If the P wave > 0.12 sec( 3 mm) usually in any lead. Notched P wave usually in lead I,aVl may be lead II Negative terminal portion of P wave in V1, 1

Size: px
Start display at page:

Download "If the P wave > 0.12 sec( 3 mm) usually in any lead. Notched P wave usually in lead I,aVl may be lead II Negative terminal portion of P wave in V1, 1"

Transcription

1

2 If the P wave > 0.12 sec( 3 mm) usually in any lead. Notched P wave usually in lead I,aVl may be lead II Negative terminal portion of P wave in V1, 1 mm depth and 3 mm width( most specific) Since Mitral valve stenosis is the most common cause of LA enlargement. It is called P Mitrale

3 P wave > 0.12 sec, 2.5 mm (pecked) usually in Lead II III avf and V1. It is called P pulmonale, because chronic pulmonary disease is frequently the cause.

4 Slide 14

5 P -WAVE P pulmonale Tall peaked P wave. Generally due to enlarged right atrium- commonly associated with congenital heart disease, tricuspid valve disease, pulmonary hypertension and diffuse lung disease. Biphasic P wave Its terminal negative deflection more than 40 ms wide and more than 1 mm deep is an ECG sign of left atrial enlargement. P mitrale Wide P wave, often bifid, may be due to mitral stenosis or left atrial enlargement.

6

7 LEFT VENTRICULAR HYPERTROPHY AND RIGHT VENTRICULAR HYPERTROPHY So, we have to start looking at the S waves and R waves

8 Voltage criteria : 1. R Lead 1 or avl > 20 mm 2. R V5 or V6 + S V1 > 35 mm 3. In sever LVH There will be ST segment depression and T wave inversion in Lateral leads (I avl,v5 V6)

9

10

11 Prominent R in V1 ( =or > S wave). prominent S in V 6( = or > R wave ). Usually associated with RT axis deviation(>+110). In sever RVH ST depression & T wave inversion V1 may be V2 V3

12

13 The impulse will be conducted from : SA node --- AV node ---- Bundle of His --- RT & LT bundle branches. Any interference with this path way leads to impulse delay or block Level of the block : SA block, AV block, Bundle branch block (BBB), Fascicular block

14

15 The most common site of block. Of three degrees : 1. 1 st Deg. : all impulses from SA node will reach the ventricle but with delay, normal P wave followed by normal QRS but the PR interval is > 0.2 sec (5mm)

16 Characterized by PR Interval > 0.20 seconds Delay in conduction AV Node Prolonged PR Interval constant Usually asymptomatic Least concerning of the blocks

17

18 Two types : 1. Mobitz type 1 (wenchebach phenomena): Progressive PR segment prolongation till the beat will drop out, P wave which will not followed by QRS, the cycle will recurs again.

19

20 P wave which is not followed by QRS with out preceding PR segment prolongation. We see P waves> than QRS complexes, if the P waves are double the no. of QRS, called 2:1 block, if every 3 Ps one QRS complexes, called 3:1 block and so on. The more the no of P for QRS the more sever the block.

21

22 The impulse generated in the SA node will not pass at all to the ventricle, the lower pace maker in the Perkinje fibers will act to stimulate the ventricle. There are P waves not related to QRS complexes, PP interval regular and different from RR interval also regular at other rate (30-40 b/min)

23

24 RT BBB : QRS > 0.12, Broad S lead I and V6 rsr in V1. T inversion in V1-V3

25 QRS duration 110ms rsr pattern or notched R wave in V 1 Wide S wave in I and V 6

26 RBBB

27 QRS > 0.11 RSR in lead I avl, V5 V6. ST segment depression, T wave inversion in the same leads. High voltage but LVH cannot be diagnosed.

28

29

30 Look at the ECG, regular or irregular. If it is regular irregularity or irregular irregularity. Look for the P wave and its relation to QRS Look to the Shape of the P wave and QRS configuration.

31

32 'supraventricular' (sinus, atrial or junctional) produce narrow QRS complexes ventricular produce narrow QRS complexes

33 There P wave for each QRS. PP or RR < 60 beat/mint. Frequently seen in : Athletes, Hypothyroidism Hypothermia, Increased intracranial pressure, inferior MI.

34

35 Hear rate > 100 b/min. P wave for each QRS. Seen in : fever, anxiety, exercise, anemia, hyperthyrodsim.

36

37 Premature Atrial Contraction PAC Basically the ECG is regular, some impulses are not, but there is P wave (which looks different from previous one) for each QRS (which is normal). The PR interval is changeable in these beats ( shorter or longer).

38

39 Very common dysrrhythmia. Heart rate b/m. Usually regular rhythm.

40

41 Rapid atrial rate b/m. Usually there is AV block (2:1, 3:1,4:1 etc.) Usually the PP rate is Faster than RR rate, the atrial rate is regular, ventricular rate could be regular or irregular depending on the degree of block. Because of very frequent P wave the base line in undulated, called saw teeth appearance.

42

43 Completely irregular (irregular irregularity). No P wave but there is f wave (fibrillatory wave). Atrial rate , ventricular rate is totally irregular.

44

45 Generally the ECG is regular with some beats looks wide,no preceding P wave, wide QRS and T wave in opposite direction to QRS. Usually followed by compensatory Pause. Could be single or multiple.

46

47

48 Runs of wide QRS complexes fast tachycardia, no preceding P wave, regular. Usually serious dysrrhytmia, may progress to more serious Ventricular fibrillation.

