advanced ecg interpretation - boston college...rsr’ complexes with a taller “left rabbit ear”....
TRANSCRIPT
![Page 1: Advanced ECG Interpretation - Boston College...RSR’ complexes with a taller “left rabbit ear”. Positive or negative concordance in precordial leads with no RS seen Brugada’s](https://reader035.vdocuments.site/reader035/viewer/2022071411/6106d3a8ebe73846d470bf7e/html5/thumbnails/1.jpg)
Advanced ECG Interpretation
Rebecca Sevigny BSN, RN, CCRN
![Page 2: Advanced ECG Interpretation - Boston College...RSR’ complexes with a taller “left rabbit ear”. Positive or negative concordance in precordial leads with no RS seen Brugada’s](https://reader035.vdocuments.site/reader035/viewer/2022071411/6106d3a8ebe73846d470bf7e/html5/thumbnails/2.jpg)
DISCLOSURES
None of the planners or presenters of this session have disclosed any conflict or
commercial interest
![Page 3: Advanced ECG Interpretation - Boston College...RSR’ complexes with a taller “left rabbit ear”. Positive or negative concordance in precordial leads with no RS seen Brugada’s](https://reader035.vdocuments.site/reader035/viewer/2022071411/6106d3a8ebe73846d470bf7e/html5/thumbnails/3.jpg)
Objectives • Identify ECG changes related to hypertrophy, bundle branch
blocks, and MI’s
• Review approach to interpretation of wide complex tachycardia
• Describe other miscellaneous causes of ECG abnormalities: pericarditis, electrolyte abnormality, medication effects, and hypothermia
• Practice using a systematic approach to interpreting 12 lead ECGs
![Page 4: Advanced ECG Interpretation - Boston College...RSR’ complexes with a taller “left rabbit ear”. Positive or negative concordance in precordial leads with no RS seen Brugada’s](https://reader035.vdocuments.site/reader035/viewer/2022071411/6106d3a8ebe73846d470bf7e/html5/thumbnails/4.jpg)
• Positive in leads I, II, V4 & V6
• Negative in aVR • Morphology changes depending on
pacemaker • .08-0.11
P Waves
![Page 5: Advanced ECG Interpretation - Boston College...RSR’ complexes with a taller “left rabbit ear”. Positive or negative concordance in precordial leads with no RS seen Brugada’s](https://reader035.vdocuments.site/reader035/viewer/2022071411/6106d3a8ebe73846d470bf7e/html5/thumbnails/5.jpg)
Atrial Enlargement
![Page 6: Advanced ECG Interpretation - Boston College...RSR’ complexes with a taller “left rabbit ear”. Positive or negative concordance in precordial leads with no RS seen Brugada’s](https://reader035.vdocuments.site/reader035/viewer/2022071411/6106d3a8ebe73846d470bf7e/html5/thumbnails/6.jpg)
![Page 7: Advanced ECG Interpretation - Boston College...RSR’ complexes with a taller “left rabbit ear”. Positive or negative concordance in precordial leads with no RS seen Brugada’s](https://reader035.vdocuments.site/reader035/viewer/2022071411/6106d3a8ebe73846d470bf7e/html5/thumbnails/7.jpg)
![Page 8: Advanced ECG Interpretation - Boston College...RSR’ complexes with a taller “left rabbit ear”. Positive or negative concordance in precordial leads with no RS seen Brugada’s](https://reader035.vdocuments.site/reader035/viewer/2022071411/6106d3a8ebe73846d470bf7e/html5/thumbnails/8.jpg)
PR Interval
![Page 9: Advanced ECG Interpretation - Boston College...RSR’ complexes with a taller “left rabbit ear”. Positive or negative concordance in precordial leads with no RS seen Brugada’s](https://reader035.vdocuments.site/reader035/viewer/2022071411/6106d3a8ebe73846d470bf7e/html5/thumbnails/9.jpg)
![Page 10: Advanced ECG Interpretation - Boston College...RSR’ complexes with a taller “left rabbit ear”. Positive or negative concordance in precordial leads with no RS seen Brugada’s](https://reader035.vdocuments.site/reader035/viewer/2022071411/6106d3a8ebe73846d470bf7e/html5/thumbnails/10.jpg)
![Page 11: Advanced ECG Interpretation - Boston College...RSR’ complexes with a taller “left rabbit ear”. Positive or negative concordance in precordial leads with no RS seen Brugada’s](https://reader035.vdocuments.site/reader035/viewer/2022071411/6106d3a8ebe73846d470bf7e/html5/thumbnails/11.jpg)
