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 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
21.03.18 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
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 21.03.18
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 21.03.18
Where does the rhythm come from?
Different pacemakers different rhythms Sinus rhythm AV node rhythm (junctional) Ventricular rhythm Many others 21.03.18
Sinus rhythm Positive P wave: II Negative P wave: avr
Sinus rhythm Positive P wave: II Negative P wave: avr
Sinus rhythm??? Positive P wave: II Negative P wave: avr
Sinus rhythm??? Positive P wave: II Negative P wave: avr
Accelerated Junctional Rhythm Sinus rhythm
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 21.03.18
Sinus rhythm??? Positive P wave: I, II Negative P wave: avr
Sinus rhythm Atrial fibrillation No P waves, only f wave Irregular
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 21.03.18
Heart Rate 25 mm/s 300 / RR 50 mm/s 600 / RR RR count of big squares between two R waves 21.03.18
Heart Rate 25 mm/s 300 / RR HR? 50 mm/s 600 / RR RR count of big squares between two R waves 21.03.18
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 21.03.18
Heart Rate 25 mm/s 300 / RR 50 mm/s 600 / RR HR? RR count of big squares between two R waves 21.03.18
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 21.03.18
Heart Rate (sinus rhytm) <60/min bradycardia 60 100 normal HR >100 tachycardia
21.03.18 Heart Rate
21.03.18 Heart Rate
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 21.03.18
21.03.18 Heart axis
21.03.18 Heart axis
21.03.18 Heart axis
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 21.03.18
21.03.18 PR interval Normal: 120 200 ms
21.03.18 PR interval Normal: 120 200 ms
21.03.18 PR interval Normal: 120 200 ms???
21.03.18 PR interval Normal: 120 200 ms
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 21.03.18
21.03.18 QRS complex width Normal: 70 120 ms
21.03.18 Normal: 70 120 ms QRS complex width
21.03.18 Normal: 70 120 ms QRS complex width
Wide QRS complex Left/ Right Bundle Branch Block Intraventricular conduction disturbances Ventricular rhythm / excitation Artificial pacemaker (ventricular stimulation) Preexcitation syndrome 21.03.18
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 21.03.18
21.03.18 ST segment, T wave, Q wave
21.03.18 ST segment elevation, T wave, Q wave
21.03.18 ST segment elevation, pathological Q wave
21.03.18 ST segment, T wave, Q wave
21.03.18 ST segment depression, Negative T wave
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 21.03.18
21.03.18 Relation between atria and ventricles
21.03.18 Relation between atria and ventricles
What rhythm Regularity Heart rate Axis Basic ECG analysis PR interval (120 200 ms) QRS width (70 120 ms) ST segment, T wave, QT interval Relation between atria and ventricles QRS morphology Signs of ischemia 21.03.18
21.03.18