SlideShare una empresa de Scribd logo
1 de 27
Descargar para leer sin conexión
ECG Rhythm Interpretation


          Module VI

Advanced 12-Lead Interpretation
Course Objectives

• To recognize the normal rhythm of the
  heart - “Normal Sinus Rhythm.”
• To recognize the 13 most common
  heart arrhythmias.
• To recognize an acute myocardial
  infarction on a 12-lead ECG.
Learning Modules

•   ECG Basics
•   How to Analyze a Rhythm
•   Normal Sinus Rhythm
•   Heart Arrhythmias
•   Diagnosing a Myocardial Infarction
•   Advanced 12-Lead Interpretation
The 12-Lead ECG
The 12-Lead ECG contains a wealth of
information. In Module V you learned that
ST segment elevation in two leads is
suggestive of an acute myocardial
infarction. In this module we will cover:
   – ST Elevation and non-ST Elevation MIs
   – Left Ventricular Hypertrophy
   – Bundle Branch Blocks
ST Elevation and
non-ST Elevation MIs
ST Elevation and non-ST Elevation MIs
• When myocardial blood supply is abruptly
  reduced or cut off to a region of the heart, a
  sequence of injurious events occur beginning
  with ischemia (inadequate tissue perfusion),
  followed by necrosis (infarction), and eventual
  fibrosis (scarring) if the blood supply isn't
  restored in an appropriate period of time.

• The ECG changes over time with each of
  these events…
ECG Changes
Ways the ECG can change include:
                       ST elevation &
                          depression




                                   T-waves

                         peaked     flattened   inverted
Appearance
of pathologic
Q-waves
ECG Changes & the Evolving MI

                                     Non-ST Elevation
There are two
distinct patterns
of ECG change
depending if the
infarction is:                           ST Elevation




–ST Elevation (Transmural or Q-wave), or
–Non-ST Elevation (Subendocardial or non-Q-wave)
ST Elevation Infarction
The ECG changes seen with a ST elevation infarction are:

 Before injury Normal ECG

 Ischemia      ST depression, peaked T-waves,
               then T-wave inversion
 Infarction    ST elevation & appearance of
               Q-waves
 Fibrosis      ST segments and T-waves return to
               normal, but Q-waves persist
ST Elevation Infarction
Here’s a diagram depicting an evolving infarction:
A. Normal ECG prior to MI

B. Ischemia from coronary artery occlusion
   results in ST depression (not shown) and
   peaked T-waves

C. Infarction from ongoing ischemia results in
   marked ST elevation

D/E. Ongoing infarction with appearance of
   pathologic Q-waves and T-wave inversion

F. Fibrosis (months later) with persistent Q-
   waves, but normal ST segment and T-
   waves
ST Elevation Infarction
Here’s an ECG of an inferior MI:
Look at the
inferior leads
(II, III, aVF).
Question:
What ECG
changes do
you see?
ST elevation
and Q-waves
Extra credit:
What is the
rhythm? Atrial fibrillation (irregularly irregular with narrow QRS)!
Non-ST Elevation Infarction
Here’s an ECG of an inferior MI later in time:
Now what do
you see in the
inferior leads?
ST elevation,
Q-waves and
T-wave
inversion
Non-ST Elevation Infarction
The ECG changes seen with a non-ST elevation infarction are:

Before injury Normal ECG

Ischemia        ST depression & T-wave inversion

Infarction      ST depression & T-wave inversion

Fibrosis        ST returns to baseline, but T-wave
                inversion persists
Non-ST Elevation Infarction
Here’s an ECG of an evolving non-ST elevation MI:
Note the ST
depression
and T-wave
inversion in
leads V2-V6.

Question:
What area of
the heart is
infarcting?

Anterolateral
Left Ventricular
 Hypertrophy
Left Ventricular Hypertrophy
 Compare these two 12-lead ECGs. What stands
 out as different with the second one?




       Normal            Left Ventricular Hypertrophy

Answer: The QRS complexes are very tall
        (increased voltage)
Left Ventricular Hypertrophy
Why is left ventricular hypertrophy characterized by tall
QRS complexes?
 As the heart muscle wall thickens there is an increase in
 electrical forces moving through the myocardium resulting
 in increased QRS voltage.




