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BASICS OF ELECTROCARDIOGRAPHY
Dr Mushfiq Newaz Ahmed
Medical Officer
Department Of Anaesthesia,
Comilla Medical College & ...
OUTLINE
1. Review of the conduction system & Action Potential
2. ECG leads and recording
3. ECG waveforms and intervals
4....
ACTION POTENTIAL OF CARDIAC CELL
BUT THE IRONY OF FATE IS……
WHAT IS AN ECG?
An ECG is the recording (gram) of the
electrical activity(electro) generated
by the cells of the heart(car...
USEFUL IN DIAGNOSIS OF…
 Cardiac Arrhythmias
 Myocardial ischemia and infarction
 Pericarditis
 Chamber hypertrophy
 ...
ECG LEADS
ECG LEADS
Leads are electrodes which measure the difference in
electrical potential between either:
1. Two different point...
ECG LEADS
The standard ECG has 12 leads: 3 Standard Limb Leads
3 Augmented Limb Leads
6 Precordial Leads
The axis of a par...
STANDARD LIMB LEADS
EINTHOVEN’S TRIANGLE
PRECORDIAL LEADS
PRECORDIAL LEADS
SUMMARY OF LEADS
Limb Leads Precordial Leads
Bipolar I, II, III
(standard limb leads)
-
Unipolar aVR, aVL, aVF (augme
nted...
ANATOMIC GROUPS
(SEPTUM)
ANATOMIC GROUPS
(ANTERIOR WALL)
ANATOMIC GROUPS
(LATERAL WALL)
ANATOMIC GROUPS
(INFERIOR WALL)
ANATOMIC GROUPS
(SUMMARY)
Localising the arterial territory
Inferior
II, III, aVF
Lateral
I, AVL,
V5-V6
Anterior /
Septal
V1-V4
SPECIAL SITUATION
 Amputation or burns or bandages should be placed
as closely as possible to the standard sites
 Dextr...
OTHER PRACTICAL POINTS
 Effective contact between electrode and skin is essential.
 Electrical Artifacts: external or in...
ECG PAPER
ECG PAPER BASICS
ECG graphs:
– Small Square
-Height 1 mm and width 0.04 s
– Large Square
-Height 5 mm and width 0.04X5=0.2...
ECG PAPER BASICS
ECG WAVES
WAVE FORMS
P WAVE
 Denotes Atrial depolarization
 Shape-Rounded, neither peaked nor notched
 Width/Duration-2.5 small sq
 Height-...
PR INTERVAL
 Distance between onset of P wave to the beginning of Q
wave(in absence of Q wave beginning of R wave)
 Deno...
NORMAL QRS COMPLEX
 Denotes Ventricular depolarization
 Normal width of QRS-2 to ‹3 small sq
 Narrow complex if less th...
COMPONENT OF QRS COMPLEX
o Q wave-width 1 small sq and depth 2 small sq and ‹25%
of following R wave
(Pathological if widt...
T WAVE
 Same direction as the preceding QRS complex
 Blunt apex with asymmetric limbs
 Height < 5 small sq in limb lead...
ST SEGMENT
 Merges smoothly with the proximal limb of the T wave
 No true horizontality
QT INTERVAL
 Distance between beginning of QRS to the end Of T wav
e
 Reciprocal relation with heart rate
 Normal 8-‹11...
U WAVE
 Best seen in midprecordial leads
 Height < 10% of preceding T wave
 Isoelectric in lead aVL (useful to measure ...
HEART RATE, RHYTHM AND AXIS
DETERMINING THE HEART RATE
Rule of 300
10 times/20 times method
RULE OF 300
Take the number of “Large Square” between neighboring
QRS complexes, and divide this into 300. More accuracy c...
RULE OF 300
It may be easiest to memorize the following table:
Number of larg
e square
Rate
1 300
2 150
3 100
4 75
5 60
6 ...
10 TIMES/20 TIMES RULE
Count the number of R in 30 large square(equivalent
to 6 second) and multiply it by 10 would becom...
DETERMINING RHYTHM
AXIS DETERMINATION
The QRS axis represents the net overall direction of the heart’s
electrical activity.
