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    EKG Interpretation: UNC Emergency Medicine Medical Student Lecture Series

    Uploaded by

    Dyah Ajeng Pratiwi
    This document provides an overview of EKG interpretation for medical students. It reviews the basics of EKG including normal conduction system, lead placement, distributions, and waveforms. It then details how to systematically interpret an EKG by assessing the rate, rhythm, axis, hypertrophy, and evidence of ischemia. Specific arrhythmias and conditions are examined such as various heart blocks, prolonged QT, ventricular hypertrophy, and signs of injury like STEMI. The document concludes by offering practice reading various EKGs depicting normal sinus rhythm, abnormalities, and pathologies.

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    EKG Interpretation: UNC Emergency Medicine Medical Student Lecture Series

    Uploaded by

    Dyah Ajeng Pratiwi
    39 views58 pages
    This document provides an overview of EKG interpretation for medical students. It reviews the basics of EKG including normal conduction system, lead placement, distributions, and waveforms. It then details how to systematically interpret an EKG by assessing the rate, rhythm, axis, hypertrophy, and evidence of ischemia. Specific arrhythmias and conditions are examined such as various heart blocks, prolonged QT, ventricular hypertrophy, and signs of injury like STEMI. The document concludes by offering practice reading various EKGs depicting normal sinus rhythm, abnormalities, and pathologies.

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    Emergency Medicine

    Original Title

    EKG Interpretation

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    This document provides an overview of EKG interpretation for medical students. It reviews the basics of EKG including normal conduction system, lead placement, distributions, and waveforms. It then details how to systematically interpret an EKG by assessing the rate, rhythm, axis, hypertrophy, and evidence of ischemia. Specific arrhythmias and conditions are examined such as various heart blocks, prolonged QT, ventricular hypertrophy, and signs of injury like STEMI. The document concludes by offering practice reading various EKGs depicting normal sinus rhythm, abnormalities, and pathologies.

    Copyright:

    © All Rights Reserved
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    39 views58 pages

    EKG Interpretation: UNC Emergency Medicine Medical Student Lecture Series

    Uploaded by

    Dyah Ajeng Pratiwi
    This document provides an overview of EKG interpretation for medical students. It reviews the basics of EKG including normal conduction system, lead placement, distributions, and waveforms. It then details how to systematically interpret an EKG by assessing the rate, rhythm, axis, hypertrophy, and evidence of ischemia. Specific arrhythmias and conditions are examined such as various heart blocks, prolonged QT, ventricular hypertrophy, and signs of injury like STEMI. The document concludes by offering practice reading various EKGs depicting normal sinus rhythm, abnormalities, and pathologies.

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    You are on page 1of 58

    EKG Interpretation

    UNC Emergency Medicine


    Medical Student Lecture
    Series

    Objectives

    The Basics
    Interpretation
    Clinical Pearls
    Practice
    Recognition

    The Normal Conduction


    System

    Lead Placement

    aVF

    All Limb Leads

    Precordial Leads

    EKG Distributions

    Anteroseptal: V1, V2, V3,


    V4
    Anterior: V1V4
    Anterolateral: V4V6, I,
    aVL
    Lateral: I and aVL
    Inferior: II, III, and aVF
    Inferolateral: II, III, aVF,
    and V5 and V6

    Waveforms

    Interpretation

    Develop a systematic approach to


    reading EKGs and use it every time
    The system we will practice is:

    Rate
    Rhythm (including intervals and blocks)
    Axis
    Hypertrophy
    Ischemia

    Rate

    Rule of 300- Divide 300 by the


    number of boxes between each
    QRS = rate
    Number
    of big
    boxes

    Rate

    300

    150

    100

    75

    60

    50

    Rate

    HR of 60-100 per minute is normal


    HR > 100 = tachycardia
    HR < 60 = bradycardia

    Differential Diagnosis of
    Tachycardia
    Tachycardi Narrow
    a
    Complex
    ST
    Regular
    SVT
    Atrial flutter

    Wide Complex
    ST w/
    aberrancy
    SVT w/
    aberrancy

    VT

    Irregular

    A-fib
    A-flutter w/
    variable
    conduction

    A-fib w/
    aberrancy

    A-fib w/ WPW

    What is the heart rate?

    www.uptodate.com

    (300 / 6) = 50 bpm

    Rhythm

    Sinus

    Originating
    from SA node
    P wave before
    every QRS
    P wave in same
    direction as
    QRS

    What is this rhythm?


