SlideShare une entreprise Scribd logo
1  sur  72
Télécharger pour lire hors ligne
ECG
Dr. Sumit Kr. Ghosh
Asst. Professor
Department of Medicine
Medical College & Hospital,
INTRODUCTION
Graphic representation of electrical activities of heart
Resting ECG
Exercise ECG / TMT
24-hr ECG / Holter
ECG Final Proff.Sumit Kr Ghosh Dept of Internal Medicine Medical College 88 College Street Kolkata
READING ECG
• Rate
• Rhythm
• Axis
• Lie & Rotation
• Voltage
• Waves & Intervals
• Abnormalities
ECG PAPER
STANDARDISATION
• 1mv will produce deflection of 10 mm / 1
cm
• Stylus should have an appropriate pressure
WAVES & INTERVAL
P Q R S T > 5mm
q r s < 5mm
P
Q
R
S
T
U
J-point
J
δ
PR
QRS
ST
QT
TP
PP & RR
LEADS
Lead = paired electrode
12 leads
Limb leads Precordial leads
Frontal or Coronal plane leads Horizontal plane leads
Bipolar unipolar (low EP) unipolar
I, II, III aVR, aVL, aVF v1, v2, v3, v4, v5, v6
rt side septum lt side
I, avL, v5, v6 : lateral wall
II, III Avf : inferior wall
Long leads
V7, v8, v9
V1r – v9r
3v1 – 3v9
Esophageal leads
Resultant vector
• Towards lead : positive / upward deflection
• Away from lead : negative / downward deflection
• Perpendicular to lead : equiphasic deflection
RATE
Ventricular rate vs Atrial rate
Rate = 1500/ no of small square = 300/no of
large square
Depends on speed of ECG paper
Usual speed = 90m/hr =1.5m/min
No of QRS complex in 1 min = HR
RHYTHM
• Regular :
~ Sinus
~ Nodal
~ Idioventricular
• Irregular :
~ Regularly irregular
~ Irregularly irregular
AXIS
• Normal axis : 0 to +90 degree (most cases +40 to +60 degree)
• LAD : 0 to -90 degree (slight LAD : 0 to -30 degree
marked LAD : -30 to -90 degree )
• RAD : +90 to ± 180 degree
• Inderminate / NW axis : -90 to ± 180 degree
an expression of :
- marked RAD
- marked LAD
- discharge of ectopic
ventricular pacemaker
AXIS DETERMINATION
• Lead I,II & III
• Pairs of perpendicular leads
• Perpendicular to the lead where R=S
• In degree
I II III
↑ ↑ ↑ Normal
↑ ↑ ↓ ↓ LAD
↓ ↑ ↑ RAD
+
+
_
_ I
aVF
0± 180
- 90
+ 90
NORMAL AXIS RAD LAD INDETERMINATE AXIS
EASY TO REMEMBER
I (left) aVF (right)
↑ ↑ Normal
↑ ↓ LAD
↓ ↑ RAD
↓ ↓ Indeterminate
LAD
• LAHB
• LBBB
• Inf wall MI
• Pacing from apex of RV/LV
• WPW
Isolated LVH does not cause
LAD
RAD
• RV dominance
- acq. Rt heart disease :
pulm embolism
chr. Cor pulmonale
- cong. heart disease :
TOF
• Anterolateral MI
• LPHB
• WPW
LIE & ROTATION
• LIE : in frontal plane [ vertical (90 degree) to horizontal (0 degree )
• Rotation : in horizontal plane
~ Clockwise – persistent S waves in v5, v6
~ Anti-clockwise – R waves in v2
P - WAVE
• Atrial activity (RA earliar than LA)
• Best seen in lead II & v1
• Normal duration : 0.08 s – 0.1 s (not > 0.11 s)
• Normal amplitude : not > 2 mm ( max – 2.5 mm)
• Diphasic in v1
• Inverted in aVR (normally), wrong electrode placement,
dextrocardia, retrograde atrial activation
• Absent : Atrial fibrillation, nodal rhythm, hyperkalemia
• P-pulmonale : tall & peaked (amplitude > 2.5 mm) » » RAH
• P-mitrale : wide & notched (duration > 0.11 s) » » LAH
• P-tricuspidale
QRS COMPLEX
• Ventricular depolarisation
Q-wave : initial negative deflection
septal depolarisation :: from left to right
R-wave : depolarisation of venticular muscle mass
S-wave : depolarisation of postero-basal part of left
ventricle, superiormost part of ventricular septum
• High amplitude : RVH / LVH
• Low amplitude : Low voltage complex
(< 5 mm in limb leads & < 10 mm in precordial leads)
Standardisation is important
• Taller in v5 than v6
QRS COMPLEX
QRS in precordial leads
T-WAVE
• Ventricular repolarisation
• Blunt apex with 2 asymerical limbs :
proximal limb shallower than distal
• Tall –peaked : hyperkalemia
• Tall- wide : hyperacute stage of MI
• Inverted : IHD, Ventricular strain, CVA
• Flat : thick chest wall, emphysema,
pericardial effusion, hypokalemia
U-WAVE
• Positive deflection after T & before P of
next cycle
• Slow repolarisation of Purkinje’s fibres,
septum, papillary muscles but uncertain
• Mid-precordial leads – v2 to v4
• Prominent : hypokalemia
• Inverted / absent : diastolic overload /
myocardial dysfunction
P-R INTERVAL
• Beginning of P-wave to beginning of QRS
complex
• Intra-atial, AV nodal & His-Purkinje coduction
• Normal duration : 0.12 – 0.20 s
• Prolonged : Acute rheumatic fever, 1st
degree
AV block
• Progressive prolongation : Mobitz type-I (2nd
degree AV block) » » Wenckebach phenomenon
• Shortened : WPW syndrome, AV nodal rhythm
QRS INTERVAL
• Total ventricular depolarisation
• Beginning of Q-wave ( beginning of P-wave,
if no Q-wave present) to termination of S-
wave
• Normal duration : usually not > 0.09 sec
(range 0.05-0.11 s)
• Prolonged : Intaventricular conduction defect
or BBB
≥ 0.12 sec » » complete BBB
• Intrinsicoid deflection / ventricular activation
time : time taken for an impulse to traverse
myocardium
VAT normally not > 0.02 s in v1, v2
& not > 0.04 s in v5, v6
ST SEGMENT
• End of QRS complex to beginning of T
• Normal ST segment merges smoothly & imperceptibly with
proximal limb of T : difficult to separate
• Time interval between ventricular depolarisation &
repolarisation
• Isoelectric to TP segment
• Elevated :
~ with upward convexity : AMI, coronary spasm, LV
Aneurysm
~ with upward concavity : acute pericarditis
• Depressed :
~ oblique/plane/sagging : CAD
~ mirror image of correction mark : digitalis effect
~ upward convexity : strain pattern
• End of QRS complex & beginning of ST segment : J point
QT INTERVAL
• Beginning of Q to end of T
• Ventricular depolarisation + repolarisation
• Corrected QT or QTc : as QT changes with heart rate
• Bazett’s formula :
QT interval
√RR interval
It should be ≤ 0.44 s
Prolonged : acute rheumatic carditis, hypokalemia,
hypocalcemia, drugs
Shortened : hypercalcemia, digitalis, hyperthermia
QTc =
PP & RR INTERVAL
• PP interval : distance between 2 successive P waves
- reflects atrial rate
• RR interval : distance between 2 successive R waves
- reflects ventricular rate
• Normally PP = RR
ECG Final Proff.Sumit Kr Ghosh Dept of Internal Medicine Medical College 88 College Street Kolkata
Atrial hypertrophy :
LAH : P-mitrale
RAH : P- pulmonale
Bi-atrial hypertrophy
Ventricular hypertrophy :
LVH
RVH
Bi-ventricular hypertrophy
LVH
• Voltage criteria :
~ Sv1 + Rv6 > 35
~ Sv1 / Rv6 ≥ 20
~ Rv6 ≥ Rv5
~ RI ≥ 15
~ RaVL ≥ 11
~ Rall(12) > 175
• Horizontal heart
• VAT in v5/v6 > 0.04 s
• Strain pattern in I, aVL, v5, v6
LAD is not a criteria for isolated LVH
• Pressure overload LVH
• Volume overload LVH
RVH
• Voltage criteria :
~ R > S
~ Rv1 > 5 mm
~ persistent Sv5 / Sv6
• Usually RAD (most common & at times only manifestation); but axis
may be normal
• Vertical heart
• VAT in v1 > 0.02 s
• Strain pattern in v1, Avr
• Associated P-pulmonale may be there
BIVENTRICULAR HYPERTROPHY
• LVH + RAD
• LVH + Clockwise rotation
• Tall Rv6 + tall Rv1 ( R > S)
ECG Final Proff.Sumit Kr Ghosh Dept of Internal Medicine Medical College 88 College Street Kolkata
CORONARY INSUFFICIENCY
• Impaired coronary blood flow : present all the time :
absolute
• Increased demand : present time to time : relative
• ST depression : horizontality, upward sloping, plane,
downward sloping
• ST elevation : coronary vasospasm
more severe than ST depression
• T wave :
~ symmetrical limbs with sharp vertex : coronary
insufficiency
