations to assist in delivering an effective training session. Participants will be asked to take a pre-test on their 12 Lead ECG Interpretation skills.
Computerized ECG interpretation in an environment where cardiological expertise is not readily available will only be possible when the good quality of the diagnostic interpretation has been proven. Difficnlties in computerized ECG interpretation In tltis paragraph, three problems are addressed that have to be dealt with when trying to .
Beginning 12 Lead ECG Workshop Virginia Hass, DNP, FNP-C, PA-C . 12-Lead ECG- Limb Lead Placement WHITE TO THE RIGHT, SMOKE OVER FIRE! GREEN IS GROUND. 12-Lead ECG: Chest Lead Placement. 12-Lead ECG: Chest Lead Placement The electrodes for the chest leads MUST go in the standard pos