    Normal sinus rhythm

    Normal Intervals

    PR

    QRS

    0.20 sec (less than one


    large box)
    0.08 0.10 sec (1-2
    small boxes)

    QT

    450 ms in men, 460 ms


    in women
    Based on sex / heart
    rate
    Half the R-R interval
    with normal HR

    Prolonged QT

    Normal

    Corrected QT (QTc)

    Men 450ms
    Women 460ms
    QTm/(R-R)

    Causes

    Drugs (Na channel blockers)


    Hypocalcemia, hypomagnesemia, hypokalemia
    Hypothermia
    AMI
    Congenital
    Increased ICP

    Blocks

    AV blocks

    First degree block

    Second degree block, Mobitz type 1

    PR gradually lengthened, then drop QRS

    Second degree block, Mobitz type 2

    PR interval fixed and > 0.2 sec

    PR fixed, but drop QRS randomly

    Type 3 block

    PR and QRS dissociated

    What is this rhythm?


    First degree AV block
    PR is fixed and longer than 0.2 sec

    What is this rhythm?


    Type 1 second degree block
    (Wenckebach)

    What is this rhythm?


    Type 2 second degree AV block
    Dropped QRS

    What is this rhythm?


    3rd degree heart block (complete)

    The QRS Axis


    Represents the overall direction of the hearts activity
    Axis of 30 to +90 degrees is normal

    The Quadrant Approach

    QRS up in I and up in aVF =


    Normal

    What is the axis?


    Normal- QRS up in I and aVF

    Hypertrophy

    Add the larger S wave of V1 or V2


    in mm, to the larger R wave of V5
    or V6.
    Sum is > 35mm = LVH

    Ischemia

    Usually indicated by ST changes

    Elevation = Acute infarction


    Depression = Ischemia

    Can manifest as T wave changes


    Remote ischemia shown by q
    waves

    What is the diagnosis?


    Acute inferior MI with ST elevation
    in leads II, III, aVF

    What do you see in this


    EKG?
    ST depression II, III, aVF, V3-V6 =
    ischemia

    Lets Practice
    The sample EKGs were obtained from the following text:

    Normal Sinus Rhythm

    Mattu, 2003

    First Degree Heart Block

    PR interval >200ms

    Accelerated Idioventricular

    Ventricular escape rhythm, 40-110 bpm


    Seen in AMI, a marker of reperfusion

    Junctional Rhythm

    Rate 40-60, no p waves, narrow complex QRS

    Hyperkalemia

    Tall, narrow and symmetric T waves

    Wellens Sign

    ST elevation and biphasic T wave in V2 and V3


    Sign of large proximal LAD lesion

    Brugada Syndrome

    RBBB or incomplete RBBB in V1-V3 with convex ST elevation

    Brugada Syndrome

    Autosomal dominant genetic mutation


    of sodium channels
    Causes syncope, v-fib, self terminating
    VT, and sudden cardiac death
    Can be intermittent on EKG
    Most common in middle-aged males
    Can be induced in EP lab
    Need ICD

    Premature Atrial
    Contractions

    Trigeminy pattern

    Atrial Flutter with Variable


    Block

    Sawtooth waves
    Typically at HR of 150

    Torsades de Pointes

    Notice twisting pattern


    Treatment: Magnesium 2 grams IV

    Digitalis

    Dubin, 4th ed. 1989

    Lateral MI

    Reciprocal changes

    Inferolateral MI

    ST elevation II, III, aVF


    ST depression in aVL, V1-V3 are reciprocal changes

    Anterolateral / Inferior
    Ischemia

    LVH, AV junctional rhythm, bradycardia

    Left Bundle Branch Block

    Monophasic R wave in I and V6, QRS > 0.12


    sec
    Loss of R wave in precordial leads
    QRS T wave discordance I, V1, V6

    Right Bundle Branch Block

    V1: RSR prime pattern with inverted T wave


    V6: Wide deep slurred S wave

    First Degree Heart Block, Mobitz Type I (Wenckebach)

    PR progressively lengthens until QRS drops

    Supraventricular
    Tachycardia

    Retrograde P waves

    Narrow complex, regular; retrograde P waves, rate <220

    Right Ventricular Myocardial


    Infarction

    Found in 1/3 of patients with inferior MI


    Increased morbidity and mortality
    ST elevation in V4-V6 of Right-sided EKG

    Ventricular Tachycardia

    Prolonged QT

    QT > 450 ms
    Inferior and anterolateral ischemia

    Second Degree Heart Block, Mobitz Type II

    PR interval fixed, QRS dropped intermittently

    Acute Pulmonary
    Embolism

    SIQIIITIII in 10-15%
    T-wave inversions, especially occurring in
    inferior and anteroseptal simultaneously
    RAD

    Wolff-Parkinson-White
    Syndrome

    Short PR interval <0.12 sec


    Prolonged QRS >0.10 sec
    Delta wave
    Can simulate ventricular hypertrophy, BBB and previous MI

    Hypokalemia

    U waves
    Can also see PVCs, ST depression, small T waves

    Thank You
    Any Questions?

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