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    ECG at A Glance

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    nurliah armand
    The document provides an overview of electrocardiography (ECG) including: 1) It describes the cardiac action potential and the properties of cardiac cells including automaticity, excitability, conductivity, and contractility. 2) It outlines the cardiac conduction system including the sinoatrial node, atrioventricular node, bundle of His, bundle branches, and Purkinje fibers. 3) It explains the standard and augmented limb leads and precordial leads used in ECG as well as the typical waveforms, measurements, abnormalities, arrhythmias, blocks, and other ECG findings.

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    ECG at A Glance

    Uploaded by

    nurliah armand
    136 views53 pages
    The document provides an overview of electrocardiography (ECG) including: 1) It describes the cardiac action potential and the properties of cardiac cells including automaticity, excitability, conductivity, and contractility. 2) It outlines the cardiac conduction system including the sinoatrial node, atrioventricular node, bundle of His, bundle branches, and Purkinje fibers. 3) It explains the standard and augmented limb leads and precordial leads used in ECG as well as the typical waveforms, measurements, abnormalities, arrhythmias, blocks, and other ECG findings.

    Original Description:

    bahan kul

    Original Title

    ECG at a glance

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    The document provides an overview of electrocardiography (ECG) including: 1) It describes the cardiac action potential and the properties of cardiac cells including automaticity, excitability, conductivity, and contractility. 2) It outlines the cardiac conduction system including the sinoatrial node, atrioventricular node, bundle of His, bundle branches, and Purkinje fibers. 3) It explains the standard and augmented limb leads and precordial leads used in ECG as well as the typical waveforms, measurements, abnormalities, arrhythmias, blocks, and other ECG findings.

    Copyright:

    © All Rights Reserved
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    136 views53 pages

    ECG at A Glance

    Uploaded by

    nurliah armand
    The document provides an overview of electrocardiography (ECG) including: 1) It describes the cardiac action potential and the properties of cardiac cells including automaticity, excitability, conductivity, and contractility. 2) It outlines the cardiac conduction system including the sinoatrial node, atrioventricular node, bundle of His, bundle branches, and Purkinje fibers. 3) It explains the standard and augmented limb leads and precordial leads used in ECG as well as the typical waveforms, measurements, abnormalities, arrhythmias, blocks, and other ECG findings.

    Copyright:

    © All Rights Reserved
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    of 53

    ECG at a glance…

    ACTION POTENTIAL
     Polarization
     Intracellular is more negative than
    extracellular
     Depolarization
     Intracellular becomes more positive
     Influx of Na+
     Repolarization
     Intracellular restores to its resting potential
     Efflux of K+
    ACTION POTENTIAL
    CARDIAC CELLS
    PROPERTIES
     Automaticity
     Excitability

     Conductivity

     Contractility
    CONDUCTION SYSTEM
     Sinoatrial Node (SA Node)
     Rhythmic rate : 60 – 100 bpm
     Internodal Pathway
     Anterior, middle, posterior pathways
     Atrioventricular Node (AV Node)
     Regions : atrionodal (AN), nodal (N),
    nodal-His (NH)
     Delays the impulse
    CONDUCTION SYSTEM
     Bundle of His
     Rate : 40 – 60 bpm
     Bundle Branches
     LBB & RBB
     LBB : anterior, posterior, septal fascicles