PR Interval
![Page 12: Advanced ECG Interpretation - Boston College...RSR’ complexes with a taller “left rabbit ear”. Positive or negative concordance in precordial leads with no RS seen Brugada’s](https://reader035.vdocuments.site/reader035/viewer/2022071411/6106d3a8ebe73846d470bf7e/html5/thumbnails/12.jpg)
![Page 13: Advanced ECG Interpretation - Boston College...RSR’ complexes with a taller “left rabbit ear”. Positive or negative concordance in precordial leads with no RS seen Brugada’s](https://reader035.vdocuments.site/reader035/viewer/2022071411/6106d3a8ebe73846d470bf7e/html5/thumbnails/13.jpg)
![Page 14: Advanced ECG Interpretation - Boston College...RSR’ complexes with a taller “left rabbit ear”. Positive or negative concordance in precordial leads with no RS seen Brugada’s](https://reader035.vdocuments.site/reader035/viewer/2022071411/6106d3a8ebe73846d470bf7e/html5/thumbnails/14.jpg)
Ventricular Hypertrophy
![Page 15: Advanced ECG Interpretation - Boston College...RSR’ complexes with a taller “left rabbit ear”. Positive or negative concordance in precordial leads with no RS seen Brugada’s](https://reader035.vdocuments.site/reader035/viewer/2022071411/6106d3a8ebe73846d470bf7e/html5/thumbnails/15.jpg)
![Page 16: Advanced ECG Interpretation - Boston College...RSR’ complexes with a taller “left rabbit ear”. Positive or negative concordance in precordial leads with no RS seen Brugada’s](https://reader035.vdocuments.site/reader035/viewer/2022071411/6106d3a8ebe73846d470bf7e/html5/thumbnails/16.jpg)
Ventricular Hypertrophy
![Page 17: Advanced ECG Interpretation - Boston College...RSR’ complexes with a taller “left rabbit ear”. Positive or negative concordance in precordial leads with no RS seen Brugada’s](https://reader035.vdocuments.site/reader035/viewer/2022071411/6106d3a8ebe73846d470bf7e/html5/thumbnails/17.jpg)
![Page 18: Advanced ECG Interpretation - Boston College...RSR’ complexes with a taller “left rabbit ear”. Positive or negative concordance in precordial leads with no RS seen Brugada’s](https://reader035.vdocuments.site/reader035/viewer/2022071411/6106d3a8ebe73846d470bf7e/html5/thumbnails/18.jpg)
Less than 5 mm in all limb leads Less than 10 mm high in all precordials
Obesity, pleural effusion, pericardial effusion
Low Voltage
![Page 19: Advanced ECG Interpretation - Boston College...RSR’ complexes with a taller “left rabbit ear”. Positive or negative concordance in precordial leads with no RS seen Brugada’s](https://reader035.vdocuments.site/reader035/viewer/2022071411/6106d3a8ebe73846d470bf7e/html5/thumbnails/19.jpg)
Q Waves
• Pathologic Q wave= Dead Myocardium
•Septal Q waves in Lead I and aVL
•QS in V1
• Less than 0.04 and less than 1/3 the height of the R wave
![Page 20: Advanced ECG Interpretation - Boston College...RSR’ complexes with a taller “left rabbit ear”. Positive or negative concordance in precordial leads with no RS seen Brugada’s](https://reader035.vdocuments.site/reader035/viewer/2022071411/6106d3a8ebe73846d470bf7e/html5/thumbnails/20.jpg)
![Page 21: Advanced ECG Interpretation - Boston College...RSR’ complexes with a taller “left rabbit ear”. Positive or negative concordance in precordial leads with no RS seen Brugada’s](https://reader035.vdocuments.site/reader035/viewer/2022071411/6106d3a8ebe73846d470bf7e/html5/thumbnails/21.jpg)
![Page 22: Advanced ECG Interpretation - Boston College...RSR’ complexes with a taller “left rabbit ear”. Positive or negative concordance in precordial leads with no RS seen Brugada’s](https://reader035.vdocuments.site/reader035/viewer/2022071411/6106d3a8ebe73846d470bf7e/html5/thumbnails/22.jpg)
• Isolate the smallest and most isoelectric limb lead
• Identify the lead perpendicular to this lead
• Is the QRS positive or negative in this lead?