  LVH                                     ECHOcardiogram
              Increased QRS voltage
Left Ventricular Hypertrophy
• Criteria exists to diagnose LVH using a 12-lead ECG.
   – For example:
      • The R wave in V5 or V6 plus the S wave in V1 or V2
        exceeds 35 mm.

• However, for now, all
  you need to know is
  that the QRS voltage
  increases with LVH.
Bundle Branch Blocks
Bundle Branch Blocks
Turning our attention to bundle branch blocks…

                            Remember normal
                            impulse conduction is
                              SA node 
                              AV node 
                              Bundle of His 
                              Bundle Branches 
                              Purkinje fibers
Normal Impulse Conduction
Sinoatrial node

    AV node

 Bundle of His

Bundle Branches

 Purkinje fibers
Bundle Branch Blocks
So, depolarization of
the Bundle Branches
and Purkinje fibers are
seen as the QRS
complex on the ECG.

Therefore, a conduction
block of the Bundle
Branches would be              Right
reflected as a change in       BBB
the QRS complex.
Bundle Branch Blocks
With Bundle Branch Blocks you will see two changes
on the ECG.
  1. QRS complex widens (> 0.12 sec).
  2. QRS morphology changes (varies depending on ECG lead,
     and if it is a right vs. left bundle branch block).
Bundle Branch Blocks
Why does the QRS complex widen?

When the conduction
pathway is blocked it
will take longer for
the electrical signal
to pass throughout
the ventricles.
Right Bundle Branch Blocks
What QRS morphology is characteristic?
For RBBB the wide QRS complex assumes a
unique, virtually diagnostic shape in those
leads overlying the right ventricle (V1 and V2).

   V1



     “Rabbit Ears”
Left Bundle Branch Blocks
What QRS morphology is characteristic?
For LBBB the wide QRS complex assumes a
characteristic change in shape in those leads
opposite the left ventricle (right ventricular
leads - V1 and V2).

                                        Broad,
Normal                                  deep S
                                        waves
Summary
This Module introduced you to:
   – ST Elevation and Non-ST Elevation MIs
   – Left Ventricular Hypertrophy
   – Bundle Branch Blocks

Don’t worry too much right now about trying to
remember all the details. You’ll focus more on
advanced ECG interpretation in your clinical
years!

Más contenido relacionado

La actualidad más candente

La actualidad más candente (20)

Ekg module 4b-1
Ekg module 4b-1Ekg module 4b-1
Ekg module 4b-1
 
ECG PART 3
ECG PART 3ECG PART 3
ECG PART 3
 
ECG PART 1
ECG PART 1ECG PART 1
ECG PART 1
 
ECG PART 6
ECG PART 6ECG PART 6
ECG PART 6
 
ECG PART 5
ECG PART 5ECG PART 5
ECG PART 5
 
Ecg
EcgEcg
Ecg
 
Normal ecg interpretation
Normal ecg interpretationNormal ecg interpretation
Normal ecg interpretation
 
ECG PART 2
ECG PART 2ECG PART 2
ECG PART 2
 
Ecg well
Ecg wellEcg well
Ecg well
 
1st part ecg basics indroduction and p waves
1st part ecg basics indroduction and p waves1st part ecg basics indroduction and p waves
1st part ecg basics indroduction and p waves
 
Smackslidecom ecg-ayzixy-5ec31bc4bd35f
Smackslidecom ecg-ayzixy-5ec31bc4bd35fSmackslidecom ecg-ayzixy-5ec31bc4bd35f
Smackslidecom ecg-ayzixy-5ec31bc4bd35f
 
ECG PART 10 final
ECG PART 10 finalECG PART 10 final
ECG PART 10 final
 
Ekg module 2
Ekg module 2Ekg module 2
Ekg module 2
 
Cardiac arrhythmias originating in sinus node modified
Cardiac arrhythmias originating in sinus node modifiedCardiac arrhythmias originating in sinus node modified
Cardiac arrhythmias originating in sinus node modified
 
A Guide TO ECG Interpretation
A Guide TO ECG InterpretationA Guide TO ECG Interpretation
A Guide TO ECG Interpretation
 
Ecg interpretation - Medicalbooksvn.wordpress.com
Ecg interpretation - Medicalbooksvn.wordpress.comEcg interpretation - Medicalbooksvn.wordpress.com
Ecg interpretation - Medicalbooksvn.wordpress.com
 