     Purkinje Fibers
     Rate : 20 – 40 bpm
    CONDUCTION SYSTEM
    CONDUCTION SYSTEM
    LEADS
     Standard Limb Leads
     Lead I, II, III
     Augmented Limb Leads
     aVL, aVR, aVF
     Precordial Leads
     V1, V2, V3, V4, V5, V6
     V1R, V2R, V3R, V4R, V5R, V6R
    LEADS
    LEADS
    LEADS VIEW OF HEART
    I, aVL Lateral
    II, III, aVF Inferior
    V1, V2 Septal
    V3, V4 Anterior
    V5, V6 Lateral
    ECG WAVEFORMS
    ECG WAVEFORMS
     P wave
     No more than 2.5 mm in
    height
     No more than 0.11 sec in
    duration
     Positive : I,II,aVF,V2-6
     May be positive, negative, or
    biphasic : III,aVL,V1
    ECG WAVEFORMS
     PR interval
     0.12 – 0.20 sec in adult,
    may be shorter in children
    and longer in elders
    ECG WAVEFORMS
     QRS Complex
     0.06 – 0.10 sec
     Q : 1st negative deflection after P
     R : 1st positive deflection after P
     S : negative deflection after R
    ECG WAVEFORMS
     ST Segment
     Isoelectric (flat)
    ECG WAVEFORMS
     T wave
     Limb lead : no more than 5 mm (height)
    Precordial lead : no more than 10 mm (height)
    ECG WAVEFORMS
    RATE MEASUREMENT
     Large Boxes  300/R-R interval
     Small Boxes  1500/R-R interval

     Six-Second Method  count the


    number of complete QRS complexes
    in 6 seconds
    AXIS DEVIATION
    ABNORMAL WAVEFORMS
     P : tall, notched
     PR interval : prolonged, shortened
     Q : pathologic Q (>0.04 sec, 25% of the R
    wave)
     QRS complex : widened (>0.10 sec)
     ST segment : depression (>1 mm), elevation
    (>1 mm in limb leads or >2mm in precordial
    leads)
     T : peaked/tall, inverted, flattened
     QT interval : prolonged, shortened
    ABNORMAL WAVEFORMS
     ST segment : depression (>1 mm),
    elevation (>1 mm in limb leads or
    >2mm in precordial leads)
    ABNORMAL WAVEFORMS
     T wave : peaked/tall, inverted, flattened
    R-WAVE PROGRESSION
    Poor R-wave progression :
     Infarction (anteroseptal)

     LBBB

     LVH

     Severe COPD (emphysema)


    ATRIAL ENLARGEMENT
     Left Atrial Enlargement
    Notched P wave
     Right Atrial Enlargement

    Peaked P Wave
    VENTRICULAR
    HYPERTROPHY
     Left Ventricular Hypertrophy
     S wave in V1/V2 + R wave in V5/V6 ≥ 35 mm (mV)
     R wave in aVL ≥ 12 mm (mV)
     Strain pattern in V5 and V6
     May be accompanied by LAD
    VENTRICULAR
    HYPERTROPHY
     Right Ventricular Hypertrophy
     RAD
     Reversed R-wave progression (taller R waves and smaller S
    waves in V1 & V2; deeper S waves & small R waves in V5 & V6
    MYOCARDIAL INFARCTION
    MYOCARDIAL INFARCTION
    Acute inferior myocardial infarction
    MYOCARDIAL INFARCTION
    Septal wall myocardial infarction
    MYOCARDIAL INFARCTION
    Extensive (whole) anterior myocardial
    infarction
    MYOCARDIAL INFARCTION
    Inferior wall myocardial infarction with a
    possible posterior wall infarction
    MYOCARDIAL
    INFARCTION
    Evolutionary changes in
    anteroseptal myocardial
    infarction

    A. At admission
    B. At 24 hours
    C. At 48 hours
    MYOCARDIAL
    INFARCTION
    Evolutionary changes in
    inferior and right
    ventricular infarction