Abnormalities of ...
THE QRS AXIS
By near-consensus, the norm
al QRS axis is defined as ran
ging from -30° to +90°.
-30° to -90° is referred to...
DETERMINING THE AXIS
 The Quadrant Method
 The Degree Method
THE QUADRANT METHOD
Examine the QRS complex in lead I/lead aVL and lead III/lead aVF
to determine if they are predominantl...
COMMON CAUSES OF LAD
 May be normal in the elderly and very obese
 Due to high diaphragm during pregnancy or ascites
 I...
COMMON CAUSES OF RAD
 Normal variant
 Right Ventricular Hypertrophy
 Anterior MI
 Right Bundle Branch Block
 Left Pos...
THE NORMAL ECG &
VARIATION WITH RESPIRATION
NORMAL SINUS RHYTHM
 Originates in the sinus node
 Rate between 60 and 100 beats per min
 Monomorphic P waves
 Normal ...
APPROACH TO INTERPRET
STEP-1:LEAD POSITION
Normal-P wave upright in lead I & II and QRS should be
downward in aVR & V1, R wave progresses from V...
Lead Malposition
Dextrocardia
STEP 2: VOLTAGE OR AMPLITUDE
 Normal ECG paper- voltage or amplitude 10 mV
 Half Voltage,5 mV used specially when severe...
Electrical Alternans-Alternate beat variation in direction,
amplitude and duration of any component of ECG. It can be
foun...
STEP 3:RHYTHM & RATE
 Rhythm Assessment- By Paper & Pencil Method or
Caliper Method
 Rate Measurement-By 300 times metho...
STEP 4: AXIS
 Normal- QRS of lead I(+aVL) and QRS of lead II+(III &
aVF) is in the same direction
 LAD- QRS of lead I(+a...
Negative in I, positive in aVF  RAD
Positive in I, negative in aVF  LAD
STEP 5: BUNDLE BRANCH BLOCK
(CLUE: WIDE QRS)
 RBBB- M pattern in QRS in Lead V1( or V2/V3). May be
normal
 LBBB-M patter...
RIGHT MARROW(RBBB) LEFT WILLOW( LBBB)
STEP 6:CHAMBER ENLARGEMENT
 Right Atrial Enlargement- Tall peaked P wave
 Left Atrial Enlargement-Broad/M Pattern/Wide/B...
RIGHT ATRIAL ENLARGEMENT
LEFT ATRIAL ENLARGEMENT
RIGHT VENTRICULAR HYPERTROPHY
RIGHT VENTRICULAR HYPERTROPHY
LEFT VENTRICULAR HYPERTROPHY
LEFT VENTRICULAR HYPERTROPHY
7. WAVE & INTERVAL ABNORMALITY
P WAVE ABNORMALITY
 Absent- Atrial Fibrillation
-Atrial Flutter
-Ventricular Tachycardia
-SVT
-Hyperkalaemia
 Single for...
Q WAVE ABNORMALITY
 Pathological Q wave- Old MI
- LVH
- LBBB
-Cardiomyopathy
-Emphysema(due to axis change)
-Pulmonary Em...
R WAVE ABNORMALITY
 Tall- LVH(in V5/V6)
- RVH(in V1/V2)
- True Posterior MI
 Small-Obesity
-Emphysema
-Pericardial Effus...
QRS COMPLEX ABNORMALITY
 High Voltage-Thin Chest Wall, Ventricular Hypertrophy
 Low Voltage-Thick Chest wall, Hypothyroi...
T WAVE ABNORMALITY
 Inversion-MI, Ventricular ectopic, Ventricular
Hypertrophy with strain, Cardiomyopathy, Acute
Pericar...
U WAVE ABNORMALITY
 Inversion- Ischemic Heart Disease
-LVH with strain
 Prominent-Hypokalaemia
-Hypercalcemia
-Hyperthyr...
PR INTERVAL ABNORMALITY
 Prolonged- First Degree Heart Block(Causes- IHD, Acute
Rheumatic Carditis, Myocarditis, Hypokala...
