ECG INTERPRETATION MANUAL
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1 Lancashire & South Cumbria Cardiac Network ECG INTERPRETATION MANUAL THE NORMAL ECG Lancashire And South Cumbria Cardiac Physiologist Training Manual
2 THE NORMAL ECG E.C.G CHECKLIST 1) Name, Paper Speed, Calibration. 2) Dangerous Arrhythmia s. 3) Rhythm P for every QRS. 4) P Wave amplitude, Duration (Lead II), Morphology Leads (II & V1). 5) PR Interval. 6) QRS Amplitude, Duration (Leads II & Chest Leads). 7) QRS Axis. 8) Chest Leads morphology (V V6). 9) Progression of R waves through chest leads. 10) ST Segment in all Leads.
3 E.C.G MEASUREMENTS 1mm / 0.04secs 0.1mv Amplitude Time Time :- Amplitude :- 25mm per 1 second. 1mm = 1/25 second 1mm = 1 small square = 0.04 seconds 10 Divisions = 10mm = 1mv Heart Rate : Number of small squares between R R Interval
4 NORMAL RHYTHMS Sinus Rhythm :- P-wave preceding each QRS complex. Heart rate Between bpm. Normal P Wave :- An upright P-wave in leads II, III and AVF, and an Inverted P-Wave in AVR which precede each QRS Complex. Which does not exceed 2.5mm in height and 0.04 to 0.08 seconds in duration. PR Interval :- QRS Complex :- QTc Interval : secs. Should not exceed 0.11 seconds.( secs) Should not exceed 0.42 seconds. QRS Interval 1mm / 0.1mv R S T Segment P T Q S 1mm / 0.04 Secs P---R Interval QT Interval
5 FRONTAL PLANE LEADS Augmented Limb Leads (Goldberger). These are the Unipolar leads AVR = RIGHT ARM AVL = LEFT ARM AVF = LEFT FOOT From the Unipolar limb leads, a system was devised by EINTHOVEN which allows the heart to be seen from 3 other leads known as the Bipolar Limb Leads of Einthoven s Triangle. RA ( I ) LA Main Cardiac Vector ( II ) ( III ) LL LEAD I = + (AVL) - (AVR) LEAD II = + (AVF) - (AVR) LEAD III = + (AVF) - (AVL)
6 DETERMINATION OF QRS AXIS The cardiac axis is an indicator of the general direction the wave of depolarisation takes as it flows through the ventricles. overall axis of depolarisation Forces travelling towards a positive lead will result in a positive deflection. Forces travelling away from a positive lead will result in a negative deflection. Forces perpendicular to a lead will result in an equi-phasic deflection. Wave of depolarisation
7 QRS AXIS FRONTAL PLANE º -60 AVR -150º -30 AVL -180º 0 LEAD I +150º LEAD III LEAD II MAIN CARDIAC +90 VECTOR AVF Normal values for Frontal Plane mean QRS Axis fall in the range of -30º (AVL) to +90º (AVF). Left Axis Deviation will fall in the range of 30º to 180º. Right Axis Deviation will fall in the range of +90º to +180º.
8 Sinus Bradycardia: Same findings as for Normal Sinus Rhythm except. Heart Rate less than 60 bpm Sinus Tachycardia: Same findings as for Normal Sinus Rhythm except. Heart Rate greater than 100 bpm Sinus Arrhythmia: Same findings as for Normal Sinus Rhythm except. The R R Interval is Irregular *Sinus Arrest* Considered Sinus rhythm but is abnormal
9 UNIPOLAR CHEST LEADS Wilson V Leads ( V V6) Relies on zero potential with an exploring chest electrode. c VENTRICULAR ACTIVATION V6 V5 V1 V2 V3 V4 V1 + V2 V3 + V4 V5 + V6 Lie close to the RV Lie close to the IVS Face towards the LV but separated by distance Size of the R wave should increase from V V6. V4 Usually at the Apex (Transitional Zone where the first negative wave appears).
10 TYPICAL COMPLEXES OF PRECORDIAL LEADS V1 V2 V3 V4 V5 V6 RV RV IVS IVS LV LV Size of R wave increases from V V6 DEPOLARISATION STAGES Phase 1:- Depolarisation of the IVS first and alone (left to right in normal). Phase 2:- Depolarisation of the free wall of the RV and LV together. KAP/LJR..N001.
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