EKG Practice. Homan Wai
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1 EKG Practice Homan Wai
2 Objectives Learn EKG by Examples Learn by repetition Learn by repetition Learn by repetition Learn by repetition Learn by repetition Learn by repetition Learn by repetition
3 Details of EKG Interpretation Rate Rhythm (sinus, Afib, Aflutter, SVT, VT, VF) Axis Interval (PR, QRS, QT) AV block Bundle Branch Block Atrial Enlargement (R and L) Ventricular Hypertrophy (R and L) Ischemic Changes (hyperacute T s, Q waves, ST depression, ST elevation, T wave inversion)
4 Details of EKG Interpretation Rate Rhythm (sinus, Afib, Aflutter, SVT, VT, VF) Axis Interval (PR, QRS, QT) AV block Bundle Branch Block Atrial Enlargement (R and L) Ventricular Hypertrophy (R and L) Ischemic Changes (hyperacute T s, Q waves, ST depression, ST elevation, T wave inversion)
5 What s the Rate?
6 Rate
7 What s the Rate?
8 What s the Rate? 10 sec 3 sec 6 sec
9 Details of EKG Interpretation Rate Rhythm (sinus, Afib, Aflutter, SVT, VT, VF) Axis Interval (PR, QRS, QT) AV block Bundle Branch Block Atrial Enlargement (R and L) Ventricular Hypertrophy (R and L) Ischemic Changes (hyperacute T s, Q waves, ST depression, ST elevation, T wave inversion)
10 Rhythm - normal sinus rhythm
11 Rhythm - Sinus Tachycardia
12 Rhythm - Sinus Bradycardia
13 Rhythm - Junctional Rhythm
14 Rhythm - Atrial Fibrillation
15 Rhythm - Atrial Fibrillation with RVR
16 Rhythm - Atrial Flutter
17 Atrial Flutter
18 Rhythm - SVT (supraventricular tachycardia)
19 Rhythm - SVT (supraventricular tachycardia)
20 Rhythm - SVT (supraventricular tachycardia)
21 Rhythm - Ventricular Tachycardia
22 Rhythm - SVT with Aberrancy
23 How do you tell? VT vs SVT with Aberrancy
24 Rhythm - Ventricular Fibrillation
25 Rhythm - Ventricular Fibrillation
26 Rhythm - Asystole or lead issues
27 Rhythm - Torsades de pointes
28 Rhythm - Torsades de pointes
29 Rhythm - PVC s
30 Rhythm - PVC s
31 Rhythm - PAC s
32 Details of EKG Interpretation Rate Rhythm (sinus, Afib, Aflutter, SVT, VT, VF) Axis Interval (PR, QRS, QT) AV block Bundle Branch Block Atrial Enlargement (R and L) Ventricular Hypertrophy (R and L) Ischemic Changes (hyperacute T s, Q waves, ST depression, ST elevation, T wave inversion)
33 Axis
34 Details of EKG Interpretation Rate Rhythm (sinus, Afib, Aflutter, SVT, VT, VF) Axis Interval (PR, QRS, QT) AV block Bundle Branch Block Atrial Enlargement (R and L) Ventricular Hypertrophy (R and L) Ischemic Changes (hyperacute T s, Q waves, ST depression, ST elevation, T wave inversion)
35 Segments/Intervals
36 QT Interval which one is longer?
37 Prolonged QTc
38 Details of EKG Interpretation Rate Rhythm (sinus, Afib, Aflutter, SVT, VT, VF) Axis Interval (PR, QRS, QT) AV block Bundle Branch Block Atrial Enlargement (R and L) Ventricular Hypertrophy (R and L) Ischemic Changes (hyperacute T s, Q waves, ST depression, ST elevation, T wave inversion)
39 Rhythm - 1 st degree AV Block
40 Rhythm - 1 st degree AV Block
41 Rhythm - 2 nd degree AV Block Mobitz Type I (Winkebach)
42 Rhythm - 2 nd degree AV Block Mobitz Type I (Winkebach)
43 Rhythm - 2 nd degree AV Block Mobitz Type II
44 Rhythm - 2:1 2 nd degree AV Block Mobitz Type I or II
45 Rhythm - 3 rd degree AV Block AV dissociation
46 Details of EKG Interpretation Rate Rhythm (sinus, Afib, Aflutter, SVT, VT, VF) Axis Interval (PR, QRS, QT) AV block Bundle Branch Block Atrial Enlargement (R and L) Ventricular Hypertrophy (R and L) Ischemic Changes (hyperacute T s, Q waves, ST depression, ST elevation, T wave inversion)
47
48 Bundle Branch Block
49 Bundle Branch Block
50 Bundle Branch Block
51 Bundle Branch Block
52 Bundle Branch Block
53 Bundle Branch Block
54 Bundle Branch Block
55 Bundle Branch Block
56 Bundle Branch Block
57 Bundle Branch Block
58 Bundle Branch Block
59 Bundle Branch Block
60 Bundle Branch Block
61 Bundle Branch Block