Mean cardiac axis (cardiac vector)
Mean cardiac axis (cardiac vector)Mean cardiac axis (cardiac vector)
Mean cardiac axis (cardiac vector)
 
Ekg Quiz 1 Arrhythmia Recognition
Ekg Quiz 1 Arrhythmia RecognitionEkg Quiz 1 Arrhythmia Recognition
Ekg Quiz 1 Arrhythmia Recognition
 
Heart block
 Heart block Heart block
Heart block
 
ecg interpretation Module 2
ecg interpretation Module 2ecg interpretation Module 2
ecg interpretation Module 2
 

Similar a Ekg module 6

Similar a Ekg module 6 (20)

ECG
ECGECG
ECG
 
Advanced 12 Lead
Advanced 12 LeadAdvanced 12 Lead
Advanced 12 Lead
 
Module 6
Module 6Module 6
Module 6
 
ecginacs-140307071705-phpapp01.pdf
ecginacs-140307071705-phpapp01.pdfecginacs-140307071705-phpapp01.pdf
ecginacs-140307071705-phpapp01.pdf
 
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
 
Basic of ECG by Harison
Basic of ECG by HarisonBasic of ECG by Harison
Basic of ECG by Harison
 
Ecg in acs
Ecg in acsEcg in acs
Ecg in acs
 
Beginners Guide for ECG Interpretation
Beginners Guide for ECG InterpretationBeginners Guide for ECG Interpretation
Beginners Guide for ECG Interpretation
 
ECG BY Dr.MOHAMED RAMADAN
ECG BY Dr.MOHAMED RAMADANECG BY Dr.MOHAMED RAMADAN
ECG BY Dr.MOHAMED RAMADAN
 
E C G M O H A M E D R A M A D A N
E C G  M O H A M E D  R A M A D A NE C G  M O H A M E D  R A M A D A N
E C G M O H A M E D R A M A D A N
 
Ecg fundamentals
Ecg fundamentalsEcg fundamentals
Ecg fundamentals
 
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
 
Ecg
EcgEcg
Ecg
 
ECG Changes in Myocardial ischemia, myocardial infarction.pptx
ECG Changes in Myocardial ischemia, myocardial infarction.pptxECG Changes in Myocardial ischemia, myocardial infarction.pptx
ECG Changes in Myocardial ischemia, myocardial infarction.pptx
 
base-110816084037-phpapp02.pdf
base-110816084037-phpapp02.pdfbase-110816084037-phpapp02.pdf
base-110816084037-phpapp02.pdf
 
Myocardial infarction (MI) ecg localisation
Myocardial infarction (MI) ecg localisationMyocardial infarction (MI) ecg localisation
Myocardial infarction (MI) ecg localisation
 
Baral ecg ppt-ecg
Baral ecg  ppt-ecgBaral ecg  ppt-ecg
Baral ecg ppt-ecg
 
Ecg 2019 b
Ecg 2019 bEcg 2019 b
Ecg 2019 b
 
acute coronary syndrome (infarction and ischemia)
acute coronary syndrome (infarction and ischemia)acute coronary syndrome (infarction and ischemia)
acute coronary syndrome (infarction and ischemia)
 
ECG Basics
ECG BasicsECG Basics
ECG Basics
 

Más de University of Miami

Blackboard Learn Course Customization: Teaching Styles and Properties
Blackboard Learn Course Customization: Teaching Styles and PropertiesBlackboard Learn Course Customization: Teaching Styles and Properties
Blackboard Learn Course Customization: Teaching Styles and PropertiesUniversity of Miami
 
Making sign up lists using self-enroll groups
Making sign up lists using self-enroll groupsMaking sign up lists using self-enroll groups
Making sign up lists using self-enroll groupsUniversity of Miami
 
Flipping the Classroom: Flipping a Lesson Using Bloom's Taxonomy
Flipping the Classroom: Flipping a Lesson Using Bloom's Taxonomy Flipping the Classroom: Flipping a Lesson Using Bloom's Taxonomy
Flipping the Classroom: Flipping a Lesson Using Bloom's Taxonomy University of Miami
 

Más de University of Miami (20)