49

50

51 Fatal dysrhythmia, no actual QRS complexes, rather bizarre and chaotic undulation of the base line. Unconscious patient No central pulsation No respiration

52

53 Hypokalemia : ECG can be used as guide to give clue about serum potassium level. Hypokalemia leads to flattening of T wave, may be U wave. Hyprekalemia showed pecked T wave

54 Flat T wave

55 Pecked T wave

ECG ABNORMALITIES D R. T AM A R A AL Q U D AH

ECG ABNORMALITIES D R. T AM A R A AL Q U D AH ECG ABNORMALITIES D R. T AM A R A AL Q U D AH When we interpret an ECG we compare it instantaneously with the normal ECG and normal variants stored in our memory; these memories are stored visually in

More information

REtrive. REpeat. RElearn Design by. Test-Enhanced Learning based ECG practice E-book

REtrive. REpeat. RElearn Design by. Test-Enhanced Learning based ECG practice E-book Test-Enhanced Learning Test-Enhanced Learning Test-Enhanced Learning Test-Enhanced Learning based ECG practice E-book REtrive REpeat RElearn Design by S I T T I N U N T H A N G J U I P E E R I Y A W A

More information

ECG (MCQs) In the fundamental rules of the ECG all the following are right EXCEP:

ECG (MCQs) In the fundamental rules of the ECG all the following are right EXCEP: ECG (MCQs) 2010 1- In the fundamental rules of the ECG all the following are right EXCEP: a- It is a biphasic record of myocardial action potential fluctuations. b- Deflection record occurs only during

More information

12-Lead ECG Interpretation. Kathy Kuznar, RN, ANP

12-Lead ECG Interpretation. Kathy Kuznar, RN, ANP 12-Lead ECG Interpretation Kathy Kuznar, RN, ANP The 12-Lead ECG Objectives Identify the normal morphology and features of the 12- lead ECG. Perform systematic analysis of the 12-lead ECG. Recognize abnormalities

More information

ECG Interpretation Made Easy

ECG Interpretation Made Easy ECG Interpretation Made Easy Dr. A Tageldien Abdellah, MSc MD EBSC Lecturer of Cardiology- Hull University Hull York Medical School 2007-2008 ECG Interpretation Made Easy Synopsis Benefits Objectives Process

More information

ECG Interpretation Cat Williams, DVM DACVIM (Cardiology)

ECG Interpretation Cat Williams, DVM DACVIM (Cardiology) ECG Interpretation Cat Williams, DVM DACVIM (Cardiology) Providing the best quality care and service for the patient, the client, and the referring veterinarian. GOAL: Reduce Anxiety about ECGs Back to

More information

1 st Degree Block Prolonged P-R interval caused by first degree heart block (lead II)

1 st Degree Block Prolonged P-R interval caused by first degree heart block (lead II) AV Heart Blocks 1 st degree A condition of a rhythm, not a true rhythm Need to always state underlying rhythm 2 nd degree Type I - Wenckebach Type II Classic dangerous to the patient Can be variable (periodic)

More information

Study methodology for screening candidates to athletes risk

Study methodology for screening candidates to athletes risk 1. Periodical Evaluations: each 2 years. Study methodology for screening candidates to athletes risk 2. Personal history: Personal history of murmur in childhood; dizziness, syncope, palpitations, intolerance

More information

Cardiology Flash Cards

Cardiology Flash Cards Cardiology Flash Cards EKG in a nut shell www.brain101.info Conduction System www.brain101.info 2 Analyzing EKG Step by step Steps in Analyzing ECG'S 1. Rhythm: - Regular _ Sinus, Junctional or Ventricular.

More information

General Introduction to ECG. Reading Assignment (p2-16 in PDF Outline )

General Introduction to ECG. Reading Assignment (p2-16 in PDF Outline ) General Introduction to ECG Reading Assignment (p2-16 in PDF Outline ) Objectives 1. Practice the 5-step Method 2. Differential Diagnosis: R & L axis deviation 3. Differential Diagnosis: Poor R-wave progression

More information

Electrical System Overview Electrocardiograms Action Potentials 12-Lead Positioning Values To Memorize Calculating Rates

Electrical System Overview Electrocardiograms Action Potentials 12-Lead Positioning Values To Memorize Calculating Rates Electrocardiograms Electrical System Overview James Lamberg 2/ 74 Action Potentials 12-Lead Positioning 3/ 74 4/ 74 Values To Memorize Inherent Rates SA: 60 to 100 AV: 40 to 60 Ventricles: 20 to 40 Normal

More information

Step by step approach to EKG rhythm interpretation:

Step by step approach to EKG rhythm interpretation: Sinus Rhythms Normal sinus arrhythmia Small, slow variation of the R-R interval i.e. variation of the normal sinus heart rate with respiration, etc. Sinus Tachycardia Defined as sinus rhythm with a rate

More information

Electrocardiogram ECG. Hilal Al Saffar FRCP FACC College of medicine,baghdad University

Electrocardiogram ECG. Hilal Al Saffar FRCP FACC College of medicine,baghdad University Electrocardiogram ECG Hilal Al Saffar FRCP FACC College of medicine,baghdad University Tuesday 29 October 2013 ECG introduction Wednesday 30 October 2013 Abnormal ECG ( ischemia, chamber hypertrophy, heart

More information

Electrocardiography Abnormalities (Arrhythmias) 7. Faisal I. Mohammed, MD, PhD

Electrocardiography Abnormalities (Arrhythmias) 7. Faisal I. Mohammed, MD, PhD Electrocardiography Abnormalities (Arrhythmias) 7 Faisal I. Mohammed, MD, PhD 1 Causes of Cardiac Arrythmias Abnormal rhythmicity of the pacemaker Shift of pacemaker from sinus node Blocks at different

More information

Please check your answers with correct statements in answer pages after the ECG cases.