ABNORMALITY OF ST SEGMENT
ST ELEVATION PATTERN
PROLONGED QTC (ABCDE)
 AntiArrythmic-Amiodarone,Flecainide,Disopyramide
 AntiBiotic-Macrolides
 AntiC(Psy)cotic-Chlorpr...
SHORTENED QT
 Digitalis effect
 Hypercalcemia
 Hyperthermia
 Vagal stimulation
ARRHYTHMIA & ECG
SINUS BRADYCARDIA
SINUS TACHYCARDIA
HEART BLOCK
 SA Block
 AV Block
-1st degree AV block
-2nd degree AV block( Type I & Type II)
-3rd degree AV block
 BBB
...
SA BLOCK
 Absence of one P-QRS-T complex
 Pause is multiple of P-P interval(or R-R interval)
IMPORTANT DIFFERENTIAL IS SA ARREST…
 Absence of one P-QRS-T complex
 Pause is NOT multiple of P-P interval(or R-R inter...
AV BLOCK
RBBB
LBBB
ATRIAL FIBRILLATION
ATRIAL FLUTTER
ATRIAL TACHYCARDIA/SVT
ATRIAL ECTOPIC/PAC
JUNCTIONAL ECTOPIC/PJC
VENTRICULAR ECTOPIC/PVC
MI & ECG
CHANGE IN INJURY, ISCHEMIA & INFARCTION
RECIPROCAL LEADS
LATERAL MI
ANTEROSEPTAL MI
EXTENSIVE ANTERIOR MI
INFERIOR MI
POSTERIOR MI
 ST depression in V2-V3
 Tall, Broad R wave in V2-V3
 Dominant R wave in V2(R>S)
 Upright T wave
Posterior MI confirmed by posterior lead V7, V8, V9
V7=Left Post. Axillary line, same plane to V6
V8=Tip of the scapula
V9...
Same case with posterior lead
ST segment elevation in V7-V9
DIFFERENCE BETWEEN MI AND ACUTE
PERICARDITIS
 ST shape-Convex Up
 Location of ST change-
Territorial
 Reciprocal ST cha...
EI & ECG
HYPOKALEMIA
HYPERKALEMIA
HYPOCALCAEMIA & HYPERCALCEMIA
THYROID DISORDER & ECG
HYPOTHYROIDISM
HYPERTHYROIDISM/ THYROTOXICOSIS
EMERGENCY ECG
VENTRICULAR TACHYCARDIA
VENTRICULAR FIBRILLATION
ASYSTOLE
THANK YOU….
Basic of ECG and Easy Interpretation
Basic of ECG and Easy Interpretation
Basic of ECG and Easy Interpretation
Basic of ECG and Easy Interpretation
Basic of ECG and Easy Interpretation
Basic of ECG and Easy Interpretation
Basic of ECG and Easy Interpretation
Basic of ECG and Easy Interpretation
Basic of ECG and Easy Interpretation
Basic of ECG and Easy Interpretation
Basic of ECG and Easy Interpretation
Basic of ECG and Easy Interpretation
Basic of ECG and Easy Interpretation
Basic of ECG and Easy Interpretation
Basic of ECG and Easy Interpretation
Basic of ECG and Easy Interpretation
Basic of ECG and Easy Interpretation
Basic of ECG and Easy Interpretation
Basic of ECG and Easy Interpretation
Basic of ECG and Easy Interpretation
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Basic of ECG and Easy Interpretation

  1. 1. BASICS OF ELECTROCARDIOGRAPHY Dr Mushfiq Newaz Ahmed Medical Officer Department Of Anaesthesia, Comilla Medical College & Hospital
  2. 2. OUTLINE 1. Review of the conduction system & Action Potential 2. ECG leads and recording 3. ECG waveforms and intervals 4. Normal ECG and its variants 5. Basic Interpretation Steps of ECG 6. Arrhythmia & ECG 7. MI & ECG 8. EI & ECG 9. Thyroid Disorder & ECG 10. Emergency ECG
  3. 3. ACTION POTENTIAL OF CARDIAC CELL
  4. 4. BUT THE IRONY OF FATE IS……
  5. 5. WHAT IS AN ECG? An ECG is the recording (gram) of the electrical activity(electro) generated by the cells of the heart(cardio) that reaches the body surface.