Course merges and augments
Course merges and augmentsCourse merges and augments
Course merges and augments
 
Using a blackboard wiki
Using a blackboard wikiUsing a blackboard wiki
Using a blackboard wiki
 
Blackboard Learn Course Customization: Teaching Styles and Properties
Blackboard Learn Course Customization: Teaching Styles and PropertiesBlackboard Learn Course Customization: Teaching Styles and Properties
Blackboard Learn Course Customization: Teaching Styles and Properties
 
The Blackboard Learn Calendar
The Blackboard Learn CalendarThe Blackboard Learn Calendar
The Blackboard Learn Calendar
 
Yammer Introduction
Yammer IntroductionYammer Introduction
Yammer Introduction
 
Blackboard Mobile Learn
Blackboard Mobile LearnBlackboard Mobile Learn
Blackboard Mobile Learn
 
Making sign up lists using self-enroll groups
Making sign up lists using self-enroll groupsMaking sign up lists using self-enroll groups
Making sign up lists using self-enroll groups
 
SafeAssign in Blackboard Learn
SafeAssign in Blackboard LearnSafeAssign in Blackboard Learn
SafeAssign in Blackboard Learn
 
Flipping the Classroom: Flipping a Lesson Using Bloom's Taxonomy
Flipping the Classroom: Flipping a Lesson Using Bloom's Taxonomy Flipping the Classroom: Flipping a Lesson Using Bloom's Taxonomy
Flipping the Classroom: Flipping a Lesson Using Bloom's Taxonomy
 
Lavadodemanoshgm pt
Lavadodemanoshgm ptLavadodemanoshgm pt
Lavadodemanoshgm pt
 
Presentacinlibroseguridad pt
Presentacinlibroseguridad ptPresentacinlibroseguridad pt
Presentacinlibroseguridad pt
 
Cursodeseguridadpowerpoint pt
Cursodeseguridadpowerpoint ptCursodeseguridadpowerpoint pt
Cursodeseguridadpowerpoint pt
 
Dv training unit 2 2013 spa
Dv training unit 2 2013 spaDv training unit 2 2013 spa
Dv training unit 2 2013 spa
 
Dv training unit 1 2013 spa
Dv training unit 1 2013 spaDv training unit 1 2013 spa
Dv training unit 1 2013 spa
 
Dv training unit 4 2013 spa
Dv training unit 4 2013 spaDv training unit 4 2013 spa
Dv training unit 4 2013 spa
 
Dv training unit 3 2013 spa
Dv training unit 3 2013 spaDv training unit 3 2013 spa
Dv training unit 3 2013 spa
 
Cursovirtualenfermagem pt
Cursovirtualenfermagem ptCursovirtualenfermagem pt
Cursovirtualenfermagem pt
 
Curso de VIHSIDA - 4
Curso de VIHSIDA - 4Curso de VIHSIDA - 4
Curso de VIHSIDA - 4
 
Curso de VIHSIDA -3
Curso de VIHSIDA -3Curso de VIHSIDA -3
Curso de VIHSIDA -3
 
Curso de VIHSIDA - 2
Curso de VIHSIDA - 2Curso de VIHSIDA - 2
Curso de VIHSIDA - 2
 

Último

DNA nucleotides Blast in NCBI and Phylogeny using MEGA Xi.pptx
DNA nucleotides Blast in NCBI and Phylogeny using MEGA Xi.pptxDNA nucleotides Blast in NCBI and Phylogeny using MEGA Xi.pptx
DNA nucleotides Blast in NCBI and Phylogeny using MEGA Xi.pptxMAsifAhmad
 
AORTIC DISSECTION and management of aortic dissection
AORTIC DISSECTION and management of aortic dissectionAORTIC DISSECTION and management of aortic dissection
AORTIC DISSECTION and management of aortic dissectiondrhanifmohdali
 
How to cure cirrhosis and chronic hepatitis naturally
How to cure cirrhosis and chronic hepatitis naturallyHow to cure cirrhosis and chronic hepatitis naturally
How to cure cirrhosis and chronic hepatitis naturallyZurück zum Ursprung
 
High-Performance Thin-Layer Chromatography (HPTLC)
High-Performance Thin-Layer Chromatography (HPTLC)High-Performance Thin-Layer Chromatography (HPTLC)
High-Performance Thin-Layer Chromatography (HPTLC)kishan singh tomar
 