    A. At admission
    B. At 12 hours
    C. Right chest leads
    CAUSES OF
    DYSRHYTHMIAS
     Enhanced Automaticity
     Reentry
     Escape Beats
     Conduction Disturbances
    SUPRAVENTRICULAR
    ARRHYTHMIAS
     Supraventricular Tachycardia
     Rate : 150-250 bpm
     Rhythm : regular
     P waves : frequently buried in preceding T waves
     PR interval : usually not possible to measure
     QRS : normal
    SUPRAVENTRICULAR
    ARRHYTHMIAS
     Atrial Flutter
     Rate : atrial : 250 – 350 bpm; ventricular : slow/fast
     Rhythm : usually regular
     P waves : “saw teeth appearance”
     PR interval : variable
     QRS : usually normal, may be widened
     Conduction ratio : 2:1, 4:1, 6:1
    SUPRAVENTRICULAR
    ARRHYTHMIAS
     Atrial Fibrillation (AFib)
     Rate : atrial : > 350 bpm; ventricular : slow/fast
     Rhythm : irregular
     P waves : no true P waves; chaotic atrial activity
     PR interval : none
     QRS : normal
    VENTRICULAR
    ARRHYTHMIAS
     Ventricular Tachycardia
     Rate : 100 – 250 bpm
     Rhythm : regular
     P waves : none or not associated with QRS
     PR interval : none
     QRS : wide (>0.10 sec), bizarre appearance
    VENTRICULAR
    ARRHYTHMIAS
     Ventricular Fibrillation
     Rate : indeterminate
     Rhythm : chaotic
     P waves : none
     PR interval : none
     QRS : none
    VENTRICULAR
    ARRHYTHMIAS
     Torsades de Pointes
     Rate : 200 – 250 bpm
     Rhythm : irregular
     P waves : none
     PR interval : none
     QRS : wide (>0.10 sec), bizarre appearance
    EXTRASYSTOLE
     Atrial Extrasystole (AES) / Premature Atrial Contraction
    (PAC)
     Rhythm : irregular due to the premature beat
    Rate : depends on its basic rhythm
    P wave : unusual compare to basic rhythm
    PR interval : normal, maybe shorten
    QRS : normal
    EXTRASYSTOLE
     Ventricular Extrasystole (VES) / Premature Ventricular
    Contraction (PVC)
     Rhythm : irregular due to the premature beat
    Rate : depends on its basic rhythm
    P wave : none
    PR interval : none
    QRS : > 0.12 sec
     Threatening VES :
    ‘R on T’ VES
    VES > 6 times/min
    Bigemini VES
    Multifocal VES
    Consecutive VES
    EXTRASYSTOLE
    BLOCKS
     1st Degree AV Block
     Rate : normal
     Rhythm : regular
     P waves : normal
     PR interval : prolonged (>0.20 sec) but constant
     QRS : usually 0.10 sec or less
    BLOCKS
     2nd Degree AV Block Type I/Mobitz Type I/Wenckebach
     Rate : atrial > ventricular
     Rhythm : atrial regular; ventricular irregular
     P wave : normal
     PR interval : lengthen with each cycle until P wave appears
    without a QRS complex
     QRS : usually 0.10 sec or less
    BLOCKS
     2nd Degree AV Block Type II/Mobitz Type II
     Rate : atrial > ventricular
     Rhythm : atrial regular; ventricular irregular
     P wave : normal
     PR interval : normal or slightly prolonged but constant for the
    conducted beats; there maybe some shortening of the PR
    interval that follows a non-conducted P wave
     QRS : usually 0.10 sec or less
     Conduction ratio 2:1, 3:1, 4:1
    BLOCKS
     3rd Degree AV Block/Complete AV Block/Total Heart Block
     Rate : atrial > ventricular.
     Rhythm : atrial regular; ventricular regular (AV dissociation)
     P wave : normal
     PR interval : none; the atria and ventricles beat independently
     QRS : narrow or wide
    BLOCKS
     Left Bundle Branch Block (LBBB)
    BLOCKS
     Right Bundle Branch Block (RBBB)
    BLOCKS
     Fascicular Block/Hemiblock
     Left Anterior Fascicular Block (LAFB) : LAD
     Left Posterior Fascicular Block (LPFB) : RAD
    PULSELESS ELECTRICAL
    ACTIVITY (PEA)
    Electrical activity is seen in ECG but no
    pulse is detected when palpating the
    artery
    Danke !

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