  6. 6. USEFUL IN DIAGNOSIS OF…  Cardiac Arrhythmias  Myocardial ischemia and infarction  Pericarditis  Chamber hypertrophy  Electrolyte disturbances
  7. 7. ECG LEADS
  8. 8. ECG LEADS Leads are electrodes which measure the difference in electrical potential between either: 1. Two different points on the body (bipolar leads) 2. One point on the body and a virtual reference point with zero electrical potential, located in the center of the heart (unipolar leads)
  9. 9. ECG LEADS The standard ECG has 12 leads: 3 Standard Limb Leads 3 Augmented Limb Leads 6 Precordial Leads The axis of a particular lead represents the viewpoint from which it looks at the heart
  10. 10. STANDARD LIMB LEADS
  11. 11. EINTHOVEN’S TRIANGLE
  12. 12. PRECORDIAL LEADS
  13. 13. PRECORDIAL LEADS
  14. 14. SUMMARY OF LEADS Limb Leads Precordial Leads Bipolar I, II, III (standard limb leads) - Unipolar aVR, aVL, aVF (augme nted limb leads) V1-V6
  15. 15. ANATOMIC GROUPS (SEPTUM)
  16. 16. ANATOMIC GROUPS (ANTERIOR WALL)
  17. 17. ANATOMIC GROUPS (LATERAL WALL)
  18. 18. ANATOMIC GROUPS (INFERIOR WALL)
  19. 19. ANATOMIC GROUPS (SUMMARY)
  20. 20. Localising the arterial territory Inferior II, III, aVF Lateral I, AVL, V5-V6 Anterior / Septal V1-V4
  21. 21. SPECIAL SITUATION  Amputation or burns or bandages should be placed as closely as possible to the standard sites  Dextrocardia right & left arm electrodes should be rev ersed pre-cordial leads should be recorded from V1R(V2) to V6
  22. 22. OTHER PRACTICAL POINTS  Effective contact between electrode and skin is essential.  Electrical Artifacts: external or internal -External can be minimized by straightening the lead wires -Internal can be due to muscle tremors, shivering , hiccups
  23. 23. ECG PAPER
  24. 24. ECG PAPER BASICS ECG graphs: – Small Square -Height 1 mm and width 0.04 s – Large Square -Height 5 mm and width 0.04X5=0.2s Paper Speed: – 25 mm/s( As 0.2 s=5 mm,1 s=25 mm) Voltage Calibration: – 1 mV= П 10 mm( 10 small square) Half strength 5mm/mV Double strength 20 mm/mV
  25. 25. ECG PAPER BASICS
  26. 26. ECG WAVES
  27. 27. WAVE FORMS
  28. 28. P WAVE  Denotes Atrial depolarization  Shape-Rounded, neither peaked nor notched  Width/Duration-2.5 small sq  Height-2.5 small sq  Better seen in Lead II/Lead V1  Upright in every lead except aVR  May be Biphasic in lead V1(Equal upward and downward deflection)
  29. 29. PR INTERVAL  Distance between onset of P wave to the beginning of Q wave(in absence of Q wave beginning of R wave)  Denotes time interval impulse travelling from SA node to Ventricular muscle through AV node  Normal Range:3 to 5 small Sq  Short if ‹3 small sq and long if ›5 small sq
  30. 30. NORMAL QRS COMPLEX  Denotes Ventricular depolarization  Normal width of QRS-2 to ‹3 small sq  Narrow complex if less than 2 small sq and Broa d Complex if more than or equal to 3 small sq
  31. 31. COMPONENT OF QRS COMPLEX o Q wave-width 1 small sq and depth 2 small sq and ‹25% of following R wave (Pathological if width›1 small sq,depth›2 small sq and ›25% of following R Wave) o R wave height varies, but must remember the thing that R wave progresses from V1 to V6(2-3 small square to les than 25 small sq/5 large sq) (Pathological if height›25 small sq/5 large sq) o S wave follow R wave, depth varies,progressively diminishes from V1 to V6