~ asymmetrical limbs with blunt vertex : strain, digitalis
effect
• Inverted U
MYOCARDIAL INFARCTION
ECG CHANGES
• Hyperacute phase
~ increased amplitude of R wave
~ increased VAT
~ slope elevation of ST segment
~ tall & wide T
• Fully evolved phase
~ pathological Q
~ ST elevation with upward convexity
~ symmetrical T inversion
• Chronic stabilized phase
~ pathological Q
~ ST segment & T may be normal or
point towards coronary insuffiency
Indicative & reciprocal changes
AMI
LV RV
v1 & v4R
Anterior wall
Extensive anterior wall
I, aVL, v1 to v6
Anterolateral wall
I, aVL, v4 to v6
Anteroseptal wal
v1 to v4
Apical wall
V5,V6
Inferior wall
II, III, aVF
Posterior wall
mirror-image change
in v1 to v3, esp v2
PATHOLOGICAL Q
• Present in indicative leads
• 0.04s in duration
• >4 mm deep
• >1/4th
of R wave magnitude
Physiological Q
• Septal depolarisation from left to right
• Present in lateral leads I, aVL, v5,v6
Loss of Q : early feature of LBBB
Deep Q with giant negative T : HOCM
ECG Final Proff.Sumit Kr Ghosh Dept of Internal Medicine Medical College 88 College Street Kolkata
ECG Final Proff.Sumit Kr Ghosh Dept of Internal Medicine Medical College 88 College Street Kolkata
• Sinus rhythm : 60-100 beats/min
• Sinus arrythmia (sinus node rate can change with
inspiration/expiration, especially in younger people
variation of the P-P interval from one beat to the
next by at least 0.12 seconds
• Sinus tachycardia : regular sinus rhythm with sinus
node rate > 100/min
• Sinus bradycardia : regular sinus rhythm with sinus
node rate < 60 / min
Similarities :
Premature
Ectopic
Etiology
Dissimilarities :
SVPB VPB
Focus in Atrium ( other than SA
node)
Ventricle
QRS complex Morphology similar
Narrow
Morphology dissimilar
Wide
ST-T No significant change Usually displaced in
opposite direction of QRS
Compensatory pause Incomplete Complete
APC / SVPB vs. VPC / VPB
SUPRAVENTRICULAR
TACHYARRYTHMIA
SVTs from a sinoatrial source:
• Inappropriate sinus tachycardia
• Sinoatrial node reentrant tachycardia (SANRT)
SVTs from an atrial source:
• Ectopic (unifocal) atrial tachycardia (EAT)
• Multifocal atrial tachycardia (MAT)
• Atrial fibrillation with a rapid ventricular response
• Atrial flutter with a rapid ventricular response
SVTs from an atrioventricular source (junctional tachycardia):
• AV nodal reentrant tachycardia (AVNRT) or junctional reciprocating
tachycardia (JRT)
• AV reentrant tachycardia (AVRT) - visible or concealed (including
Wolff-Parkinson-White syndrome)
• Junctional ectopic tachycardia
PAT / PSVT / AVNRT
• A run of rapidly repeated SVPBs ( usually ≥ 3 )
• Narrow QRS
• Rate around 160-220/ min
• Usually 1:1 conduction; sometimes AV block associated
(PAT with block)
• Prolonged PR
• Management : carotid sinus massage, adenosine,
verapamil, DC cardioversion
Atrial fibrillation
• Chaotic atrial excitation & contraction
• Atrial rate 350-600 / min
• No definite P; replaced by ‘f’ wave
• Irregularly irregular ventricular rhythm
• Narrow QRS
• Etiology :
• Management :
Atrial flutter
• Regular atrial contraction
• Atrial rate 220-350 / min
• Ventricular rate ½ - ¼ th of atrial rate; may be
irregular; QRS complex : normal morphology
• “Saw-toothed” appearance; flutter wave
VENTRICULAR
TACHYARRYTHMIA
VT
VFl
VF
VPC
Bigeminy : alternate sinus beat & VPC
Trigeminy : 2 sinus beat followed by VPC
Couplets / pairs : 2 successive VPCs
VT : ≥ 3 consecutive VPCs with rate >100
VT
Sustained VT : >30s in duration & symptomatic :
generally requires termination by anti-tachycardia
pacing techniques
Non-sustained VT : episodes are short (≥3 beats) and
terminate spontaneously
Monomorphic VT : regular rate and rhythm and fixed
shape or morphology of the ECG trace
Polymorphic VT : irregular in rate and rhythm and has
varying shapes or morphologies on the ECG
Monomorphic VT may deteriorate into polymorphic
VT to VF
VFl
• High frequency (250- 350/min) beats
• The ECG signal looks like sinusoidal or ‘sine-
like wave’ form
• High rate of contraction of heart chambers : time
of blood flow into the chamber becomes very
small : very little blood flows to body
• The person who is experiencing VFl is close to
unconsciousness
VF
• Most dangerous arrythmia
• Ventricular rate 350-450/min
• Totally uncoordinated : no discriminate waves :
totally irregular, bizarre & deformed deflections
of varying width, height & shape
• No audible heart sounds, no palpable pulse
• Treatment : immediate electrical defibrillation
• If lucky to survive from VT, chance of VF in near
future
ATRIOVENTRICULAR
CONDUCTION DEFECTS
• 1st
degree
• 2nd
degree
~ Mobitz type I
~ Mobitz type II
~ Constant / fixed AV block
• 3rd
degree / Complete block
1st
degree
Prolonged PR interval (>0.2 s)
2nd
degree
Mobitz type I
Mobitz type II
Constant / fixed AV block
3rd
degree / Complete block
No SA impulse pass through AV
node
Idioventricular rhythm
No synchrony between atrial rhythm
& ventricular rhythm
Mobitz type I Mobitz type II
More common Less common
Benign Serious
Inf wall MI Ant wall MI
Proximal to
bundle of His
Distal to bundle of
His
Prognosis better Prognosis worse
INTERVENTRICULAR
CONDUCTION DEFECTS
• Unilateral bundle branch block ( LBBB,
RBBB)
• Peripheral block ( LAHB, LPHB, Septal
block)
• Bifascicular block
• Trifascicular block
BBB
LBBB
• M pattern or M-shaped complexes in lead I, aVL, v5, v6
• Absent Q
• ST depression with T inversion
• QRS interval more or less 0.12s
• Usually LAD
• Usually VAT prolonged
Most cases have organic heart disease
Recent onset LBBB : think of AMI
Presence of Q in lateral leads : never LBBB
RBBB
• RSR’ pattern in v1, v2, aVR, v3R
• ST depression with T inversion
• Wide & slurred S in I, aVL, v5, v6
• QRS interval more or less 0.12 s
• Usually VAT prolonged
Commoner than LBBB, often without any
cardiac diseases
LAHB
• LAD
• qR in I, aVL & rS in II, III, aVF
LPHB
• RAD
• qR in II, III, aVF
Bifascicular block
• RBBB + LAHB
• RBBB + LPHB
• LAHB + LPHB
Trifascicular block
• LAD + RBBB + Prolonged PR
ECG Final Proff.Sumit Kr Ghosh Dept of Internal Medicine Medical College 88 College Street Kolkata
ECG Final Proff.Sumit Kr Ghosh Dept of Internal Medicine Medical College 88 College Street Kolkata
ECG Final Proff.Sumit Kr Ghosh Dept of Internal Medicine Medical College 88 College Street Kolkata
ECG Final Proff.Sumit Kr Ghosh Dept of Internal Medicine Medical College 88 College Street Kolkata
ECG Final Proff.Sumit Kr Ghosh Dept of Internal Medicine Medical College 88 College Street Kolkata
ECG Final Proff.Sumit Kr Ghosh Dept of Internal Medicine Medical College 88 College Street Kolkata
ECG Final Proff.Sumit Kr Ghosh Dept of Internal Medicine Medical College 88 College Street Kolkata
ECG Final Proff.Sumit Kr Ghosh Dept of Internal Medicine Medical College 88 College Street Kolkata
ECG Final Proff.Sumit Kr Ghosh Dept of Internal Medicine Medical College 88 College Street Kolkata
ECG Final Proff.Sumit Kr Ghosh Dept of Internal Medicine Medical College 88 College Street Kolkata
ECG Final Proff.Sumit Kr Ghosh Dept of Internal Medicine Medical College 88 College Street Kolkata
ECG Final Proff.Sumit Kr Ghosh Dept of Internal Medicine Medical College 88 College Street Kolkata
ECG Final Proff.Sumit Kr Ghosh Dept of Internal Medicine Medical College 88 College Street Kolkata
ECG Final Proff.Sumit Kr Ghosh Dept of Internal Medicine Medical College 88 College Street Kolkata