Please check your answers with correct statements in answer pages after the ECG cases. ECG Cases ECG Case 1 Springer International Publishing AG, part of Springer Nature 2018 S. Okutucu, A. Oto, Interpreting ECGs in Clinical Practice, In Clinical Practice, https://doi.org/10.1007/978-3-319-90557-0

More information

ELECTROCARDIOGRAPH. General. Heart Rate. Starship Children s Health Clinical Guideline

ELECTROCARDIOGRAPH. General. Heart Rate. Starship Children s Health Clinical Guideline General Heart Rate QRS Axis T Wave Axis PR Interval according to Heart Rate & Age P Wave Duration and Amplitude QRS Duration according to Age QT Interval R & S voltages according to Lead & Age R/S ratio

More information

Appendix D Output Code and Interpretation of Analysis

Appendix D Output Code and Interpretation of Analysis Appendix D Output Code and Interpretation of Analysis 8 Arrhythmia Code No. Description 8002 Marked rhythm irregularity 8110 Sinus rhythm 8102 Sinus arrhythmia 8108 Marked sinus arrhythmia 8120 Sinus tachycardia

More information

ECG Practice Strips Discussion part 1:

ECG Practice Strips Discussion part 1: ECG Practice Strips Discussion part 1: The first 20 strips are for teaching various abnormalities of the morphology of the waves of the ECG. Strips 21 and following are for teaching some abnormalities

More information

Understanding the 12-lead ECG, part II

Understanding the 12-lead ECG, part II Bundle-branch blocks Understanding the 12-lead ECG, part II Most common electrocardiogram (ECG) abnormality Appears as a wider than normal S complex Occurs when one of the two bundle branches can t conduct

More information

UNDERSTANDING YOUR ECG: A REVIEW

UNDERSTANDING YOUR ECG: A REVIEW UNDERSTANDING YOUR ECG: A REVIEW Health professionals use the electrocardiograph (ECG) rhythm strip to systematically analyse the cardiac rhythm. Before the systematic process of ECG analysis is described

More information

Pathologic ECG. Adelina Vlad, MD PhD

Pathologic ECG. Adelina Vlad, MD PhD Pathologic ECG Adelina Vlad, MD PhD Basic Interpretation of the ECG 1) Evaluate calibration 2) Calculate rate 3) Determine rhythm 4) Determine QRS axis 5) Measure intervals 6) Analyze the morphology and

More information

Pennsylvania Academy of Family Physicians Foundation & UPMC 43rd Refresher Course in Family Medicine CME Conference March 10-13, 2016

Pennsylvania Academy of Family Physicians Foundation & UPMC 43rd Refresher Course in Family Medicine CME Conference March 10-13, 2016 Pennsylvania Academy of Family Physicians Foundation & UPMC 43rd Refresher Course in Family Medicine CME Conference March 10-13, 2016 Disclosures: EKG Workshop Louis Mancano, MD Speaker has no disclosures

More information

ECG CONVENTIONS AND INTERVALS

ECG CONVENTIONS AND INTERVALS 1 ECG Waveforms and Intervals ECG waveforms labeled alphabetically P wave== represents atrial depolarization QRS complex=ventricular depolarization ST-T-U complex (ST segment, T wave, and U wave)== V repolarization.

More information

Rhythm ECG Characteristics Example. Normal Sinus Rhythm (NSR)

Rhythm ECG Characteristics Example. Normal Sinus Rhythm (NSR) Normal Sinus Rhythm (NSR) Rate: 60-100 per minute Rhythm: R- R = P waves: Upright, similar P-R: 0.12-0.20 second & consistent P:qRs: 1P:1qRs Sinus Tachycardia Exercise Hypovolemia Medications Fever Substances

More information

ECG Basics Sonia Samtani 7/2017 UCI Resident Lecture Series

ECG Basics Sonia Samtani 7/2017 UCI Resident Lecture Series ECG Basics Sonia Samtani 7/2017 UCI Resident Lecture Series Agenda I. Introduction II.The Conduction System III.ECG Basics IV.Cardiac Emergencies V.Summary The Conduction System Lead Placement avf Precordial

More information

Conduction Problems / Arrhythmias. Conduction

Conduction Problems / Arrhythmias. Conduction Conduction Problems / Arrhythmias Conduction Wolf-Parkinson White Syndrome (WPW) and Lown-Ganong-Levine (LGL): Atrial impulses bypass the AV node through an accessory pathway or bypass tract (bundle of

More information

The Electrocardiogram part II. Dr. Adelina Vlad, MD PhD

The Electrocardiogram part II. Dr. Adelina Vlad, MD PhD The Electrocardiogram part II Dr. Adelina Vlad, MD PhD Basic Interpretation of the ECG 1) Evaluate calibration 2) Calculate rate 3) Determine rhythm 4) Determine QRS axis 5) Measure intervals 6) Analyze

More information

FLB s What Are Those Funny-Looking Beats?