CPR.nursingoutlook.pdf , Bsc nursing student
CPR.nursingoutlook.pdf , Bsc nursing studentCPR.nursingoutlook.pdf , Bsc nursing student
CPR.nursingoutlook.pdf , Bsc nursing studentsaileshpanda05
 
Pharmacokinetic Models by Dr. Ram D. Bawankar.ppt
Pharmacokinetic Models by Dr. Ram D.  Bawankar.pptPharmacokinetic Models by Dr. Ram D.  Bawankar.ppt
Pharmacokinetic Models by Dr. Ram D. Bawankar.pptRamDBawankar1
 
Red Blood Cells_anemia & polycythemia.pdf
Red Blood Cells_anemia & polycythemia.pdfRed Blood Cells_anemia & polycythemia.pdf
Red Blood Cells_anemia & polycythemia.pdfMedicoseAcademics
 
Trustworthiness of AI based predictions Aachen 2024
Trustworthiness of AI based predictions Aachen 2024Trustworthiness of AI based predictions Aachen 2024
Trustworthiness of AI based predictions Aachen 2024EwoutSteyerberg1
 
blood bank management system project report
blood bank management system project reportblood bank management system project report
blood bank management system project reportNARMADAPETROLEUMGAS
 
AUTONOMIC NERVOUS SYSTEM organization and functions
AUTONOMIC NERVOUS SYSTEM organization and functionsAUTONOMIC NERVOUS SYSTEM organization and functions
AUTONOMIC NERVOUS SYSTEM organization and functionsMedicoseAcademics
 
SGK RỐI LOẠN TOAN KIỀM ĐHYHN RẤT HAY VÀ ĐẶC SẮC.pdf
SGK RỐI LOẠN TOAN KIỀM ĐHYHN RẤT HAY VÀ ĐẶC SẮC.pdfSGK RỐI LOẠN TOAN KIỀM ĐHYHN RẤT HAY VÀ ĐẶC SẮC.pdf
SGK RỐI LOẠN TOAN KIỀM ĐHYHN RẤT HAY VÀ ĐẶC SẮC.pdfHongBiThi1
 
Adenomyosis or Fibroid- making right diagnosis
Adenomyosis or Fibroid- making right diagnosisAdenomyosis or Fibroid- making right diagnosis
Adenomyosis or Fibroid- making right diagnosisSujoy Dasgupta
 
SGK RỐI LOẠN KALI MÁU CỰC KỲ QUAN TRỌNG.pdf
SGK RỐI LOẠN KALI MÁU CỰC KỲ QUAN TRỌNG.pdfSGK RỐI LOẠN KALI MÁU CỰC KỲ QUAN TRỌNG.pdf
SGK RỐI LOẠN KALI MÁU CỰC KỲ QUAN TRỌNG.pdfHongBiThi1
 
Unit I herbs as raw materials, biodynamic agriculture.ppt
Unit I herbs as raw materials, biodynamic agriculture.pptUnit I herbs as raw materials, biodynamic agriculture.ppt
Unit I herbs as raw materials, biodynamic agriculture.pptPradnya Wadekar
 
ANATOMICAL FAETURES OF BONES FOR NURSING STUDENTS .pptx
ANATOMICAL FAETURES OF BONES  FOR NURSING STUDENTS .pptxANATOMICAL FAETURES OF BONES  FOR NURSING STUDENTS .pptx
ANATOMICAL FAETURES OF BONES FOR NURSING STUDENTS .pptxWINCY THIRUMURUGAN
 
MedMatch: Your Health, Our Mission. Pitch deck.
MedMatch: Your Health, Our Mission. Pitch deck.MedMatch: Your Health, Our Mission. Pitch deck.
MedMatch: Your Health, Our Mission. Pitch deck.whalesdesign
 
power point presentation of Clinical evaluation of strabismus
power point presentation of Clinical evaluation  of strabismuspower point presentation of Clinical evaluation  of strabismus
power point presentation of Clinical evaluation of strabismusChandrasekar Reddy
 
