EKG Practice Homan Wai
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
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)
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)
What s the Rate?
Rate
What s the Rate?
What s the Rate? 10 sec 3 sec 6 sec
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)
Rhythm - normal sinus rhythm
Rhythm - Sinus Tachycardia
Rhythm - Sinus Bradycardia
Rhythm - Junctional Rhythm
Rhythm - Atrial Fibrillation
Rhythm - Atrial Fibrillation with RVR
Rhythm - Atrial Flutter
Atrial Flutter
Rhythm - SVT (supraventricular tachycardia)
Rhythm - SVT (supraventricular tachycardia)
Rhythm - SVT (supraventricular tachycardia)
Rhythm - Ventricular Tachycardia
Rhythm - SVT with Aberrancy
How do you tell? http://lifeinthefastlane.com/ecg-library/basics/vt_vs_svt/ VT vs SVT with Aberrancy
Rhythm - Ventricular Fibrillation
Rhythm - Ventricular Fibrillation
Rhythm - Asystole or lead issues
Rhythm - Torsades de pointes
Rhythm - Torsades de pointes
Rhythm - PVC s
Rhythm - PVC s
Rhythm - PAC s
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)
Axis
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)
Segments/Intervals
QT Interval which one is longer?
Prolonged QTc
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)
Rhythm - 1 st degree AV Block
Rhythm - 1 st degree AV Block
Rhythm - 2 nd degree AV Block Mobitz Type I (Winkebach)
Rhythm - 2 nd degree AV Block Mobitz Type I (Winkebach)
Rhythm - 2 nd degree AV Block Mobitz Type II
Rhythm - 2:1 2 nd degree AV Block Mobitz Type I or II
Rhythm - 3 rd degree AV Block AV dissociation
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)
Bundle Branch Block
Bundle Branch Block
Bundle Branch Block
Bundle Branch Block
Bundle Branch Block
Bundle Branch Block
Bundle Branch Block
Bundle Branch Block
Bundle Branch Block
Bundle Branch Block
Bundle Branch Block
Bundle Branch Block
Bundle Branch Block
Bundle Branch Block
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)
Atrial Enlargement Lead II Lead v1 > 2.5 mm > 1.5 mm > 120 msec > 1 mm > 40 msec
Atrial Enlargement
Atrial Enlargement
Atrial Enlargement
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)
Ventricular Hypertrophy Sokolow-Lyon: S in V1 + R in V5 or V6 >= 35mm 14 + 23 = 37mm
Ventricular Hypertrophy
Ventricular Hypertrophy
Ventricular Hypertrophy 15mm R in avl >= 11mm + 26mm = 41mm Cornell: R in avl + S in V3 >28mm (men) or >20mm (women)
Ventricular Hypertrophy - strain
Ventricular Hypertrophy 16 mm R > S in V1 R in V1 > 7mm
Ventricular Hypertrophy
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)
Ischemic Changes by Region lateral Septal lateral anterior Inferior lateral
Ischemic Changes Q waves ST elevation ST depression T wave inversion Hyper-acute T waves
Ischemic Changes
Ischemic Changes
Ischemic Changes
Ischemic Changes
Ischemic Changes
Ischemic Changes
Ischemic Changes
Ischemic Changes
Ischemic Changes
Ischemic Changes
Ischemic Changes
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
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.
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
PE w right heart strain S 1 Q 3 T 3
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.
WPW Bonus Question: What is the name of the accessory pathway in WPW? Bundle of Kent
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.
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
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)
References http://www.learntheheart.com/ekgexampl es.html Google images Sabatine et al. Pocket Medicine. The Massachusetts General Hospital Handbook of Internal Medicine. 2004. http://ecg.bidmc.harvard.edu/maven/mave nmain.asp
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