Contenu connexe

Tendances

Ambulatory bp monitoring should it be routine?
Ambulatory bp monitoring should it be routine?Ambulatory bp monitoring should it be routine?
Ambulatory bp monitoring should it be routine?Vallabhaneni Bhupal
 
Ambulatory BP monitoring
Ambulatory BP monitoring Ambulatory BP monitoring
Ambulatory BP monitoring Ajay Kurian
 
Dibu's approach to congenital heart disease
Dibu's approach to congenital heart diseaseDibu's approach to congenital heart disease
Dibu's approach to congenital heart diseasedibufolio
 
ECG Lecture: Sinus arrest, sinoatrial exit block, AV block and escape rhythms
ECG Lecture: Sinus arrest, sinoatrial exit block, AV block and escape rhythmsECG Lecture: Sinus arrest, sinoatrial exit block, AV block and escape rhythms
ECG Lecture: Sinus arrest, sinoatrial exit block, AV block and escape rhythmsMichael-Joseph Agbayani
 
Echocardiography Cardiac Ultrasound
Echocardiography Cardiac UltrasoundEchocardiography Cardiac Ultrasound
Echocardiography Cardiac UltrasoundEneutron
 
Diagonosis and management of Arrhythmia final Dr. Onn Akbar Ali Adelaide Hilt...
Diagonosis and management of Arrhythmia final Dr. Onn Akbar Ali Adelaide Hilt...Diagonosis and management of Arrhythmia final Dr. Onn Akbar Ali Adelaide Hilt...
Diagonosis and management of Arrhythmia final Dr. Onn Akbar Ali Adelaide Hilt...Onn Akbar Ali MBBS ; FRACP; FCSANZ
 
Stemi criteria
Stemi criteriaStemi criteria
Stemi criteriachricres
 
Myocardial infarction (MI) ecg localisation
Myocardial infarction (MI) ecg localisationMyocardial infarction (MI) ecg localisation
Myocardial infarction (MI) ecg localisationMalleswara rao Dangeti
 
Ventricular arrhythmias
Ventricular arrhythmiasVentricular arrhythmias
Ventricular arrhythmiasarnab ghosh
 
SvO2 & ScvO2 monitoring
SvO2 & ScvO2 monitoringSvO2 & ScvO2 monitoring
SvO2 & ScvO2 monitoringAhsan Ahmed
 
Echo made easy
Echo made easyEcho made easy
Echo made easyHospital
 

Tendances (20)

Ecg quiz
Ecg quizEcg quiz
Ecg quiz
 
HOCM Hypertrophic cardiomyopathy
HOCM Hypertrophic cardiomyopathyHOCM Hypertrophic cardiomyopathy
HOCM Hypertrophic cardiomyopathy
 
Ambulatory bp monitoring should it be routine?
Ambulatory bp monitoring should it be routine?Ambulatory bp monitoring should it be routine?
Ambulatory bp monitoring should it be routine?
 
Right bundle branch block
Right bundle branch blockRight bundle branch block
Right bundle branch block
 
Ambulatory BP monitoring
Ambulatory BP monitoring Ambulatory BP monitoring
Ambulatory BP monitoring
 
Dibu's approach to congenital heart disease
Dibu's approach to congenital heart diseaseDibu's approach to congenital heart disease
Dibu's approach to congenital heart disease
 
ECG Lecture: Sinus arrest, sinoatrial exit block, AV block and escape rhythms
ECG Lecture: Sinus arrest, sinoatrial exit block, AV block and escape rhythmsECG Lecture: Sinus arrest, sinoatrial exit block, AV block and escape rhythms
ECG Lecture: Sinus arrest, sinoatrial exit block, AV block and escape rhythms
 
ECG
ECGECG
ECG
 
Echocardiography Cardiac Ultrasound
Echocardiography Cardiac UltrasoundEchocardiography Cardiac Ultrasound
Echocardiography Cardiac Ultrasound
 
Diagonosis and management of Arrhythmia final Dr. Onn Akbar Ali Adelaide Hilt...
Diagonosis and management of Arrhythmia final Dr. Onn Akbar Ali Adelaide Hilt...Diagonosis and management of Arrhythmia final Dr. Onn Akbar Ali Adelaide Hilt...
Diagonosis and management of Arrhythmia final Dr. Onn Akbar Ali Adelaide Hilt...
 
Stemi criteria
Stemi criteriaStemi criteria
Stemi criteria
 
Ecg basics
Ecg basicsEcg basics
Ecg basics
 
Myocardial infarction (MI) ecg localisation
Myocardial infarction (MI) ecg localisationMyocardial infarction (MI) ecg localisation
Myocardial infarction (MI) ecg localisation
 
Ventricular arrhythmias
Ventricular arrhythmiasVentricular arrhythmias
Ventricular arrhythmias
 
Axis
AxisAxis
Axis
 
Ecg workshop
Ecg workshopEcg workshop
Ecg workshop
 
SvO2 & ScvO2 monitoring
SvO2 & ScvO2 monitoringSvO2 & ScvO2 monitoring
SvO2 & ScvO2 monitoring
 
Echo made easy
Echo made easyEcho made easy
Echo made easy
 
LBBB
LBBBLBBB
LBBB
 
Ecg interpretation
Ecg interpretationEcg interpretation
Ecg interpretation
 

En vedette (20)

Neonatal ecg part2
Neonatal ecg part2Neonatal ecg part2
Neonatal ecg part2
 
ECG interpretation: the basics
ECG interpretation: the basicsECG interpretation: the basics
ECG interpretation: the basics
 
Cardio physiology
Cardio physiologyCardio physiology
Cardio physiology
 
cardiac pathology
cardiac pathologycardiac pathology
cardiac pathology
 
ECG Basics
ECG BasicsECG Basics
ECG Basics
 
Basics of ECG.ppt dr.k.subramanyam
Basics of ECG.ppt dr.k.subramanyamBasics of ECG.ppt dr.k.subramanyam
Basics of ECG.ppt dr.k.subramanyam
 
02 water electrolytes_ptiii
02 water electrolytes_ptiii02 water electrolytes_ptiii
02 water electrolytes_ptiii
 
ECG: Hypokalemia
ECG: HypokalemiaECG: Hypokalemia
ECG: Hypokalemia
 
Cardiac cycle
Cardiac cycleCardiac cycle
Cardiac cycle
 
Heart Physiology, Schleich
Heart Physiology, SchleichHeart Physiology, Schleich
Heart Physiology, Schleich
 