SGK LEUKEMIA KINH DÒNG BẠCH CÂU HẠT HAY.pdf
SGK LEUKEMIA KINH DÒNG BẠCH CÂU HẠT HAY.pdfSGK LEUKEMIA KINH DÒNG BẠCH CÂU HẠT HAY.pdf
SGK LEUKEMIA KINH DÒNG BẠCH CÂU HẠT HAY.pdfHongBiThi1
 
SGK ĐIỆN GIẬT ĐHYHN RẤT LÀ HAY TUYỆT VỜI.pdf
SGK ĐIỆN GIẬT ĐHYHN        RẤT LÀ HAY TUYỆT VỜI.pdfSGK ĐIỆN GIẬT ĐHYHN        RẤT LÀ HAY TUYỆT VỜI.pdf
SGK ĐIỆN GIẬT ĐHYHN RẤT LÀ HAY TUYỆT VỜI.pdfHongBiThi1
 

Último (20)

DNA nucleotides Blast in NCBI and Phylogeny using MEGA Xi.pptx
DNA nucleotides Blast in NCBI and Phylogeny using MEGA Xi.pptxDNA nucleotides Blast in NCBI and Phylogeny using MEGA Xi.pptx
DNA nucleotides Blast in NCBI and Phylogeny using MEGA Xi.pptx
 
AORTIC DISSECTION and management of aortic dissection
AORTIC DISSECTION and management of aortic dissectionAORTIC DISSECTION and management of aortic dissection
AORTIC DISSECTION and management of aortic dissection
 
How to cure cirrhosis and chronic hepatitis naturally
How to cure cirrhosis and chronic hepatitis naturallyHow to cure cirrhosis and chronic hepatitis naturally
How to cure cirrhosis and chronic hepatitis naturally
 
High-Performance Thin-Layer Chromatography (HPTLC)
High-Performance Thin-Layer Chromatography (HPTLC)High-Performance Thin-Layer Chromatography (HPTLC)
High-Performance Thin-Layer Chromatography (HPTLC)
 
CPR.nursingoutlook.pdf , Bsc nursing student
CPR.nursingoutlook.pdf , Bsc nursing studentCPR.nursingoutlook.pdf , Bsc nursing student
CPR.nursingoutlook.pdf , Bsc nursing student
 
Pharmacokinetic Models by Dr. Ram D. Bawankar.ppt
Pharmacokinetic Models by Dr. Ram D.  Bawankar.pptPharmacokinetic Models by Dr. Ram D.  Bawankar.ppt
Pharmacokinetic Models by Dr. Ram D. Bawankar.ppt
 
Red Blood Cells_anemia & polycythemia.pdf
Red Blood Cells_anemia & polycythemia.pdfRed Blood Cells_anemia & polycythemia.pdf
Red Blood Cells_anemia & polycythemia.pdf
 
Trustworthiness of AI based predictions Aachen 2024
Trustworthiness of AI based predictions Aachen 2024Trustworthiness of AI based predictions Aachen 2024
Trustworthiness of AI based predictions Aachen 2024
 
blood bank management system project report
blood bank management system project reportblood bank management system project report
blood bank management system project report
 
Immune labs basics part 1 acute phase reactants ESR, CRP Ahmed Yehia Ismaeel,...
Immune labs basics part 1 acute phase reactants ESR, CRP Ahmed Yehia Ismaeel,...Immune labs basics part 1 acute phase reactants ESR, CRP Ahmed Yehia Ismaeel,...
Immune labs basics part 1 acute phase reactants ESR, CRP Ahmed Yehia Ismaeel,...
 
AUTONOMIC NERVOUS SYSTEM organization and functions
AUTONOMIC NERVOUS SYSTEM organization and functionsAUTONOMIC NERVOUS SYSTEM organization and functions
AUTONOMIC NERVOUS SYSTEM organization and functions
 
SGK RỐI LOẠN TOAN KIỀM ĐHYHN RẤT HAY VÀ ĐẶC SẮC.pdf
SGK RỐI LOẠN TOAN KIỀM ĐHYHN RẤT HAY VÀ ĐẶC SẮC.pdfSGK RỐI LOẠN TOAN KIỀM ĐHYHN RẤT HAY VÀ ĐẶC SẮC.pdf
SGK RỐI LOẠN TOAN KIỀM ĐHYHN RẤT HAY VÀ ĐẶC SẮC.pdf
 