FLB s What Are Those Funny-Looking Beats? FLB s What Are Those Funny-Looking Beats? Reading Assignment (pages 27-45 in Outline ) The 5-Step Method ECG #: Mearurements: Rhythm (s): Conduction: Waveform: Interpretation: A= V= PR= QRS= QT= Axis=

More information

ECG Underwriting Puzzler Dr. Regina Rosace AVP & Medical Director

ECG Underwriting Puzzler Dr. Regina Rosace AVP & Medical Director December 2018 ECG Underwriting Puzzler Dr. Regina Rosace AVP & Medical Director To obtain best results Select Slide Show from the ribbon at the top of your PowerPoint screen Select From Beginning on the

More information

Basic electrocardiography reading. R3 lee wei-chieh

Basic electrocardiography reading. R3 lee wei-chieh Basic electrocardiography reading R3 lee wei-chieh The Normal Conduction System Lead Placement avf Limb Leads Precordial Leads Interpretation Rate Rhythm Interval Axis Chamber abnormality QRST change What

More information

Introduction to Electrocardiography

Introduction to Electrocardiography Introduction to Electrocardiography Class Objectives: Introduction to ECG monitoring Discuss principles of interpretation Identify the components and measurements of the ECG ECG analysis ECG Monitoring

More information

Electrocardiography for Healthcare Professionals. Chapter 14 Basic 12-Lead ECG Interpretation

Electrocardiography for Healthcare Professionals. Chapter 14 Basic 12-Lead ECG Interpretation Electrocardiography for Healthcare Professionals Chapter 14 Basic 12-Lead ECG Interpretation 2012 The Companies, Inc. All rights reserved. Learning Outcomes 14.1 Discuss the anatomic views seen on a 12-lead

More information

ECG Interpretation. Best to have a system to methodically evaluate ECG (from Dubin) * Rate * Rhythm * Axis * Intervals * Hypertrophy * Infarction

ECG Interpretation. Best to have a system to methodically evaluate ECG (from Dubin) * Rate * Rhythm * Axis * Intervals * Hypertrophy * Infarction ECG to save Babies ECG Interpretation Best to have a system to methodically evaluate ECG (from Dubin) * Rate * Rhythm * Axis * Intervals * Hypertrophy * Infarction Electrical Activity in the heart 5 events

More information

Supraventricular Arrhythmias. Reading Assignment. Chapter 5 (p17-30)

Supraventricular Arrhythmias. Reading Assignment. Chapter 5 (p17-30) Supraventricular Arrhythmias Reading Assignment Chapter 5 (p17-30) The Supraventricular Rhythms In Our Lives Site of Origin Single Events Slow Rates Intermediate Rates Fast Rates (>100 bpm) Sinus Sinus

More information

HR: 50 bpm (Sinus) PR: 280 ms QRS: 120 ms QT: 490 ms Axis: -70. Sinus bradycardia with one ventricular escape (*)

HR: 50 bpm (Sinus) PR: 280 ms QRS: 120 ms QT: 490 ms Axis: -70. Sinus bradycardia with one ventricular escape (*) 1? HR: 50 bpm (Sinus) PR: 280 ms QRS: 120 ms QT: 490 ms Axis: -70 1 Sinus P waves? 2 sinus cycles The pause (2 sinus cycles) suggests that the sinus fired (?) but did not conduct to the atria (i.e., missing

More information

ELECTROCARDIOGRAPHY (III) THE ANALYSIS OF THE ELECTROCARDIOGRAM

ELECTROCARDIOGRAPHY (III) THE ANALYSIS OF THE ELECTROCARDIOGRAM ELECTROCARDIOGRAPHY (III) THE ANALYSIS OF THE ELECTROCARDIOGRAM Scridon Alina, Șerban Răzvan Constantin Recording and analysis of the 12-lead ECG is part of the basic medical assessment performed for every

More information

ECGs and Arrhythmias: Family Medicine Board Review 2009

ECGs and Arrhythmias: Family Medicine Board Review 2009 Rate Rhythm Intervals Hypertrophy ECGs and Arrhythmias: Family Medicine Board Review 2009 Axis Jess (Fogler) Waldura, MD University of California, San Francisco walduraj@nccc.ucsf.edu Ischemia Overview

More information

Basic Dysrhythmia Interpretation

Basic Dysrhythmia Interpretation Basic Dysrhythmia Interpretation Objectives 2 To understand the Basic ECG To understand the meaning of Dysrhythmia To describe the normal heart conduction system. To describe the normal impulse pathways.

More information

Paediatric ECG Interpretation

Paediatric ECG Interpretation Paediatric ECG Interpretation Dr Sanj Fernando (thanks to http://lifeinthefastlane.com/ecg-library/paediatric-ecginterpretation/) 3 yo boy complaining of abdominal pain and chest pain Child ECG vs Adult

More information

Section V. Objectives

Section V. Objectives Section V Landscape of an MI Objectives At the conclusion of this presentation the participant will be able to Outline a systematic approach to 12 lead ECG interpretation Demonstrate the process for determining

More information

TEST BANK FOR ECGS MADE EASY 5TH EDITION BY AEHLERT

TEST BANK FOR ECGS MADE EASY 5TH EDITION BY AEHLERT Link download full: http://testbankair.com/download/test-bank-for-ecgs-made-easy-5thedition-by-aehlert/ TEST BANK FOR ECGS MADE EASY 5TH EDITION BY AEHLERT Chapter 5 TRUE/FALSE 1. The AV junction consists

More information

Dr. Schroeder has no financial relationships to disclose

Dr. Schroeder has no financial relationships to disclose Valerie A Schroeder MD MS Assistant Professor University of Kansas Medical Center READING THE WAVES- THE HEART S ELECTRICAL MESSAGE FINANCIAL DISCLOSURE Dr. Schroeder has no financial relationships to

More information

Huseng Vefali MD St. Luke s University Health Network Department of Cardiology

Huseng Vefali MD St. Luke s University Health Network Department of Cardiology Huseng Vefali MD St. Luke s University Health Network Department of Cardiology Learning Objectives Establish Consistent Approach to Interpreting ECGs Review Essential Cases for Paramedics and first responders

More information

Reading Assignment (p1-91 in Outline ) Objectives What s in an ECG?