  32. 32. T WAVE  Same direction as the preceding QRS complex  Blunt apex with asymmetric limbs  Height < 5 small sq in limb leads and <10 small square in precordial leads  Smooth contours  May be tall in athletes
  33. 33. ST SEGMENT  Merges smoothly with the proximal limb of the T wave  No true horizontality
  34. 34. QT INTERVAL  Distance between beginning of QRS to the end Of T wav e  Reciprocal relation with heart rate  Normal 8-‹11 small sq  If arrhythmia is present( HR less than 60 or more than 1 00 bpm) then QT interval should be corrected. Corrected QT(QTc)=QT/√RR
  35. 35. U WAVE  Best seen in midprecordial leads  Height < 10% of preceding T wave  Isoelectric in lead aVL (useful to measure QTc)  Rarely exceeds 1 small sq in amplitude  May be tall in athletes (2 small sq)
  36. 36. HEART RATE, RHYTHM AND AXIS
  37. 37. DETERMINING THE HEART RATE Rule of 300 10 times/20 times method
  38. 38. RULE OF 300 Take the number of “Large Square” between neighboring QRS complexes, and divide this into 300. More accuracy can be achieved if the number of “small square” between neighboring QRS complexes divided into 1500 Although fast, this method only works for regular rhythms.
  39. 39. RULE OF 300 It may be easiest to memorize the following table: Number of larg e square Rate 1 300 2 150 3 100 4 75 5 60 6 50 7 43
  40. 40. 10 TIMES/20 TIMES RULE Count the number of R in 30 large square(equivalent to 6 second) and multiply it by 10 would become rate in 60 sec.  If small strip-counting the number in 15 large square (equivalent to 3 second) and multiply it by 20 This method works well for irregular rhythms.
  41. 41. DETERMINING RHYTHM
  42. 42. AXIS DETERMINATION The QRS axis represents the net overall direction of the heart’s electrical activity. Abnormalities of axis can hint at: Ventricular enlargement Conduction blocks (i.e. hemiblocks)
  43. 43. THE QRS AXIS By near-consensus, the norm al QRS axis is defined as ran ging from -30° to +90°. -30° to -90° is referred to as a left axis deviation (LAD) +90° to +180° is referred to as a right axis deviation (RAD)
  44. 44. DETERMINING THE AXIS  The Quadrant Method  The Degree Method
  45. 45. THE QUADRANT METHOD Examine the QRS complex in lead I/lead aVL and lead III/lead aVF to determine if they are predominantly positive or predominantly negative. The combination should place the axis into one of the 4 quadrants below.
  46. 46. COMMON CAUSES OF LAD  May be normal in the elderly and very obese  Due to high diaphragm during pregnancy or ascites  Inferior wall MI  Left Anterior Hemi block  Left Bundle Branch Block  Emphysema
  47. 47. COMMON CAUSES OF RAD  Normal variant  Right Ventricular Hypertrophy  Anterior MI  Right Bundle Branch Block  Left Posterior Hemiblock
  48. 48. THE NORMAL ECG & VARIATION WITH RESPIRATION
  49. 49. NORMAL SINUS RHYTHM  Originates in the sinus node  Rate between 60 and 100 beats per min  Monomorphic P waves  Normal relationship between P and QRS  Some sinus arrhythmia is normal
  50. 50. APPROACH TO INTERPRET