Adenomyosis or Fibroid- making right diagnosis
Adenomyosis or Fibroid- making right diagnosisAdenomyosis or Fibroid- making right diagnosis
Adenomyosis or Fibroid- making right diagnosis
 
SGK RỐI LOẠN KALI MÁU CỰC KỲ QUAN TRỌNG.pdf
SGK RỐI LOẠN KALI MÁU CỰC KỲ QUAN TRỌNG.pdfSGK RỐI LOẠN KALI MÁU CỰC KỲ QUAN TRỌNG.pdf
SGK RỐI LOẠN KALI MÁU CỰC KỲ QUAN TRỌNG.pdf
 
Unit I herbs as raw materials, biodynamic agriculture.ppt
Unit I herbs as raw materials, biodynamic agriculture.pptUnit I herbs as raw materials, biodynamic agriculture.ppt
Unit I herbs as raw materials, biodynamic agriculture.ppt
 
ANATOMICAL FAETURES OF BONES FOR NURSING STUDENTS .pptx
ANATOMICAL FAETURES OF BONES  FOR NURSING STUDENTS .pptxANATOMICAL FAETURES OF BONES  FOR NURSING STUDENTS .pptx
ANATOMICAL FAETURES OF BONES FOR NURSING STUDENTS .pptx
 
MedMatch: Your Health, Our Mission. Pitch deck.
MedMatch: Your Health, Our Mission. Pitch deck.MedMatch: Your Health, Our Mission. Pitch deck.
MedMatch: Your Health, Our Mission. Pitch deck.
 
power point presentation of Clinical evaluation of strabismus
power point presentation of Clinical evaluation  of strabismuspower point presentation of Clinical evaluation  of strabismus
power point presentation of Clinical evaluation of strabismus
 
SGK LEUKEMIA KINH DÒNG BẠCH CÂU HẠT HAY.pdf
SGK LEUKEMIA KINH DÒNG BẠCH CÂU HẠT HAY.pdfSGK LEUKEMIA KINH DÒNG BẠCH CÂU HẠT HAY.pdf
SGK LEUKEMIA KINH DÒNG BẠCH CÂU HẠT HAY.pdf
 
SGK ĐIỆN GIẬT ĐHYHN RẤT LÀ HAY TUYỆT VỜI.pdf
SGK ĐIỆN GIẬT ĐHYHN        RẤT LÀ HAY TUYỆT VỜI.pdfSGK ĐIỆN GIẬT ĐHYHN        RẤT LÀ HAY TUYỆT VỜI.pdf
SGK ĐIỆN GIẬT ĐHYHN RẤT LÀ HAY TUYỆT VỜI.pdf
 