Reading Assignment (p1-91 in Outline ) Objectives What s in an ECG? Reading Assignment (p1-91 in Outline ) Objectives What s in an ECG? The 5-Step Method ECG #: Mearurements: Rhythm (s): Conduction: Waveform: Interpretation: A= V= PR= QRS= QT= Axis= 1. Compute the 5 basic

More information

Miscellaneous Stuff Keep reading the Outline

Miscellaneous Stuff Keep reading the Outline Miscellaneous Stuff Keep reading the Outline Welcome to the 5-Step Method ECG #: Mearurements: Rhythm (s): Conduction: Waveform: Interpretation: A= V= PR= QRS= QT= Axis= 1. Compute the 5 basic measurements:

More information

Blocks & Dissociations. Reading Assignment (p47-52 in Outline )

Blocks & Dissociations. Reading Assignment (p47-52 in Outline ) Blocks & Dissociations Reading Assignment (p47-52 in Outline ) Objectives Who are Wenckebach and Mobitz? Review SA and AV Blocks AV Dissociations: learning who s the boss and why 2 nd degree SA Block:

More information

Chapter 2 Practical Approach

Chapter 2 Practical Approach Chapter 2 Practical Approach There are beginners in electrocardiogram (ECG) analysis who are fascinated by a special pattern (e.g., a bundle-branch block or a striking Q wave) and thereby overlook other

More information

402 Index. B β-blockers, 4, 5 Bradyarrhythmias, 76 77

402 Index. B β-blockers, 4, 5 Bradyarrhythmias, 76 77 Index A Acquired immunodeficiency syndrome (AIDS), 126, 163 Action potentials, 1, 5, 27 Acute coronary syndromes, 123t, 129 Adenosine, intravenous, 277 Alcohol abuse, as T wave inversion cause, 199 Aneurysm,

More information

12 Lead ECG. Presented by Rebecca Sevigny BSN, RN Professional Practice & Development Dept.

12 Lead ECG. Presented by Rebecca Sevigny BSN, RN Professional Practice & Development Dept. 12 Lead ECG Presented by Rebecca Sevigny BSN, RN Professional Practice & Development Dept. Two Main Coronary Arteries RCA LCA which branches into Left Anterior Descending Circumflex Artery Two Main Coronary

More information

EKG Abnormalities. Adapted from:

EKG Abnormalities. Adapted from: EKG Abnormalities Adapted from: http://www.bem.fi/book/19/19.htm Some key terms: Arrhythmia-an abnormal rhythm or sequence of events in the EKG Flutter-rapid depolarizations (and therefore contractions)

More information

Rate: The atrial and ventricular rates are equal; heart rate is greater than 100 bpm (usually between bpm).

Rate: The atrial and ventricular rates are equal; heart rate is greater than 100 bpm (usually between bpm). Sinus Bradycardia Regularity: The R-R intervals are constant; the rhythm is regular. Rate: The atrial and ventricular rates are equal; heart rate is less than 60 bpm. P wave: There is a uniform P wave

More information

Lab Activity 24 EKG. Portland Community College BI 232

Lab Activity 24 EKG. Portland Community College BI 232 Lab Activity 24 EKG Reference: Dubin, Dale. Rapid Interpretation of EKG s. 6 th edition. Tampa: Cover Publishing Company, 2000. Portland Community College BI 232 Graph Paper 1 second equals 25 little boxes

More information

ECG interpretation basics

ECG interpretation basics ECG interpretation basics Michał Walczewski, MD Krzysztof Ozierański, MD 21.03.18 Electrical conduction system of the heart Limb leads Precordial leads 21.03.18 Precordial leads Precordial leads 21.03.18

More information

, David Stultz, MD.

, David Stultz, MD. http://www.dilbert.com EKG Rounds Handouts available at http://www.drstultz.com January 5, 2004 David Stultz, MD Cardiology Fellow, PGY 4 Overview of Topics How to read an EKG Normal EKG Determination

More information

Ekg pra pr c a tice D.HAMMOUDI.MD

Ekg pra pr c a tice D.HAMMOUDI.MD Ekg practice D.HAMMOUDI.MD Anatomy Revisited RCA (Right Coronary Artery) Right ventricle Inferior wall of LV Posterior wall of LV (75%) SA Node (60%) AV Node (>80%) LCA (Left Coronary Artery) Septal wall

More information

BEDSIDE ECG INTERPRETATION

BEDSIDE ECG INTERPRETATION BEDSIDE ECG INTERPRETATION Presented by: Ryan Dean, RN, MSN, CCRN, CCNS, CFRN Flight Nurse 2017 Based on presentations originally by Gennifer DePaoli, RN Objectives Hospital policies Electrical conduction

More information

EKG Competency for Agency

EKG Competency for Agency EKG Competency for Agency Name: Date: Agency: 1. The upper chambers of the heart are known as the: a. Atria b. Ventricles c. Mitral Valve d. Aortic Valve 2. The lower chambers of the heart are known as

More information

2017 EKG Workshop Advanced. Family Medicine Review Course Lou Mancano, MD, FAAFP Reading Health System Family and Community Medicine Reading, PA

2017 EKG Workshop Advanced. Family Medicine Review Course Lou Mancano, MD, FAAFP Reading Health System Family and Community Medicine Reading, PA 2017 EKG Workshop Advanced Family Medicine Review Course Lou Mancano, MD, FAAFP Reading Health System Family and Community Medicine Reading, PA Part II - Objective Describe a useful approach to interpreting

More information

The ECG in healthy people

The ECG in healthy people The ECG in healthy people The normal cardiac rhythm 3 The heart rate 3 Extrasystoles 7 The P wave 7 The PR interval The QRS complex 3 The ST segment 29 The T wave 33 The QT interval 42 The ECG in athletes