Block Diagrams_all
Block Diagrams_allBlock Diagrams_all
Block Diagrams_all
 
Ecg interpretation
Ecg interpretationEcg interpretation
Ecg interpretation
 
ECG PART 3
ECG PART 3ECG PART 3
ECG PART 3
 
ECG PART 8
ECG PART 8ECG PART 8
ECG PART 8
 
Basic ecg stripsnew
Basic ecg stripsnewBasic ecg stripsnew
Basic ecg stripsnew
 
Cardiac conduction system II
Cardiac conduction system IICardiac conduction system II
Cardiac conduction system II
 
ECG Basics
ECG BasicsECG Basics
ECG Basics
 
Ekg module 1
Ekg module 1Ekg module 1
Ekg module 1
 
Ekg module 2
Ekg module 2Ekg module 2
Ekg module 2
 
Unit 1 heart and valves 2012
Unit 1 heart and valves 2012Unit 1 heart and valves 2012
Unit 1 heart and valves 2012
 

Similaire à ECG Final Proff.Sumit Kr Ghosh Dept of Internal Medicine Medical College 88 College Street Kolkata

Cardiology 2.1. ECG or EKG - by Dr. Farjad Ikram
Cardiology 2.1. ECG or EKG - by Dr. Farjad IkramCardiology 2.1. ECG or EKG - by Dr. Farjad Ikram
Cardiology 2.1. ECG or EKG - by Dr. Farjad IkramFarjad Ikram
 
Complete EKG Interpretation Course
Complete EKG Interpretation Course Complete EKG Interpretation Course
Complete EKG Interpretation Course Kerolus Shehata
 
ECG- ELECTROCARDIOGRAM basics and interpretation
ECG- ELECTROCARDIOGRAM basics and interpretationECG- ELECTROCARDIOGRAM basics and interpretation
ECG- ELECTROCARDIOGRAM basics and interpretationDISHANTVADDORIYA
 
Ecg interpretation
Ecg interpretationEcg interpretation
Ecg interpretationSudhir Dev
 
ECG Interpretation
ECG InterpretationECG Interpretation
ECG Interpretationdrmainuddin
 
How to read ECG systematically with practice strips
How to read ECG systematically with practice strips How to read ECG systematically with practice strips
How to read ECG systematically with practice strips Khaled AlKhodari
 
Ecg 5th year 2016
Ecg 5th year 2016Ecg 5th year 2016
Ecg 5th year 2016Yousef Biuk
 
ECG-2 RAMA.pptx
ECG-2 RAMA.pptxECG-2 RAMA.pptx
ECG-2 RAMA.pptxmanishadya
 
Pediatric ECG final.pptx
Pediatric ECG final.pptxPediatric ECG final.pptx
Pediatric ECG final.pptxHabeebRehman12
 
Ecginterpretation s-150311230402-conversion-gate01
Ecginterpretation s-150311230402-conversion-gate01Ecginterpretation s-150311230402-conversion-gate01
Ecginterpretation s-150311230402-conversion-gate01Ajmal Mashwani
 
Systematic ECG Interpretation
Systematic ECG InterpretationSystematic ECG Interpretation
Systematic ECG InterpretationSCGH ED CME
 
ecg_systemic_approach_12-lead_compressed.pdf
ecg_systemic_approach_12-lead_compressed.pdfecg_systemic_approach_12-lead_compressed.pdf
ecg_systemic_approach_12-lead_compressed.pdfjiregnaetichadako
 

Similaire à ECG Final Proff.Sumit Kr Ghosh Dept of Internal Medicine Medical College 88 College Street Kolkata (20)

Ecg made easy
Ecg made easyEcg made easy
Ecg made easy
 
Cardiology 2.1. ECG or EKG - by Dr. Farjad Ikram
Cardiology 2.1. ECG or EKG - by Dr. Farjad IkramCardiology 2.1. ECG or EKG - by Dr. Farjad Ikram
Cardiology 2.1. ECG or EKG - by Dr. Farjad Ikram
 
Complete EKG Interpretation Course
Complete EKG Interpretation Course Complete EKG Interpretation Course
Complete EKG Interpretation Course
 
Tutorial in ecg
Tutorial in ecgTutorial in ecg
Tutorial in ecg
 
Ecg fundamentals
Ecg fundamentalsEcg fundamentals
Ecg fundamentals
 
ECG- ELECTROCARDIOGRAM basics and interpretation
ECG- ELECTROCARDIOGRAM basics and interpretationECG- ELECTROCARDIOGRAM basics and interpretation
ECG- ELECTROCARDIOGRAM basics and interpretation
 
Ecg interpretation
Ecg interpretationEcg interpretation
Ecg interpretation
 
Basics of ecg
Basics of ecgBasics of ecg
Basics of ecg
 
ECG
ECGECG
ECG
 
ECG Interpretation
ECG InterpretationECG Interpretation
ECG Interpretation
 
ECG Interpretation
ECG InterpretationECG Interpretation
ECG Interpretation
 
How to read ECG systematically with practice strips
How to read ECG systematically with practice strips How to read ECG systematically with practice strips
How to read ECG systematically with practice strips
 
ECG Analysis
ECG AnalysisECG Analysis
ECG Analysis
 
Ecg 5th year 2016
Ecg 5th year 2016Ecg 5th year 2016
Ecg 5th year 2016
 
ECG-2 RAMA.pptx
ECG-2 RAMA.pptxECG-2 RAMA.pptx
ECG-2 RAMA.pptx
 
Pediatric ECG final.pptx
Pediatric ECG final.pptxPediatric ECG final.pptx
Pediatric ECG final.pptx
 
Ecginterpretation s-150311230402-conversion-gate01
Ecginterpretation s-150311230402-conversion-gate01Ecginterpretation s-150311230402-conversion-gate01
Ecginterpretation s-150311230402-conversion-gate01
 
Systematic ECG Interpretation
Systematic ECG InterpretationSystematic ECG Interpretation
Systematic ECG Interpretation
 
ecg_systemic_approach_12-lead_compressed.pdf
ecg_systemic_approach_12-lead_compressed.pdfecg_systemic_approach_12-lead_compressed.pdf
ecg_systemic_approach_12-lead_compressed.pdf
 
Ecg final the best
Ecg final the bestEcg final the best
Ecg final the best
 

Plus de Chirantan MD

approach to splenomegaly
approach to splenomegalyapproach to splenomegaly
approach to splenomegalyChirantan MD
 
Snake bite management India
Snake bite management IndiaSnake bite management India
Snake bite management IndiaChirantan MD
 
thalassemia subtypes
thalassemia subtypesthalassemia subtypes
thalassemia subtypesChirantan MD
 
Thallassemia molecular pathogenesis
Thallassemia molecular pathogenesisThallassemia molecular pathogenesis
Thallassemia molecular pathogenesisChirantan MD
 
CT Scan Proff.Sumit Kr Ghosh Dept of Internal Medicine Medical College 88 Col...
CT Scan Proff.Sumit Kr Ghosh Dept of Internal Medicine Medical College 88 Col...CT Scan Proff.Sumit Kr Ghosh Dept of Internal Medicine Medical College 88 Col...
CT Scan Proff.Sumit Kr Ghosh Dept of Internal Medicine Medical College 88 Col...Chirantan MD
 
Pathopyshiology of Intestinal Obstruction CHIRANTAN MANDAL Medical College ko...
Pathopyshiology of Intestinal Obstruction CHIRANTAN MANDAL Medical College ko...Pathopyshiology of Intestinal Obstruction CHIRANTAN MANDAL Medical College ko...
Pathopyshiology of Intestinal Obstruction CHIRANTAN MANDAL Medical College ko...Chirantan MD
 
Introduction of intestinal obstruction Pallavi Shekhar Medical College kolkata
Introduction of intestinal obstruction Pallavi Shekhar  Medical College kolkataIntroduction of intestinal obstruction Pallavi Shekhar  Medical College kolkata
Introduction of intestinal obstruction Pallavi Shekhar Medical College kolkataChirantan MD
 