Ekg module 6

  • 1. ECG Rhythm Interpretation Module VI Advanced 12-Lead Interpretation
  • 2. Course Objectives • To recognize the normal rhythm of the heart - “Normal Sinus Rhythm.” • To recognize the 13 most common heart arrhythmias. • To recognize an acute myocardial infarction on a 12-lead ECG.
  • 3. Learning Modules • ECG Basics • How to Analyze a Rhythm • Normal Sinus Rhythm • Heart Arrhythmias • Diagnosing a Myocardial Infarction • Advanced 12-Lead Interpretation
  • 4. The 12-Lead ECG The 12-Lead ECG contains a wealth of information. In Module V you learned that ST segment elevation in two leads is suggestive of an acute myocardial infarction. In this module we will cover: – ST Elevation and non-ST Elevation MIs – Left Ventricular Hypertrophy – Bundle Branch Blocks
  • 5. ST Elevation and non-ST Elevation MIs
  • 6. ST Elevation and non-ST Elevation MIs • When myocardial blood supply is abruptly reduced or cut off to a region of the heart, a sequence of injurious events occur beginning with ischemia (inadequate tissue perfusion), followed by necrosis (infarction), and eventual fibrosis (scarring) if the blood supply isn't restored in an appropriate period of time. • The ECG changes over time with each of these events…
  • 7. ECG Changes Ways the ECG can change include: ST elevation & depression T-waves peaked flattened inverted Appearance of pathologic Q-waves
  • 8. ECG Changes & the Evolving MI Non-ST Elevation There are two distinct patterns of ECG change depending if the infarction is: ST Elevation –ST Elevation (Transmural or Q-wave), or –Non-ST Elevation (Subendocardial or non-Q-wave)
  • 9. ST Elevation Infarction The ECG changes seen with a ST elevation infarction are: Before injury Normal ECG Ischemia ST depression, peaked T-waves, then T-wave inversion Infarction ST elevation & appearance of Q-waves Fibrosis ST segments and T-waves return to normal, but Q-waves persist
  • 10. ST Elevation Infarction Here’s a diagram depicting an evolving infarction: A. Normal ECG prior to MI B. Ischemia from coronary artery occlusion results in ST depression (not shown) and peaked T-waves C. Infarction from ongoing ischemia results in marked ST elevation D/E. Ongoing infarction with appearance of pathologic Q-waves and T-wave inversion F. Fibrosis (months later) with persistent Q- waves, but normal ST segment and T- waves
  • 11. ST Elevation Infarction Here’s an ECG of an inferior MI: Look at the inferior leads (II, III, aVF). Question: What ECG changes do you see? ST elevation and Q-waves Extra credit: What is the rhythm? Atrial fibrillation (irregularly irregular with narrow QRS)!
  • 12. Non-ST Elevation Infarction Here’s an ECG of an inferior MI later in time: Now what do you see in the inferior leads? ST elevation, Q-waves and T-wave inversion
  • 13. Non-ST Elevation Infarction The ECG changes seen with a non-ST elevation infarction are: Before injury Normal ECG Ischemia ST depression & T-wave inversion Infarction ST depression & T-wave inversion Fibrosis ST returns to baseline, but T-wave inversion persists
  • 14. Non-ST Elevation Infarction Here’s an ECG of an evolving non-ST elevation MI: Note the ST depression and T-wave inversion in leads V2-V6. Question: What area of the heart is infarcting? Anterolateral
  • 16. Left Ventricular Hypertrophy Compare these two 12-lead ECGs. What stands out as different with the second one? Normal Left Ventricular Hypertrophy Answer: The QRS complexes are very tall (increased voltage)
  • 17. Left Ventricular Hypertrophy Why is left ventricular hypertrophy characterized by tall QRS complexes? As the heart muscle wall thickens there is an increase in electrical forces moving through the myocardium resulting in increased QRS voltage. LVH ECHOcardiogram Increased QRS voltage
  • 18. Left Ventricular Hypertrophy • Criteria exists to diagnose LVH using a 12-lead ECG. – For example: • The R wave in V5 or V6 plus the S wave in V1 or V2 exceeds 35 mm. • However, for now, all you need to know is that the QRS voltage increases with LVH.
  • 20. Bundle Branch Blocks Turning our attention to bundle branch blocks… Remember normal impulse conduction is SA node  AV node  Bundle of His  Bundle Branches  Purkinje fibers
  • 21. Normal Impulse Conduction Sinoatrial node AV node Bundle of His Bundle Branches Purkinje fibers
  • 22. Bundle Branch Blocks So, depolarization of the Bundle Branches and Purkinje fibers are seen as the QRS complex on the ECG. Therefore, a conduction block of the Bundle Branches would be Right reflected as a change in BBB the QRS complex.
  • 23. Bundle Branch Blocks With Bundle Branch Blocks you will see two changes on the ECG. 1. QRS complex widens (> 0.12 sec). 2. QRS morphology changes (varies depending on ECG lead, and if it is a right vs. left bundle branch block).
  • 24. Bundle Branch Blocks Why does the QRS complex widen? When the conduction pathway is blocked it will take longer for the electrical signal to pass throughout the ventricles.
  • 25. Right Bundle Branch Blocks What QRS morphology is characteristic? For RBBB the wide QRS complex assumes a unique, virtually diagnostic shape in those leads overlying the right ventricle (V1 and V2). V1 “Rabbit Ears”
  • 26. Left Bundle Branch Blocks What QRS morphology is characteristic? For LBBB the wide QRS complex assumes a characteristic change in shape in those leads opposite the left ventricle (right ventricular leads - V1 and V2). Broad, Normal deep S waves
  • 27. Summary This Module introduced you to: – ST Elevation and Non-ST Elevation MIs – Left Ventricular Hypertrophy – Bundle Branch Blocks Don’t worry too much right now about trying to remember all the details. You’ll focus more on advanced ECG interpretation in your clinical years!