More information

Acute Coronary Syndromes Unstable Angina Non ST segment Elevation MI (NSTEMI) ST segment Elevation MI (STEMI)

Acute Coronary Syndromes Unstable Angina Non ST segment Elevation MI (NSTEMI) ST segment Elevation MI (STEMI) Leanna R. Miller, RN, MN, CCRN-CSC, PCCN-CMC, CEN, CNRN, CMSRN, NP Education Specialist LRM Consulting Nashville, TN Objectives Evaluate common abnormalities that mimic myocardial infarction. Identify

More information

Bundle Branch & Fascicular Blocks. Reading Assignment (p53-58 in Outline )

Bundle Branch & Fascicular Blocks. Reading Assignment (p53-58 in Outline ) Bundle Branch & Fascicular Blocks Reading Assignment (p53-58 in Outline ) Objectives 1. QRS analysis of Right and Left BBB 2. Uncomplicated vs complicated BBB 3. Diagnosis of RBBB with LAFB and LPFB 4.

More information

I have no conflicts of interest relative to this lecture.

I have no conflicts of interest relative to this lecture. PATHWAYS AROUND THE PITFALLS OF EKG RHYTHM INTERPRETATION Donald D. Brown, MD April 4, 2019 I have no conflicts of interest relative to this lecture. OBJECTIVES FOR PATHWAYS AROUND PITFALLS OF EKG RHYTHM

More information

ACLS Study Guide for Precourse Self-Assessment

ACLS Study Guide for Precourse Self-Assessment 20 rhythm strips on Precourse Self-Assessment with the following matching choices: Agonal Rhythm/Asystole Atrial Fibrillation Flutter Ventricular Fibrillation Monomorphic Ventricular Normal Sinus Rhythm

More information

The Efficient and Smart Methods for Diagnosis of SVT 대구파티마병원순환기내과정병천

The Efficient and Smart Methods for Diagnosis of SVT 대구파티마병원순환기내과정병천 The Efficient and Smart Methods for Diagnosis of SVT 대구파티마병원순환기내과정병천 Differentiation Supraventricular Origin from Ventricular Origin on ECG. QRS-Complex Width. 1. Narrow QRS-Complex Tachycardia (

More information

PATIENT S NAME, DATE/TIME,

PATIENT S NAME, DATE/TIME, ECG and Arrhythmias Dec, 1 st 2014 Doctor Mohammad Jarrah References: - Lecture and Slides - ECG Made Easy - Davidson Principles of Medicine - First Aid Cases for the USMLE Step 1 - Mini-OSCE Archive ECG

More information

Electrocardiography for Healthcare Professionals

Electrocardiography for Healthcare Professionals Electrocardiography for Healthcare Professionals Chapter 7: Junctional Dysrhythmias 2012 The Companies, Inc. All rights reserved. Learning Outcomes 7.1 Describe the various junctional dysrhythmias 7.2

More information

8/20/2012. Learning Outcomes (Cont d)

8/20/2012. Learning Outcomes (Cont d) 1 2 3 4 Electrocardiography for Healthcare Professionals Chapter 7: Junctional Dysrhythmias Learning Outcomes 7.1 Describe the various junctional dysrhythmias 7.2 Identify premature junctional complexes

More information

15 16 September Seminar W10O. ECG for General Practice

15 16 September Seminar W10O. ECG for General Practice 15 16 September 2012 Seminar W10O ECG for General Practice Speaker: Ms Natasha Eaton ECG for General Practice Speaker: Natasha Eaton Cardiac CNC Executive Representative Electrocardiography The graphic

More information

ECG Interpretation. Introduction to Cardiac Telemetry. Michael Peters, RN, CCRN, CFRN CALSTAR Air Medical Services

ECG Interpretation. Introduction to Cardiac Telemetry. Michael Peters, RN, CCRN, CFRN CALSTAR Air Medical Services ECG Interpretation Introduction to Cardiac Telemetry Michael Peters, RN, CCRN, CFRN CALSTAR Air Medical Services Disclosures Nothing to disclose Objectives Describe the electrical conduction pathway in

More information

Other 12-Lead ECG Findings

Other 12-Lead ECG Findings Other 12-Lead ECG Findings Left Atrial Enlargement Left atrial enlargement is illustrated by increased P wave duration in lead II, top ECG, and by the prominent negative P terminal force in lead V1, bottom

More information

Junctional Premature Contraction (JPC)

Junctional Premature Contraction (JPC) Where s the PAC? Junctional Premature Contraction (JPC) A junctional premature contraction (JPC) is a beat that originates prematurely in the AV node. It can occur sporadically or in a grouped pattern.

More information

2017 EKG Workshop Basic. Family Medicine Review Course Lou Mancano, MD, FAAFP Reading Health System Family and Community Medicine Reading, PA

2017 EKG Workshop Basic. Family Medicine Review Course Lou Mancano, MD, FAAFP Reading Health System Family and Community Medicine Reading, PA 2017 EKG Workshop Basic Family Medicine Review Course Lou Mancano, MD, FAAFP Reading Health System Family and Community Medicine Reading, PA Part I - Objectives Discuss a systematic approach to EKG interpretation

More information

ECGs: Everything a finalist needs to know. Dr Amy Coulden As part of the Simply Finals series

ECGs: Everything a finalist needs to know. Dr Amy Coulden As part of the Simply Finals series ECGs: Everything a finalist needs to know Dr Amy Coulden As part of the Simply Finals series Aims and objectives To be able to interpret basic ECG abnormalities To be able to recognise commonly tested

More information

A Review of Cardiac Pathophysiology and EKG. Jamie Dyson PT, DPT Kathy Swanick PT, DPT, OCS