  51. 51. STEP-1:LEAD POSITION Normal-P wave upright in lead I & II and QRS should be downward in aVR & V1, R wave progresses from V1 to V6(height increases) Lead Malposition-P wave downward in lead I & II and QRS should be upright in aVR & V1, R wave progresses from V1 to V6(height increases) Dextrocardia- P wave downward in lead I & II and QRS should be upright in aVR & V1, R wave regresses from V1 to V6(height decreases)
  52. 52. Lead Malposition Dextrocardia
  53. 53. STEP 2: VOLTAGE OR AMPLITUDE  Normal ECG paper- voltage or amplitude 10 mV  Half Voltage,5 mV used specially when severe LVH causes very large QRS complex which merges with QRS complexes of above or below leads
  54. 54. Electrical Alternans-Alternate beat variation in direction, amplitude and duration of any component of ECG. It can be found in-Pericardial Effusion, Pericardial Mesothelioma, Pericardial TB, Myocarditis, Hypothermia
  55. 55. STEP 3:RHYTHM & RATE  Rhythm Assessment- By Paper & Pencil Method or Caliper Method  Rate Measurement-By 300 times method/20 times method
  56. 56. STEP 4: AXIS  Normal- QRS of lead I(+aVL) and QRS of lead II+(III & aVF) is in the same direction  LAD- QRS of lead I(+aVL) upward and QRS of lead II+(III & aVF) downward  RAD- QRS of lead I(+aVL) downward and QRS of lead II+(III & aVF) upward
  57. 57. Negative in I, positive in aVF  RAD
  58. 58. Positive in I, negative in aVF  LAD
  59. 59. STEP 5: BUNDLE BRANCH BLOCK (CLUE: WIDE QRS)  RBBB- M pattern in QRS in Lead V1( or V2/V3). May be normal  LBBB-M pattern in QRS in Lead V6( or V4/V5). T inversion can be found. New onset always Alarming  Bifascicular block- RBBB+ Left posterior Hemiblock----›features of RBBB+RAD(Ostium Secundum ASD) RBBB+ Left anterior Hemiblock ----›features of RBBB+LAD(Ostium Primum ASD)
  60. 60. RIGHT MARROW(RBBB) LEFT WILLOW( LBBB)
  61. 61. STEP 6:CHAMBER ENLARGEMENT  Right Atrial Enlargement- Tall peaked P wave  Left Atrial Enlargement-Broad/M Pattern/Wide/Bifid or notched P wave  Right Ventricular Enlargement-Tall R in V1 and deep S in V5/V6  Left Ventricular Enlargement-Unusually tall R in V5/V6 and unusually deep S in V1(R+S>35 mm)
  62. 62. RIGHT ATRIAL ENLARGEMENT
  63. 63. LEFT ATRIAL ENLARGEMENT
  64. 64. RIGHT VENTRICULAR HYPERTROPHY
  65. 65. RIGHT VENTRICULAR HYPERTROPHY
  66. 66. LEFT VENTRICULAR HYPERTROPHY
  67. 67. LEFT VENTRICULAR HYPERTROPHY
  68. 68. 7. WAVE & INTERVAL ABNORMALITY
  69. 69. P WAVE ABNORMALITY  Absent- Atrial Fibrillation -Atrial Flutter -Ventricular Tachycardia -SVT -Hyperkalaemia  Single for every QRS complex Tall/Peaked-Right Atrial Hypertrophy/Enlargement Wide/Broad/Notched-LA Hypertrophy/Enlargement  Multiple-AV Block(Either Partial Or Complete)
  70. 70. Q WAVE ABNORMALITY  Pathological Q wave- Old MI - LVH - LBBB -Cardiomyopathy -Emphysema(due to axis change) -Pulmonary Embolism(lead III)
  71. 71. R WAVE ABNORMALITY  Tall- LVH(in V5/V6) - RVH(in V1/V2) - True Posterior MI  Small-Obesity -Emphysema -Pericardial Effusion -Hypothyroidism -Hypothermia  Poor Progression of R wave-COPD -PE(left) -Pneumothorax (left) -Cardiomyopathy -Ant/Anteroseptal MI
  72. 72. QRS COMPLEX ABNORMALITY  High Voltage-Thin Chest Wall, Ventricular Hypertrophy  Low Voltage-Thick Chest wall, Hypothyroidism, Pericardial Effusion, Emphysema, Hypothermia, Chronic constrictive Pericarditis  Wide QRS-BBB -Ventricular Ectopic -VT -Ventricular Enlargement -Hyperkalaemia  Narrow QRS-SVT