Clinical aspect of intestinal obstruction Ritasman Baisya Medical College kol...
Clinical aspect of intestinal obstruction Ritasman Baisya Medical College kol...Clinical aspect of intestinal obstruction Ritasman Baisya Medical College kol...
Clinical aspect of intestinal obstruction Ritasman Baisya Medical College kol...Chirantan MD
 
Imaging modalities of intestinal obstruction Mithilesh Kumar Medical College ...
Imaging modalities of intestinal obstruction Mithilesh Kumar Medical College ...Imaging modalities of intestinal obstruction Mithilesh Kumar Medical College ...
Imaging modalities of intestinal obstruction Mithilesh Kumar Medical College ...Chirantan MD
 
General management of intestinal obstruction Arindam Roy Medical College Ko...
General management  of intestinal  obstruction Arindam Roy Medical College Ko...General management  of intestinal  obstruction Arindam Roy Medical College Ko...
General management of intestinal obstruction Arindam Roy Medical College Ko...Chirantan MD
 
Surgical management of intestinal obstruction Shinjan Patra Medical College K...
Surgical management of intestinal obstruction Shinjan Patra Medical College K...Surgical management of intestinal obstruction Shinjan Patra Medical College K...
Surgical management of intestinal obstruction Shinjan Patra Medical College K...Chirantan MD
 
Thalassemia Urmimala
Thalassemia UrmimalaThalassemia Urmimala
Thalassemia UrmimalaChirantan MD
 
Thalassemia major minor & other subtypes Soumaditya
Thalassemia major minor & other subtypes Soumaditya Thalassemia major minor & other subtypes Soumaditya
Thalassemia major minor & other subtypes Soumaditya Chirantan MD
 
Laboratory Diagonosis thalassemia Chirantan
Laboratory Diagonosis  thalassemia Chirantan Laboratory Diagonosis  thalassemia Chirantan
Laboratory Diagonosis thalassemia Chirantan Chirantan MD
 
Parietal cells in health & diseases
Parietal cells in health & diseasesParietal cells in health & diseases
Parietal cells in health & diseasesChirantan MD
 
Types of muscle contraction ushnish
Types of muscle contraction ushnishTypes of muscle contraction ushnish
Types of muscle contraction ushnishChirantan MD
 
Respiratoty response to exercise dipayan
Respiratoty response to exercise dipayanRespiratoty response to exercise dipayan
Respiratoty response to exercise dipayanChirantan MD
 
Performance enhancers bad effects of doping avik basu
Performance enhancers bad effects of doping avik basuPerformance enhancers bad effects of doping avik basu
Performance enhancers bad effects of doping avik basuChirantan MD
 

Plus de Chirantan MD (20)

approach to splenomegaly
approach to splenomegalyapproach to splenomegaly
approach to splenomegaly
 
Snake bite management India
Snake bite management IndiaSnake bite management India
Snake bite management India
 
HIV AIDS
HIV AIDS HIV AIDS
HIV AIDS
 
thalassemia subtypes
thalassemia subtypesthalassemia subtypes
thalassemia subtypes
 
Thallassemia molecular pathogenesis
Thallassemia molecular pathogenesisThallassemia molecular pathogenesis
Thallassemia molecular pathogenesis
 
CT Scan Proff.Sumit Kr Ghosh Dept of Internal Medicine Medical College 88 Col...
CT Scan Proff.Sumit Kr Ghosh Dept of Internal Medicine Medical College 88 Col...CT Scan Proff.Sumit Kr Ghosh Dept of Internal Medicine Medical College 88 Col...
CT Scan Proff.Sumit Kr Ghosh Dept of Internal Medicine Medical College 88 Col...
 
Pathopyshiology of Intestinal Obstruction CHIRANTAN MANDAL Medical College ko...
Pathopyshiology of Intestinal Obstruction CHIRANTAN MANDAL Medical College ko...Pathopyshiology of Intestinal Obstruction CHIRANTAN MANDAL Medical College ko...
Pathopyshiology of Intestinal Obstruction CHIRANTAN MANDAL Medical College ko...
 
Introduction of intestinal obstruction Pallavi Shekhar Medical College kolkata
Introduction of intestinal obstruction Pallavi Shekhar  Medical College kolkataIntroduction of intestinal obstruction Pallavi Shekhar  Medical College kolkata
Introduction of intestinal obstruction Pallavi Shekhar Medical College kolkata
 
Clinical aspect of intestinal obstruction Ritasman Baisya Medical College kol...
Clinical aspect of intestinal obstruction Ritasman Baisya Medical College kol...Clinical aspect of intestinal obstruction Ritasman Baisya Medical College kol...
Clinical aspect of intestinal obstruction Ritasman Baisya Medical College kol...
 
Imaging modalities of intestinal obstruction Mithilesh Kumar Medical College ...
Imaging modalities of intestinal obstruction Mithilesh Kumar Medical College ...Imaging modalities of intestinal obstruction Mithilesh Kumar Medical College ...
Imaging modalities of intestinal obstruction Mithilesh Kumar Medical College ...
 
General management of intestinal obstruction Arindam Roy Medical College Ko...
General management  of intestinal  obstruction Arindam Roy Medical College Ko...General management  of intestinal  obstruction Arindam Roy Medical College Ko...
General management of intestinal obstruction Arindam Roy Medical College Ko...
 
Surgical management of intestinal obstruction Shinjan Patra Medical College K...
Surgical management of intestinal obstruction Shinjan Patra Medical College K...Surgical management of intestinal obstruction Shinjan Patra Medical College K...
Surgical management of intestinal obstruction Shinjan Patra Medical College K...
 
Thalassemia Urmimala
Thalassemia UrmimalaThalassemia Urmimala
Thalassemia Urmimala
 
Thalassemia major minor & other subtypes Soumaditya
Thalassemia major minor & other subtypes Soumaditya Thalassemia major minor & other subtypes Soumaditya
Thalassemia major minor & other subtypes Soumaditya
 
Laboratory Diagonosis thalassemia Chirantan
Laboratory Diagonosis  thalassemia Chirantan Laboratory Diagonosis  thalassemia Chirantan
Laboratory Diagonosis thalassemia Chirantan
 
Thalassemia Avik
Thalassemia AvikThalassemia Avik
Thalassemia Avik
 
Parietal cells in health & diseases
Parietal cells in health & diseasesParietal cells in health & diseases
Parietal cells in health & diseases
 
Types of muscle contraction ushnish
Types of muscle contraction ushnishTypes of muscle contraction ushnish
Types of muscle contraction ushnish
 
Respiratoty response to exercise dipayan
Respiratoty response to exercise dipayanRespiratoty response to exercise dipayan
Respiratoty response to exercise dipayan
 
Performance enhancers bad effects of doping avik basu
Performance enhancers bad effects of doping avik basuPerformance enhancers bad effects of doping avik basu
Performance enhancers bad effects of doping avik basu
 

Dernier

Ten lessons learnt as anesthetist.pptx
Ten  lessons  learnt as anesthetist.pptxTen  lessons  learnt as anesthetist.pptx
Ten lessons learnt as anesthetist.pptxtusharchokshi1
 
Brief introduction to information ecosystem x public health.pptx
Brief introduction to information ecosystem x public health.pptxBrief introduction to information ecosystem x public health.pptx
Brief introduction to information ecosystem x public health.pptxTina Purnat
 
ANATOMY OF THE CEREBRUM WITH CLINICAL ANATOMY.pptx
ANATOMY OF THE CEREBRUM WITH CLINICAL ANATOMY.pptxANATOMY OF THE CEREBRUM WITH CLINICAL ANATOMY.pptx
ANATOMY OF THE CEREBRUM WITH CLINICAL ANATOMY.pptxsiddharthroy26587
 
HERPES SIMPLEX VIRUS 12032019 TUESDAY pptx
HERPES SIMPLEX VIRUS 12032019 TUESDAY  pptxHERPES SIMPLEX VIRUS 12032019 TUESDAY  pptx
HERPES SIMPLEX VIRUS 12032019 TUESDAY pptxPulkitMittal54
 
