This document provides an overview of ECG interpretation. It discusses key elements like rhythm, axis, intervals, complexes and segments. Specific conditions are highlighted like inferior posterior STEMI and RV infarct. The importance of systematic analysis is emphasized. Pattern recognition, trends over serial ECGs and correlating findings with the clinical scenario are important skills. Confirming posterior STEMI with lateral precordial lead placement is advised. Overall it is a comprehensive guide to the fundamentals of ECG interpretation and applications in patient care.
3. The eyes may be the window to the
soul
But the ECG is the window to the heart,
lungs, toxicology, electrolytes, body
temperature and sometimes even the
brain
32. Killer Qs
Pathological Qs
> 40 ms (1 mm) wide
> 2 mm deep
> 25% of depth of QRS complex
Seen in leads V1-3
Q waves 2˚ to MI
May still be thrombolysable
HOCM
42. Original Sgarbossa Criteria
Concordant ST-segment elevation ≥ 1 mm in any lead (5 points)
oncordant ST-segment depression ≥ 1 mm in lead V1 – V3 (3 poin
Discordant ST-segment elevation ≥ 5 mm in any lead (2 points)
48. Repeat
ECGs
Same patient 13 minutes later, pain free:
Biphasic T in V2
T wave inversion aVL
Deep anterior T wave inversion
Wellen’s syndrome (type B)
Don’t put a Wellen’s patient on a treadmill
they tend to drop dead
54. T waves
Lateral and high lateral
T wave inversion
due to ischaemia
T wave inversion due to
subarachnoid haemorrhage
(rare)
Hyperkalaemia
55. QTc
Long QT syndrome (genetic)
Drugs incl amiodarone, digoxin, macrolides,
antipsychotics, tricyclics, SSRIs, loratidine
Hypothermia
HyperCa
HypoK, hypoMag
Myocardial ischaemia
ICH
+ others
> 440ms in men or
> 460ms in women
56. QTc
Long QT syndrome (genetic)
Drugs incl amiodarone, digoxin, macrolides,
antipsychotics, tricyclics, SSRIs, loratidine
Hypothermia
HyperCa
HypoK, hypoMag
Myocardial ischaemia
ICH
+ others
> 440ms in men or
> 460ms in women
Prolonged QT
Prolonged QT
leading to
Torsades de pointes
58. Just to reinforce …
Anterior-septal marked ST depression
(reciprocal ST elevation)
and prominent S R waves
(reciprocal Qs)
=probable posterior STEMI
61. Methodical read
Record your interpretation
Time
Name stamp
Further actions esp
repeat ECGs q10min x 3 for CP
eg Trodat Printy 4910
http://www.selfinkingstamps.co.nz/shop/trodat-4910-26x9mm/
$20 delivered
62. References and images
Most facts checked with and images obtained from
Life in The Fast Lane
http://lifeinthefastlane.com/
Notas del editor
10-20 times a day a ECG will be put under your nose
Nurses and HCAs trained: ECG not complete till it has been read by a doctor.
Use I and aVF or I and II
Ayo: ECG: Sinus tachycardia rate 114.
Axis: -90- 120˚ With p pulmonale probably extreme R axis deviation. COPCXR consistent with pulmonary hypertension. JVP + 3cm, no oedema. ?Shd of had respiratory follow-up.
Use I and aVF or I and II
Ayo: ECG: Sinus tachycardia rate 114.
Axis: -90- 120˚ With p pulmonale probably extreme R axis deviation. COPCXR consistent with pulmonary hypertension. JVP + 3cm, no oedema. ?Shd of had respiratory follow-up.
Incomplete trifascilar block
RBBB, LAD and 1˚HB
Incomplete trifascilar block
RBBB, LAD and 1˚HB
P mitrale eg mitral stenosis
P mitrale eg mitral stenosis
1˚ HB eg rheumatic fever, short PR in Lown-Ganong-Levine syndrome, PR depression (and elevation in aVR) in pericarditis. Mobitz 1 = Wenckeback. TP segment is the baseline.
1˚ HB eg rheumatic fever, short PR in Lown-Ganong-Levine syndrome, PR depression (and elevation in aVR) in pericarditis. Mobitz 1 = Wenckeback. TP segment is the baseline.
LBBB
RBBB
VT
LBBB
RBBB
VT
Na channel blockade / TCA overdose with prominent R wave in aVR
Hyperkalaemia
Na channel blockade / TCA overdose with prominent R wave in aVR
Hyperkalaemia
HyperK
HyperK
Q wave MI ≠ too late for thrombolysis
HOCM
Q wave MI ≠ too late for thrombolysis
HOCM
LBBB
Brugada
LVH
LBBB
Brugada
LVH
RV infarct
Posterior STEMI
RV infarct
Posterior STEMI
Posterior-inferior-lateral MI
Posterior-inferior-lateral MI
Sgarbossa paced
Sgarbossa paced
LMCA occlusion
LMCA occlusion
Clockwise: Chest pain, hyperacute Ts. Read 7 hours later. Wellen’s type A, hyper K, Wellen’s type B
Clockwise: Chest pain, hyperacute Ts. Read 7 hours later. Wellen’s type A, Wellen’s type B
Wellens’
Wellens’
Clock wise RV strain: PE, lateral TWI due to LVH, Lateral TWI due to LBBB
Clock wise RV strain: PE, lateral TWI due to LVH, Lateral TWI due to LBBB