A Review of Cardiac Pathophysiology and EKG. Jamie Dyson PT, DPT Kathy Swanick PT, DPT, OCS A Review of Cardiac Pathophysiology and EKG Jamie Dyson PT, DPT Kathy Swanick PT, DPT, OCS Cardiac Pathophysiology Coronary Artery Disease Congestive Heart Failure Valvular Heart Disease Athletic Heart

More information

ECG pre-reading manual. Created for the North West Regional EMET training program

ECG pre-reading manual. Created for the North West Regional EMET training program ECG pre-reading manual Created for the North West Regional EMET training program Author:- Dr Juan Carlos Ascencio-Lane juan.ascencio-lane@ths.tas.gov.au 1 Disclaimer This handbook has been created for

More information

at least 4 8 hours per week

at least 4 8 hours per week ECG IN ATHLETS An athlete is defined as an individual who engages in regular exercise or training for sport or general fitness, typically with a premium on performance, and often engaged in individual

More information

12 Lead ECG Skills: Building Confidence for Clinical Practice. Presented By: Cynthia Webner, BSN, RN, CCRN-CMC. Karen Marzlin, BSN, RN,CCRN-CMC

12 Lead ECG Skills: Building Confidence for Clinical Practice. Presented By: Cynthia Webner, BSN, RN, CCRN-CMC. Karen Marzlin, BSN, RN,CCRN-CMC 12 Lead ECG Skills: Building Confidence for Clinical Practice NTI 2009 Preconference Session 803 Presented By: Karen Marzlin, BSN, RN,CCRN-CMC 1 12 Lead ECG Fundamentals: The Starting Place for Linking

More information

HTEC 91. Performing ECGs: Procedure. Normal Sinus Rhythm (NSR) Topic for Today: Sinus Rhythms. Characteristics of NSR. Conduction Pathway

HTEC 91. Performing ECGs: Procedure. Normal Sinus Rhythm (NSR) Topic for Today: Sinus Rhythms. Characteristics of NSR. Conduction Pathway HTEC 91 Medical Office Diagnostic Tests Week 3 Performing ECGs: Procedure o ECG protocol: you may NOT do ECG if you have not signed up! If you are signed up and the room is occupied with people who did

More information

ECG Cases and Questions. Ashish Sadhu, MD, FHRS, FACC Electrophysiology/Cardiology

ECG Cases and Questions. Ashish Sadhu, MD, FHRS, FACC Electrophysiology/Cardiology ECG Cases and Questions Ashish Sadhu, MD, FHRS, FACC Electrophysiology/Cardiology 32 yo female Life Insurance Physical 56 yo male with chest pain Terminology Injury ST elevation Ischemia T wave inversion

More information

Skin supplied by T1-4 (medial upper arm and neck) T5-9- epigastrium Visceral afferents from skin and heart are the same dorsal root ganglio

Skin supplied by T1-4 (medial upper arm and neck) T5-9- epigastrium Visceral afferents from skin and heart are the same dorsal root ganglio Cardio 2 ECG... 3 Cardiac Remodelling... 11 Valvular Diseases... 13 Hypertension... 18 Aortic Coarctation... 24 Erythropoiesis... 27 Haemostasis... 30 Anaemia... 36 Atherosclerosis... 44 Angina... 48 Myocardial

More information

CORONARY ARTERIES. LAD Anterior wall of the left vent Lateral wall of left vent Anterior 2/3 of interventricluar septum R & L bundle branches

CORONARY ARTERIES. LAD Anterior wall of the left vent Lateral wall of left vent Anterior 2/3 of interventricluar septum R & L bundle branches CORONARY ARTERIES RCA Right atrium Right ventricle SA node 55% AV node 90% Posterior wall of left ventricle in 90% Posterior third of interventricular septum 90% LAD Anterior wall of the left vent Lateral

More information

2017 BDKA Review. Regularity Rate P waves PRI QRS Interpretation. Regularity Rate P waves PRI QRS Interpretation 1/1/2017

2017 BDKA Review. Regularity Rate P waves PRI QRS Interpretation. Regularity Rate P waves PRI QRS Interpretation 1/1/2017 1. 2017 BDKA Review 2. 3. 4. Interpretation 5. QT 6. 7. 8. 9. 10. QT 11. 12. 13. 14. 15. 16. 17. 18. QT 19. 20. QT 21. 22. QT 23. 24. Where are pacer spikes? Before the P wave or before the QRS complex?

More information

Pathological Arrhythmias/ Tachyarrhythmias

Pathological Arrhythmias/ Tachyarrhythmias Pathological Arrhythmias/ Tachyarrhythmias caused by: 1.Ectopic focus: Extrasystole or premature beat. If discharge is occasional. Can be: Atrial Extrasystole Vevtricular Extrasystole 2.Cardiac Arrhythmia

More information

ELECTROCARDIOGRAPHY KEVIN REBECK PA-C. For more presentations

ELECTROCARDIOGRAPHY KEVIN REBECK PA-C. For more presentations ELECTROCARDIOGRAPHY KEVIN REBECK PA-C For more presentations www.medicalppt.blogspot.com Objectives ECG History Pathophysiology Basics Case Historys Electrical activation of the heart In the heart

More information

Ben Taylor, PhD, PA-C

Ben Taylor, PhD, PA-C Ben Taylor, PhD, PA-C The patient is a 23-year-old white male with a history of polysubstance abuse who was found unresponsive, last seen the day before. Classic signs of systemic hypothermia with prominent