SGK VIÊM KHỚP DẠNG THẤP YHN .pdf
SGK VIÊM KHỚP DẠNG THẤP YHN              .pdfSGK VIÊM KHỚP DẠNG THẤP YHN              .pdf
SGK VIÊM KHỚP DẠNG THẤP YHN .pdfHongBiThi1
 
bleeding disorders 1 Dr.Nannika Pradhan
bleeding disorders 1  Dr.Nannika Pradhanbleeding disorders 1  Dr.Nannika Pradhan
bleeding disorders 1 Dr.Nannika Pradhanthesalberry
 
Range of Secondary Electrons and Electron Build-Up: Impact on Scatter in Homo...
Range of Secondary Electrons and Electron Build-Up: Impact on Scatter in Homo...Range of Secondary Electrons and Electron Build-Up: Impact on Scatter in Homo...
Range of Secondary Electrons and Electron Build-Up: Impact on Scatter in Homo...Dr. Dheeraj Kumar
 
SGK BỆNH LÝ GOUT YHN hay lắm nha aaaa.pdf
SGK BỆNH LÝ GOUT YHN hay lắm nha aaaa.pdfSGK BỆNH LÝ GOUT YHN hay lắm nha aaaa.pdf
SGK BỆNH LÝ GOUT YHN hay lắm nha aaaa.pdfHongBiThi1
 
Tracheostomy .pdf ENT by QuickMedTALK. getting things done on time
Tracheostomy .pdf ENT by QuickMedTALK. getting things done on timeTracheostomy .pdf ENT by QuickMedTALK. getting things done on time
Tracheostomy .pdf ENT by QuickMedTALK. getting things done on timeQuick MedTalk
 
Ovarian tumors Lecture notes for MBBS.pptx
Ovarian tumors Lecture notes for MBBS.pptxOvarian tumors Lecture notes for MBBS.pptx
Ovarian tumors Lecture notes for MBBS.pptxSizan Thapa
 
SGK PHÙ PHỔI CẤP ĐHYHN .pdf
SGK PHÙ PHỔI CẤP ĐHYHN                   .pdfSGK PHÙ PHỔI CẤP ĐHYHN                   .pdf
SGK PHÙ PHỔI CẤP ĐHYHN .pdfHongBiThi1
 
(IDE)and(IVD),QMS,21 CFR part820 , 801)
(IDE)and(IVD),QMS,21 CFR part820  , 801)(IDE)and(IVD),QMS,21 CFR part820  , 801)
(IDE)and(IVD),QMS,21 CFR part820 , 801)chahattyagi200
 
airway management recorded for S2.pptx
airway management  recorded  for S2.pptxairway management  recorded  for S2.pptx
airway management recorded for S2.pptxnakera38
 
Histology of lymph node(lymph node histology)
Histology of lymph node(lymph node histology)Histology of lymph node(lymph node histology)
Histology of lymph node(lymph node histology)pranavguleria2
 
Basic of Thyroid Hormone:- An In-depth Analysis
Basic of Thyroid Hormone:- An In-depth AnalysisBasic of Thyroid Hormone:- An In-depth Analysis
Basic of Thyroid Hormone:- An In-depth AnalysisAshishMaletha2
 
Methicillin-resistant Staphylococcus Aureus (MRSA)
Methicillin-resistant Staphylococcus Aureus (MRSA)Methicillin-resistant Staphylococcus Aureus (MRSA)
Methicillin-resistant Staphylococcus Aureus (MRSA)Ahmad Thanin
 
SMA Implementation science seminar (Day 1).pptx
SMA Implementation science seminar (Day 1).pptxSMA Implementation science seminar (Day 1).pptx
SMA Implementation science seminar (Day 1).pptxAbdirahmanWaseem
 
Reproductive and Child Health Services ppt.pptx
Reproductive and Child Health Services ppt.pptxReproductive and Child Health Services ppt.pptx
Reproductive and Child Health Services ppt.pptxVeereshDemashetti
 
Ayurveda research in Hypothyroidism, P
Ayurveda  research  in Hypothyroidism, PAyurveda  research  in Hypothyroidism, P
Ayurveda research in Hypothyroidism, PDr.Shalu Jain
 

Dernier (20)

Ten lessons learnt as anesthetist.pptx
Ten  lessons  learnt as anesthetist.pptxTen  lessons  learnt as anesthetist.pptx
Ten lessons learnt as anesthetist.pptx
 
Brief introduction to information ecosystem x public health.pptx
Brief introduction to information ecosystem x public health.pptxBrief introduction to information ecosystem x public health.pptx
Brief introduction to information ecosystem x public health.pptx
 
ANATOMY OF THE CEREBRUM WITH CLINICAL ANATOMY.pptx
ANATOMY OF THE CEREBRUM WITH CLINICAL ANATOMY.pptxANATOMY OF THE CEREBRUM WITH CLINICAL ANATOMY.pptx
ANATOMY OF THE CEREBRUM WITH CLINICAL ANATOMY.pptx
 
HERPES SIMPLEX VIRUS 12032019 TUESDAY pptx
HERPES SIMPLEX VIRUS 12032019 TUESDAY  pptxHERPES SIMPLEX VIRUS 12032019 TUESDAY  pptx
HERPES SIMPLEX VIRUS 12032019 TUESDAY pptx
 
SGK VIÊM KHỚP DẠNG THẤP YHN .pdf
SGK VIÊM KHỚP DẠNG THẤP YHN              .pdfSGK VIÊM KHỚP DẠNG THẤP YHN              .pdf
SGK VIÊM KHỚP DẠNG THẤP YHN .pdf
 
bleeding disorders 1 Dr.Nannika Pradhan
bleeding disorders 1  Dr.Nannika Pradhanbleeding disorders 1  Dr.Nannika Pradhan
bleeding disorders 1 Dr.Nannika Pradhan
 
Range of Secondary Electrons and Electron Build-Up: Impact on Scatter in Homo...
Range of Secondary Electrons and Electron Build-Up: Impact on Scatter in Homo...Range of Secondary Electrons and Electron Build-Up: Impact on Scatter in Homo...
Range of Secondary Electrons and Electron Build-Up: Impact on Scatter in Homo...
 
SGK BỆNH LÝ GOUT YHN hay lắm nha aaaa.pdf
SGK BỆNH LÝ GOUT YHN hay lắm nha aaaa.pdfSGK BỆNH LÝ GOUT YHN hay lắm nha aaaa.pdf
SGK BỆNH LÝ GOUT YHN hay lắm nha aaaa.pdf
 
Tracheostomy .pdf ENT by QuickMedTALK. getting things done on time
Tracheostomy .pdf ENT by QuickMedTALK. getting things done on timeTracheostomy .pdf ENT by QuickMedTALK. getting things done on time
Tracheostomy .pdf ENT by QuickMedTALK. getting things done on time
 
Ovarian tumors Lecture notes for MBBS.pptx
Ovarian tumors Lecture notes for MBBS.pptxOvarian tumors Lecture notes for MBBS.pptx
Ovarian tumors Lecture notes for MBBS.pptx
 
SGK PHÙ PHỔI CẤP ĐHYHN .pdf
SGK PHÙ PHỔI CẤP ĐHYHN                   .pdfSGK PHÙ PHỔI CẤP ĐHYHN                   .pdf
SGK PHÙ PHỔI CẤP ĐHYHN .pdf
 
(IDE)and(IVD),QMS,21 CFR part820 , 801)
(IDE)and(IVD),QMS,21 CFR part820  , 801)(IDE)and(IVD),QMS,21 CFR part820  , 801)
(IDE)and(IVD),QMS,21 CFR part820 , 801)
 
airway management recorded for S2.pptx
airway management  recorded  for S2.pptxairway management  recorded  for S2.pptx
airway management recorded for S2.pptx
 
Histology of lymph node(lymph node histology)
Histology of lymph node(lymph node histology)Histology of lymph node(lymph node histology)
Histology of lymph node(lymph node histology)
 
Basic of Thyroid Hormone:- An In-depth Analysis
Basic of Thyroid Hormone:- An In-depth AnalysisBasic of Thyroid Hormone:- An In-depth Analysis
Basic of Thyroid Hormone:- An In-depth Analysis
 
