ECG interpretation basics
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1 ECG interpretation basics Michał Walczewski, MD Krzysztof Ozierański, MD
2 Electrical conduction system of the heart
3 Limb leads
4 Precordial leads
5 Precordial leads
6 Precordial leads
7
8
9
10
11 Small square (1 mm) Paper speed 25 mm/s 50 mm/s 0,04 s = 40 ms 0,02 s = 20 ms Big square (5 mm) 0,2 s = 200 ms 0,1 s = 100 ms
12 Patient 1 25 mm/s 0,04 s = 40 ms 0,2 s = 200 ms 50 mm/s 0,02 s = 20 ms 0,1 s = 100 ms
13 What rhythm Regularity Heart rate Axis PR interval QRS width Basic ECG analysis ST segment, T wave, QT interval Relation between atria and ventricles QRS morphology Signs of ischemia
14 What rhythm Regularity Heart rate Axis PR interval QRS width Basic ECG analysis ST segment, T wave, QT interval Relation between atria and ventricles QRS morphology Signs of ischemia
15 Where does the rhythm come from?
16 Different pacemakers different rhythms Sinus rhythm AV node rhythm (junctional) Ventricular rhythm Many others
17 Sinus rhythm Positive P wave: II Negative P wave: avr
18 Sinus rhythm Positive P wave: II Negative P wave: avr
19 Sinus rhythm??? Positive P wave: II Negative P wave: avr
20 Sinus rhythm??? Positive P wave: II Negative P wave: avr
21 Accelerated Junctional Rhythm Sinus rhythm
22 What rhythm Regularity Heart rate Axis PR interval QRS width Basic ECG analysis ST segment, T wave, QT interval Relation between atria and ventricles QRS morphology Signs of ischemia
23 Sinus rhythm??? Positive P wave: I, II Negative P wave: avr
24 Sinus rhythm Atrial fibrillation No P waves, only f wave Irregular
25 What rhythm Regularity Heart rate Axis PR interval QRS width Basic ECG analysis ST segment, T wave, QT interval Relation between atria and ventricles QRS morphology Signs of ischemia
26 Heart Rate 25 mm/s 300 / RR 50 mm/s 600 / RR RR count of big squares between two R waves
27 Heart Rate 25 mm/s 300 / RR HR? 50 mm/s 600 / RR RR count of big squares between two R waves
28 Heart Rate 25 mm/s 300 / RR HR = 300 / 3,5 = 8 50 mm/s 600 / RR RR count of big squares between two R waves
29 Heart Rate 25 mm/s 300 / RR 50 mm/s 600 / RR HR? RR count of big squares between two R waves
30 HR = 600/7,5 = 80 Heart Rate 25 mm/s 300 / RR 50 mm/s 600 / RR RR count of big squares between two R waves
31 Heart Rate (sinus rhytm) <60/min bradycardia normal HR >100 tachycardia
32 Heart Rate
33 Heart Rate
34 What rhythm Regularity Heart rate Axis PR interval QRS width Basic ECG analysis ST segment, T wave, QT interval Relation between atria and ventricles QRS morphology Signs of ischemia
35 Heart axis
36 Heart axis
37 Heart axis
38 What rhythm Regularity Heart rate Axis PR interval QRS width Basic ECG analysis ST segment, T wave, QT interval Relation between atria and ventricles QRS morphology Signs of ischemia
39 PR interval Normal: ms
40 PR interval Normal: ms
41 PR interval Normal: ms???
42 PR interval Normal: ms
43 What rhythm Regularity Heart rate Axis PR interval QRS width Basic ECG analysis ST segment, T wave, QT interval Relation between atria and ventricles QRS morphology Signs of ischemia
44 QRS complex width Normal: ms
45 Normal: ms QRS complex width
46 Normal: ms QRS complex width
47 Wide QRS complex Left/ Right Bundle Branch Block Intraventricular conduction disturbances Ventricular rhythm / excitation Artificial pacemaker (ventricular stimulation) Preexcitation syndrome
48 What rhythm Regularity Heart rate Axis PR interval QRS width Basic ECG analysis ST segment, T wave, QT interval Relation between atria and ventricles QRS morphology Signs of ischemia
49 ST segment, T wave, Q wave
50 ST segment elevation, T wave, Q wave
51 ST segment elevation, pathological Q wave
52 ST segment, T wave, Q wave
53 ST segment depression, Negative T wave
54 What rhythm Regularity Heart rate Axis PR interval QRS width Basic ECG analysis ST segment, T wave, QT interval Relation between atria and ventricles QRS morphology Signs of ischemia
55 Relation between atria and ventricles
56 Relation between atria and ventricles
57 What rhythm Regularity Heart rate Axis Basic ECG analysis PR interval ( ms) QRS width ( ms) ST segment, T wave, QT interval Relation between atria and ventricles QRS morphology Signs of ischemia
58
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