62 Details of EKG Interpretation Rate Rhythm (sinus, Afib, Aflutter, SVT, VT, VF) Axis Interval (PR, QRS, QT) AV block Bundle Branch Block Atrial Enlargement (R and L) Ventricular Hypertrophy (R and L) Ischemic Changes (hyperacute T s, Q waves, ST depression, ST elevation, T wave inversion)
63 Atrial Enlargement Lead II Lead v1 > 2.5 mm > 1.5 mm > 120 msec > 1 mm > 40 msec
64 Atrial Enlargement
65 Atrial Enlargement
66 Atrial Enlargement
67 Details of EKG Interpretation Rate Rhythm (sinus, Afib, Aflutter, SVT, VT, VF) Axis Interval (PR, QRS, QT) AV block Bundle Branch Block Atrial Enlargement (R and L) Ventricular Hypertrophy (R and L) Ischemic Changes (hyperacute T s, Q waves, ST depression, ST elevation, T wave inversion)
68 Ventricular Hypertrophy Sokolow-Lyon: S in V1 + R in V5 or V6 >= 35mm = 37mm
69 Ventricular Hypertrophy
70 Ventricular Hypertrophy
71 Ventricular Hypertrophy 15mm R in avl >= 11mm + 26mm = 41mm Cornell: R in avl + S in V3 >28mm (men) or >20mm (women)
72 Ventricular Hypertrophy - strain
73 Ventricular Hypertrophy 16 mm R > S in V1 R in V1 > 7mm
74 Ventricular Hypertrophy
75 Details of EKG Interpretation Rate Rhythm (sinus, Afib, Aflutter, SVT, VT, VF) Axis Interval (PR, QRS, QT) AV block Bundle Branch Block Atrial Enlargement (R and L) Ventricular Hypertrophy (R and L) Ischemic Changes (hyperacute T s, Q waves, ST depression, ST elevation, T wave inversion)
76 Ischemic Changes by Region lateral Septal lateral anterior Inferior lateral
77 Ischemic Changes Q waves ST elevation ST depression T wave inversion Hyper-acute T waves
78 Ischemic Changes
79 Ischemic Changes
80 Ischemic Changes
81 Ischemic Changes
82 Ischemic Changes
83 Ischemic Changes
84 Ischemic Changes
85 Ischemic Changes
86 Ischemic Changes
87 Ischemic Changes
88 Ischemic Changes
89 Details of EKG Interpretation Rate Rhythm (sinus, Afib, Aflutter, SVT, VT, VF) Axis Interval (PR, QRS, QT) AV block Bundle Branch Block Atrial Enlargement (R and L) Ventricular Hypertrophy (R and L) Ischemic Changes (hyperacute T s, Q waves, ST depression, ST elevation, T wave inversion) Cases
90 Pericarditis A 78-year-old man with a past history remarkable only for gout is seen because of the acute onset of chest pain. He describes a 4-day prodrome of rhinorrhea, nonproductive cough, myalgias, and anorexia. Approximately 8 hours before he is seen in the emergency room (ER), he began to notice the gradual onset of sharp substernal chest pain, worse with inspiration, relieved by sitting up, and associated with diaphoresis.
91 Pulmonary Embolism 35 year old female with smoking history presents with sudden onset of pleuritic chest pain and shortness of breath. She just returned from a 10 hour flight from a business trip and reports having started birth control pills recently
92 PE w right heart strain S 1 Q 3 T 3
93 WPW 26 year old high school basketball player is here for a routine health checkup. He denies any Hint: what is the PR interval? issues. Family history is significant for father and a brother with sudden death in their 20 s.
94 WPW Bonus Question: What is the name of the accessory pathway in WPW? Bundle of Kent
95 Osborne Wave A middle age homeless man is brought to the hospital after being found unresponsive on the street in the middle of a snowstorm. His temperature was measured to be 90 degrees Fahrenheit.
96 Summary of Objectives Learn EKG by Examples Learn by repetition Learn by repetition Learn by repetition Learn by repetition Learn by repetition Learn by repetition Learn by repetition
97 Summary of EKG Interpretation Rate Rhythm (sinus, Afib, Aflutter, SVT, VT, VF) Axis Interval (PR, QRS, QT) AV block Bundle Branch Block Atrial Enlargement (R and L) Ventricular Hypertrophy (R and L) Ischemic Changes (hyperacute T s, Q waves, ST depression, ST elevation, T wave inversion) Cases (pacemakers)
98 References es.html Google images Sabatine et al. Pocket Medicine. The Massachusetts General Hospital Handbook of Internal Medicine nmain.asp
99 Please remember to recycle!
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