Methicillin-resistant Staphylococcus Aureus (MRSA)
Methicillin-resistant Staphylococcus Aureus (MRSA)Methicillin-resistant Staphylococcus Aureus (MRSA)
Methicillin-resistant Staphylococcus Aureus (MRSA)
 
SMA Implementation science seminar (Day 1).pptx
SMA Implementation science seminar (Day 1).pptxSMA Implementation science seminar (Day 1).pptx
SMA Implementation science seminar (Day 1).pptx
 
Reproductive and Child Health Services ppt.pptx
Reproductive and Child Health Services ppt.pptxReproductive and Child Health Services ppt.pptx
Reproductive and Child Health Services ppt.pptx
 
Ayurveda research in Hypothyroidism, P
Ayurveda  research  in Hypothyroidism, PAyurveda  research  in Hypothyroidism, P
Ayurveda research in Hypothyroidism, P
 
Oral disorders .pptx
Oral disorders .pptxOral disorders .pptx
Oral disorders .pptx
 

ECG Final Proff.Sumit Kr Ghosh Dept of Internal Medicine Medical College 88 College Street Kolkata

  • 1. ECG Dr. Sumit Kr. Ghosh Asst. Professor Department of Medicine Medical College & Hospital,
  • 2. INTRODUCTION Graphic representation of electrical activities of heart Resting ECG Exercise ECG / TMT 24-hr ECG / Holter
  • 4. READING ECG • Rate • Rhythm • Axis • Lie & Rotation • Voltage • Waves & Intervals • Abnormalities
  • 6. STANDARDISATION • 1mv will produce deflection of 10 mm / 1 cm • Stylus should have an appropriate pressure
  • 7. WAVES & INTERVAL P Q R S T > 5mm q r s < 5mm P Q R S T U J-point J δ PR QRS ST QT TP PP & RR
  • 8. LEADS Lead = paired electrode 12 leads Limb leads Precordial leads Frontal or Coronal plane leads Horizontal plane leads Bipolar unipolar (low EP) unipolar I, II, III aVR, aVL, aVF v1, v2, v3, v4, v5, v6 rt side septum lt side I, avL, v5, v6 : lateral wall II, III Avf : inferior wall Long leads V7, v8, v9 V1r – v9r 3v1 – 3v9 Esophageal leads
  • 9. Resultant vector • Towards lead : positive / upward deflection • Away from lead : negative / downward deflection • Perpendicular to lead : equiphasic deflection
  • 10. RATE Ventricular rate vs Atrial rate Rate = 1500/ no of small square = 300/no of large square Depends on speed of ECG paper Usual speed = 90m/hr =1.5m/min No of QRS complex in 1 min = HR
  • 11. RHYTHM • Regular : ~ Sinus ~ Nodal ~ Idioventricular • Irregular : ~ Regularly irregular ~ Irregularly irregular
  • 12. AXIS • Normal axis : 0 to +90 degree (most cases +40 to +60 degree) • LAD : 0 to -90 degree (slight LAD : 0 to -30 degree marked LAD : -30 to -90 degree ) • RAD : +90 to ± 180 degree • Inderminate / NW axis : -90 to ± 180 degree an expression of : - marked RAD - marked LAD - discharge of ectopic ventricular pacemaker
  • 13. AXIS DETERMINATION • Lead I,II & III • Pairs of perpendicular leads • Perpendicular to the lead where R=S • In degree I II III ↑ ↑ ↑ Normal ↑ ↑ ↓ ↓ LAD ↓ ↑ ↑ RAD
  • 14. + + _ _ I aVF 0± 180 - 90 + 90 NORMAL AXIS RAD LAD INDETERMINATE AXIS
  • 15. EASY TO REMEMBER I (left) aVF (right) ↑ ↑ Normal ↑ ↓ LAD ↓ ↑ RAD ↓ ↓ Indeterminate
  • 16. LAD • LAHB • LBBB • Inf wall MI • Pacing from apex of RV/LV • WPW Isolated LVH does not cause LAD RAD • RV dominance - acq. Rt heart disease : pulm embolism chr. Cor pulmonale - cong. heart disease : TOF • Anterolateral MI • LPHB • WPW
  • 17. LIE & ROTATION • LIE : in frontal plane [ vertical (90 degree) to horizontal (0 degree ) • Rotation : in horizontal plane ~ Clockwise – persistent S waves in v5, v6 ~ Anti-clockwise – R waves in v2
  • 18. P - WAVE • Atrial activity (RA earliar than LA) • Best seen in lead II & v1 • Normal duration : 0.08 s – 0.1 s (not > 0.11 s) • Normal amplitude : not > 2 mm ( max – 2.5 mm) • Diphasic in v1 • Inverted in aVR (normally), wrong electrode placement, dextrocardia, retrograde atrial activation • Absent : Atrial fibrillation, nodal rhythm, hyperkalemia • P-pulmonale : tall & peaked (amplitude > 2.5 mm) » » RAH • P-mitrale : wide & notched (duration > 0.11 s) » » LAH • P-tricuspidale
  • 19. QRS COMPLEX • Ventricular depolarisation Q-wave : initial negative deflection septal depolarisation :: from left to right R-wave : depolarisation of venticular muscle mass S-wave : depolarisation of postero-basal part of left ventricle, superiormost part of ventricular septum • High amplitude : RVH / LVH • Low amplitude : Low voltage complex (< 5 mm in limb leads & < 10 mm in precordial leads) Standardisation is important • Taller in v5 than v6
  • 20. QRS COMPLEX QRS in precordial leads
  • 21. T-WAVE • Ventricular repolarisation • Blunt apex with 2 asymerical limbs : proximal limb shallower than distal • Tall –peaked : hyperkalemia • Tall- wide : hyperacute stage of MI • Inverted : IHD, Ventricular strain, CVA • Flat : thick chest wall, emphysema, pericardial effusion, hypokalemia
  • 22. U-WAVE • Positive deflection after T & before P of next cycle • Slow repolarisation of Purkinje’s fibres, septum, papillary muscles but uncertain • Mid-precordial leads – v2 to v4 • Prominent : hypokalemia • Inverted / absent : diastolic overload / myocardial dysfunction
  • 23. P-R INTERVAL • Beginning of P-wave to beginning of QRS complex • Intra-atial, AV nodal & His-Purkinje coduction • Normal duration : 0.12 – 0.20 s • Prolonged : Acute rheumatic fever, 1st degree AV block • Progressive prolongation : Mobitz type-I (2nd degree AV block) » » Wenckebach phenomenon • Shortened : WPW syndrome, AV nodal rhythm
  • 24. QRS INTERVAL • Total ventricular depolarisation • Beginning of Q-wave ( beginning of P-wave, if no Q-wave present) to termination of S- wave • Normal duration : usually not > 0.09 sec (range 0.05-0.11 s) • Prolonged : Intaventricular conduction defect or BBB ≥ 0.12 sec » » complete BBB • Intrinsicoid deflection / ventricular activation time : time taken for an impulse to traverse myocardium VAT normally not > 0.02 s in v1, v2 & not > 0.04 s in v5, v6
  • 25. ST SEGMENT • End of QRS complex to beginning of T • Normal ST segment merges smoothly & imperceptibly with proximal limb of T : difficult to separate • Time interval between ventricular depolarisation & repolarisation • Isoelectric to TP segment • Elevated : ~ with upward convexity : AMI, coronary spasm, LV Aneurysm ~ with upward concavity : acute pericarditis • Depressed : ~ oblique/plane/sagging : CAD ~ mirror image of correction mark : digitalis effect ~ upward convexity : strain pattern • End of QRS complex & beginning of ST segment : J point
  • 26. QT INTERVAL • Beginning of Q to end of T • Ventricular depolarisation + repolarisation • Corrected QT or QTc : as QT changes with heart rate • Bazett’s formula : QT interval √RR interval It should be ≤ 0.44 s Prolonged : acute rheumatic carditis, hypokalemia, hypocalcemia, drugs Shortened : hypercalcemia, digitalis, hyperthermia QTc =
  • 27. PP & RR INTERVAL • PP interval : distance between 2 successive P waves - reflects atrial rate • RR interval : distance between 2 successive R waves - reflects ventricular rate • Normally PP = RR