More information

SIMPLY ECGs. Dr William Dooley

SIMPLY ECGs. Dr William Dooley SIMPLY ECGs Dr William Dooley 1 No anatomy just interpretation 2 Setting up an ECG 3 Setting up an ECG 1 V1-4 th Right intercostal space at sternal border 2 V2-4 th Left intercostal space at sternal border

More information

The ABC of Pediatric ECG

The ABC of Pediatric ECG The ABC of Pediatric ECG Mohamed Hamdan, MD, FAAP, FACC Assistant Professor of Pediatrics Columbia University College of Physicians and Surgeons, NY, USA Consultant Pediatric Cardiologist & Co-Director

More information

ECG. Prepared by: Dr.Fatima Daoud Reference: Guyton and Hall Textbook of Medical Physiology,12 th edition Chapters: 11,12,13

ECG. Prepared by: Dr.Fatima Daoud Reference: Guyton and Hall Textbook of Medical Physiology,12 th edition Chapters: 11,12,13 ECG Prepared by: Dr.Fatima Daoud Reference: Guyton and Hall Textbook of Medical Physiology,12 th edition Chapters: 11,12,13 The Concept When the cardiac impulse passes through the heart, electrical current

More information

ABCs of ECGs. Shelby L. Durler

ABCs of ECGs. Shelby L. Durler ABCs of ECGs Shelby L. Durler Objectives Review the A&P of the cardiac conduction system Placement and obtaining 4-lead and 12-lead ECGs Overview of the basics of ECG rhythm interpretation Intrinsic

More information

2) Heart Arrhythmias 2 - Dr. Abdullah Sharif

2) Heart Arrhythmias 2 - Dr. Abdullah Sharif 2) Heart Arrhythmias 2 - Dr. Abdullah Sharif Rhythms from the Sinus Node Sinus Tachycardia: HR > 100 b/m Causes: o Withdrawal of vagal tone & Sympathetic stimulation (exercise, fight or flight) o Fever

More information

This presentation will deal with the basics of ECG description as well as the physiological basics of

This presentation will deal with the basics of ECG description as well as the physiological basics of Snímka 1 Electrocardiography basics This presentation will deal with the basics of ECG description as well as the physiological basics of Snímka 2 Lecture overview 1. Cardiac conduction system functional

More information

SIMPLY ECGs. Dr William Dooley

SIMPLY ECGs. Dr William Dooley SIMPLY ECGs Dr William Dooley Content Basic ECG interpretation pattern Some common (examined) abnormalities Presenting ECGs in context Setting up an ECG Setting up an ECG 1 V1-4 th Right intercostal space

More information

Dr.Binoy Skaria 13/07/15

Dr.Binoy Skaria  13/07/15 Dr.Binoy Skaria binoyskaria@hotmail.com binoy.skaria@heartofengland.nhs.uk 13/07/15 Acknowledgement Medtronic, Google images & Elsevier for slides Natalie Ryan, Events Manager, HEFT- for organising the

More information

Making Sense of Those Little Lines Advanced ECG Interpretation

Making Sense of Those Little Lines Advanced ECG Interpretation Making Sense of Those Little Lines Advanced ECG Interpretation Cara Solodky-Hardy, ND, ANP-BC, AACC MD24 House Call Cardiology My patients www.ecglibrary.com Image Sources The Alan E. Lindsay Ecg Learning

More information

Proceedings of the World Small Animal Veterinary Association Sydney, Australia 2007

Proceedings of the World Small Animal Veterinary Association Sydney, Australia 2007 Proceedings of the World Small Animal Sydney, Australia 2007 Hosted by: Next WSAVA Congress ECG INTERPRETATION Adrian Boswood MA VetMB DVC DECVIM-CA(Cardiology) MRCVS The Royal Veterinary College, Hawkshead

More information

DR QAZI IMTIAZ RASOOL OBJECTIVES

DR QAZI IMTIAZ RASOOL OBJECTIVES PRACTICAL ELECTROCARDIOGRAPHY DR QAZI IMTIAZ RASOOL OBJECTIVES Recording of electrical events in heart Established electrode pattern results in specific tracing pattern Health of heart i. e. Anatomical

More information

Biventricular Enlargement/ Hypertrophy

Biventricular Enlargement/ Hypertrophy Biventricular Enlargement/ Hypertrophy Keywords congenital heart disease left ventricular hypertrophy right ventricular hypertrophy SR MITTAL Abstract Electrocardiographic diagnosis of early biventricular

More information

PAEDIATRIC ECG Dimosthenis Avramidis, MD.

PAEDIATRIC ECG Dimosthenis Avramidis, MD. PAEDIATRIC ECG Dimosthenis Avramidis, MD. Consultant Mitera Children s Hospital Athens Greece S. Associate 1st Cardiology Dpt Evangelismos Hospital Athens Greece 5 y/o with sinus tach Background ECG changes

More information

Northwest Community Healthcare Paramedic Education Program AV Conduction Defects/AV Blocks Connie J. Mattera, M.S., R.N., EMT-P

Northwest Community Healthcare Paramedic Education Program AV Conduction Defects/AV Blocks Connie J. Mattera, M.S., R.N., EMT-P Northwest Community Healthcare Paramedic Education Program AV Conduction Defects/ Connie J. Mattera, M.S., R.N., EMT-P Reading assignments: Bledsoe Vol. 3: pp. 88-93; 120-121 (atropine, norepinephrine,

More information

Electrocardiography for Healthcare Professionals

Electrocardiography for Healthcare Professionals Electrocardiography for Healthcare Professionals Chapter 9: Ventricular Dysrhythmias 2012 The Companies, Inc. All rights reserved. Learning Outcomes 9.1 Describe the various ventricular dysrhythmias 9.2

More information