  73. 73. T WAVE ABNORMALITY  Inversion-MI, Ventricular ectopic, Ventricular Hypertrophy with strain, Cardiomyopathy, Acute Pericarditis, BBB  Tall Peaked-Hyperkalaemia, Hyper acute MI, Acute True Post. MI  Small- Hypokalaemia, Hypothyroidism, Pericardial Effusion
  74. 74. U WAVE ABNORMALITY  Inversion- Ischemic Heart Disease -LVH with strain  Prominent-Hypokalaemia -Hypercalcemia -Hyperthyroidism
  75. 75. PR INTERVAL ABNORMALITY  Prolonged- First Degree Heart Block(Causes- IHD, Acute Rheumatic Carditis, Myocarditis, Hypokalaemia, Atrial Dilatation or Hypertrophy)  Short- WPW syndrome  Variable-Second Degree Block( Type I and Type II) -Third Degree Block
  76. 76. ABNORMALITY OF ST SEGMENT
  77. 77. ST ELEVATION PATTERN
  78. 78. PROLONGED QTC (ABCDE)  AntiArrythmic-Amiodarone,Flecainide,Disopyramide  AntiBiotic-Macrolides  AntiC(Psy)cotic-Chlorpromazine, Haloperidol  AntiDepressant-TCA EI-Hypokalaemia, Hypomagnaesemia, Hypocalcemia
  79. 79. SHORTENED QT  Digitalis effect  Hypercalcemia  Hyperthermia  Vagal stimulation
  80. 80. ARRHYTHMIA & ECG
  81. 81. SINUS BRADYCARDIA
  82. 82. SINUS TACHYCARDIA
  83. 83. HEART BLOCK  SA Block  AV Block -1st degree AV block -2nd degree AV block( Type I & Type II) -3rd degree AV block  BBB -RBBB -LBBB
  84. 84. SA BLOCK  Absence of one P-QRS-T complex  Pause is multiple of P-P interval(or R-R interval)
  85. 85. IMPORTANT DIFFERENTIAL IS SA ARREST…  Absence of one P-QRS-T complex  Pause is NOT multiple of P-P interval(or R-R interval)
  86. 86. AV BLOCK
  87. 87. RBBB
  88. 88. LBBB
  89. 89. ATRIAL FIBRILLATION
  90. 90. ATRIAL FLUTTER
  91. 91. ATRIAL TACHYCARDIA/SVT
  92. 92. ATRIAL ECTOPIC/PAC
  93. 93. JUNCTIONAL ECTOPIC/PJC
  94. 94. VENTRICULAR ECTOPIC/PVC
  95. 95. MI & ECG
  96. 96. CHANGE IN INJURY, ISCHEMIA & INFARCTION
  97. 97. RECIPROCAL LEADS
  98. 98. LATERAL MI
  99. 99. ANTEROSEPTAL MI
  100. 100. EXTENSIVE ANTERIOR MI
  101. 101. INFERIOR MI
  102. 102. POSTERIOR MI  ST depression in V2-V3  Tall, Broad R wave in V2-V3  Dominant R wave in V2(R>S)  Upright T wave
  103. 103. Posterior MI confirmed by posterior lead V7, V8, V9 V7=Left Post. Axillary line, same plane to V6 V8=Tip of the scapula V9=Left Paraspinal line
  104. 104. Same case with posterior lead ST segment elevation in V7-V9
  105. 105. DIFFERENCE BETWEEN MI AND ACUTE PERICARDITIS  ST shape-Convex Up  Location of ST change- Territorial  Reciprocal ST change- Present  Q wave change-May be Present  ST shape-Concave up  Location of ST change- Limb & Precordial  Reciprocal ST change- Absent  Q wave change-Absent Acute MI Acute Pericarditis
  106. 106. EI & ECG
  107. 107. HYPOKALEMIA
  108. 108. HYPERKALEMIA
  109. 109. HYPOCALCAEMIA & HYPERCALCEMIA
  110. 110. THYROID DISORDER & ECG
  111. 111. HYPOTHYROIDISM
  112. 112. HYPERTHYROIDISM/ THYROTOXICOSIS
  113. 113. EMERGENCY ECG
  114. 114. VENTRICULAR TACHYCARDIA
  115. 115. VENTRICULAR FIBRILLATION
  116. 116. ASYSTOLE
  117. 117. THANK YOU….
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Basic ECG, Interpretation Skill development & common ECG findings

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