  • 29. Atrial hypertrophy : LAH : P-mitrale RAH : P- pulmonale Bi-atrial hypertrophy Ventricular hypertrophy : LVH RVH Bi-ventricular hypertrophy
  • 30. LVH • Voltage criteria : ~ Sv1 + Rv6 > 35 ~ Sv1 / Rv6 ≥ 20 ~ Rv6 ≥ Rv5 ~ RI ≥ 15 ~ RaVL ≥ 11 ~ Rall(12) > 175 • Horizontal heart • VAT in v5/v6 > 0.04 s • Strain pattern in I, aVL, v5, v6 LAD is not a criteria for isolated LVH • Pressure overload LVH • Volume overload LVH
  • 31. RVH • Voltage criteria : ~ R > S ~ Rv1 > 5 mm ~ persistent Sv5 / Sv6 • Usually RAD (most common & at times only manifestation); but axis may be normal • Vertical heart • VAT in v1 > 0.02 s • Strain pattern in v1, Avr • Associated P-pulmonale may be there
  • 32. BIVENTRICULAR HYPERTROPHY • LVH + RAD • LVH + Clockwise rotation • Tall Rv6 + tall Rv1 ( R > S)
  • 34. CORONARY INSUFFICIENCY • Impaired coronary blood flow : present all the time : absolute • Increased demand : present time to time : relative • ST depression : horizontality, upward sloping, plane, downward sloping • ST elevation : coronary vasospasm more severe than ST depression • T wave : ~ symmetrical limbs with sharp vertex : coronary insufficiency ~ asymmetrical limbs with blunt vertex : strain, digitalis effect • Inverted U
  • 36. ECG CHANGES • Hyperacute phase ~ increased amplitude of R wave ~ increased VAT ~ slope elevation of ST segment ~ tall & wide T • Fully evolved phase ~ pathological Q ~ ST elevation with upward convexity ~ symmetrical T inversion • Chronic stabilized phase ~ pathological Q ~ ST segment & T may be normal or point towards coronary insuffiency Indicative & reciprocal changes
  • 37. AMI LV RV v1 & v4R Anterior wall Extensive anterior wall I, aVL, v1 to v6 Anterolateral wall I, aVL, v4 to v6 Anteroseptal wal v1 to v4 Apical wall V5,V6 Inferior wall II, III, aVF Posterior wall mirror-image change in v1 to v3, esp v2
  • 38. PATHOLOGICAL Q • Present in indicative leads • 0.04s in duration • >4 mm deep • >1/4th of R wave magnitude Physiological Q • Septal depolarisation from left to right • Present in lateral leads I, aVL, v5,v6 Loss of Q : early feature of LBBB Deep Q with giant negative T : HOCM
  • 41. • Sinus rhythm : 60-100 beats/min • Sinus arrythmia (sinus node rate can change with inspiration/expiration, especially in younger people variation of the P-P interval from one beat to the next by at least 0.12 seconds • Sinus tachycardia : regular sinus rhythm with sinus node rate > 100/min • Sinus bradycardia : regular sinus rhythm with sinus node rate < 60 / min
  • 42. Similarities : Premature Ectopic Etiology Dissimilarities : SVPB VPB Focus in Atrium ( other than SA node) Ventricle QRS complex Morphology similar Narrow Morphology dissimilar Wide ST-T No significant change Usually displaced in opposite direction of QRS Compensatory pause Incomplete Complete APC / SVPB vs. VPC / VPB
  • 43. SUPRAVENTRICULAR TACHYARRYTHMIA SVTs from a sinoatrial source: • Inappropriate sinus tachycardia • Sinoatrial node reentrant tachycardia (SANRT) SVTs from an atrial source: • Ectopic (unifocal) atrial tachycardia (EAT) • Multifocal atrial tachycardia (MAT) • Atrial fibrillation with a rapid ventricular response • Atrial flutter with a rapid ventricular response SVTs from an atrioventricular source (junctional tachycardia): • AV nodal reentrant tachycardia (AVNRT) or junctional reciprocating tachycardia (JRT) • AV reentrant tachycardia (AVRT) - visible or concealed (including Wolff-Parkinson-White syndrome) • Junctional ectopic tachycardia
  • 44. PAT / PSVT / AVNRT • A run of rapidly repeated SVPBs ( usually ≥ 3 ) • Narrow QRS • Rate around 160-220/ min • Usually 1:1 conduction; sometimes AV block associated (PAT with block) • Prolonged PR • Management : carotid sinus massage, adenosine, verapamil, DC cardioversion
  • 45. Atrial fibrillation • Chaotic atrial excitation & contraction • Atrial rate 350-600 / min • No definite P; replaced by ‘f’ wave • Irregularly irregular ventricular rhythm • Narrow QRS • Etiology : • Management :
  • 46. Atrial flutter • Regular atrial contraction • Atrial rate 220-350 / min • Ventricular rate ½ - ¼ th of atrial rate; may be irregular; QRS complex : normal morphology • “Saw-toothed” appearance; flutter wave
  • 47. VENTRICULAR TACHYARRYTHMIA VT VFl VF VPC Bigeminy : alternate sinus beat & VPC Trigeminy : 2 sinus beat followed by VPC Couplets / pairs : 2 successive VPCs VT : ≥ 3 consecutive VPCs with rate >100
  • 48. VT Sustained VT : >30s in duration & symptomatic : generally requires termination by anti-tachycardia pacing techniques Non-sustained VT : episodes are short (≥3 beats) and terminate spontaneously Monomorphic VT : regular rate and rhythm and fixed shape or morphology of the ECG trace Polymorphic VT : irregular in rate and rhythm and has varying shapes or morphologies on the ECG Monomorphic VT may deteriorate into polymorphic VT to VF
  • 49. VFl • High frequency (250- 350/min) beats • The ECG signal looks like sinusoidal or ‘sine- like wave’ form • High rate of contraction of heart chambers : time of blood flow into the chamber becomes very small : very little blood flows to body • The person who is experiencing VFl is close to unconsciousness
  • 50. VF • Most dangerous arrythmia • Ventricular rate 350-450/min • Totally uncoordinated : no discriminate waves : totally irregular, bizarre & deformed deflections of varying width, height & shape • No audible heart sounds, no palpable pulse • Treatment : immediate electrical defibrillation • If lucky to survive from VT, chance of VF in near future
  • 51. ATRIOVENTRICULAR CONDUCTION DEFECTS • 1st degree • 2nd degree ~ Mobitz type I ~ Mobitz type II ~ Constant / fixed AV block • 3rd degree / Complete block
  • 52. 1st degree Prolonged PR interval (>0.2 s) 2nd degree Mobitz type I Mobitz type II Constant / fixed AV block 3rd degree / Complete block No SA impulse pass through AV node Idioventricular rhythm No synchrony between atrial rhythm & ventricular rhythm Mobitz type I Mobitz type II More common Less common Benign Serious Inf wall MI Ant wall MI Proximal to bundle of His Distal to bundle of His Prognosis better Prognosis worse
  • 53. INTERVENTRICULAR CONDUCTION DEFECTS • Unilateral bundle branch block ( LBBB, RBBB) • Peripheral block ( LAHB, LPHB, Septal block) • Bifascicular block • Trifascicular block
  • 54. BBB
  • 55. LBBB • M pattern or M-shaped complexes in lead I, aVL, v5, v6 • Absent Q • ST depression with T inversion • QRS interval more or less 0.12s • Usually LAD • Usually VAT prolonged Most cases have organic heart disease Recent onset LBBB : think of AMI Presence of Q in lateral leads : never LBBB
  • 56. RBBB • RSR’ pattern in v1, v2, aVR, v3R • ST depression with T inversion • Wide & slurred S in I, aVL, v5, v6 • QRS interval more or less 0.12 s • Usually VAT prolonged Commoner than LBBB, often without any cardiac diseases
  • 57. LAHB • LAD • qR in I, aVL & rS in II, III, aVF LPHB • RAD • qR in II, III, aVF
  • 58. Bifascicular block • RBBB + LAHB • RBBB + LPHB • LAHB + LPHB Trifascicular block • LAD + RBBB + Prolonged PR