• Is the isoelectric lead more positive or negative?
QRS AXIS
![Page 23: Advanced ECG Interpretation - Boston College...RSR’ complexes with a taller “left rabbit ear”. Positive or negative concordance in precordial leads with no RS seen Brugada’s](https://reader035.vdocuments.site/reader035/viewer/2022071411/6106d3a8ebe73846d470bf7e/html5/thumbnails/23.jpg)
Right Bundle Branch Block
• QRS > 0.12
•Slurred S wave in leads I and V6
•RSR’ pattern in V1 or V2
QRS Morphology
![Page 24: Advanced ECG Interpretation - Boston College...RSR’ complexes with a taller “left rabbit ear”. Positive or negative concordance in precordial leads with no RS seen Brugada’s](https://reader035.vdocuments.site/reader035/viewer/2022071411/6106d3a8ebe73846d470bf7e/html5/thumbnails/24.jpg)
![Page 25: Advanced ECG Interpretation - Boston College...RSR’ complexes with a taller “left rabbit ear”. Positive or negative concordance in precordial leads with no RS seen Brugada’s](https://reader035.vdocuments.site/reader035/viewer/2022071411/6106d3a8ebe73846d470bf7e/html5/thumbnails/25.jpg)
Left Bundle Branch Block
• QRS > 0.12
•Broad, monomorphic R waves in I and V6
•Broad monomorphic S waves in V1
QRS Morphology
![Page 26: Advanced ECG Interpretation - Boston College...RSR’ complexes with a taller “left rabbit ear”. Positive or negative concordance in precordial leads with no RS seen Brugada’s](https://reader035.vdocuments.site/reader035/viewer/2022071411/6106d3a8ebe73846d470bf7e/html5/thumbnails/26.jpg)
![Page 27: Advanced ECG Interpretation - Boston College...RSR’ complexes with a taller “left rabbit ear”. Positive or negative concordance in precordial leads with no RS seen Brugada’s](https://reader035.vdocuments.site/reader035/viewer/2022071411/6106d3a8ebe73846d470bf7e/html5/thumbnails/27.jpg)
Concordant ST elevation > 1mm in leads with a positive QRS complex
(score 5)
Concordant ST depression > 1 mm in V1-V3 (score 3)
Excessively discordant ST elevation > 5 mm in leads with a negative QRS complex (score 2).
A total score of ≥ 3 is reported to have a specificity
of 90% for diagnosing myocardial infarction.
Sgarbossa’s Criteria
Sgarbosa’s Criteria
![Page 28: Advanced ECG Interpretation - Boston College...RSR’ complexes with a taller “left rabbit ear”. Positive or negative concordance in precordial leads with no RS seen Brugada’s](https://reader035.vdocuments.site/reader035/viewer/2022071411/6106d3a8ebe73846d470bf7e/html5/thumbnails/28.jpg)
Intraventricular Conduction Delay
![Page 29: Advanced ECG Interpretation - Boston College...RSR’ complexes with a taller “left rabbit ear”. Positive or negative concordance in precordial leads with no RS seen Brugada’s](https://reader035.vdocuments.site/reader035/viewer/2022071411/6106d3a8ebe73846d470bf7e/html5/thumbnails/29.jpg)
Intraventricular Conduction Delay
![Page 30: Advanced ECG Interpretation - Boston College...RSR’ complexes with a taller “left rabbit ear”. Positive or negative concordance in precordial leads with no RS seen Brugada’s](https://reader035.vdocuments.site/reader035/viewer/2022071411/6106d3a8ebe73846d470bf7e/html5/thumbnails/30.jpg)
QRS
![Page 31: Advanced ECG Interpretation - Boston College...RSR’ complexes with a taller “left rabbit ear”. Positive or negative concordance in precordial leads with no RS seen Brugada’s](https://reader035.vdocuments.site/reader035/viewer/2022071411/6106d3a8ebe73846d470bf7e/html5/thumbnails/31.jpg)
Left Anterior Hemiblock
Left Axis Deviation -30 to -90
qR or and R wave in lead I
rS in lead III, and probably II & aVF
![Page 32: Advanced ECG Interpretation - Boston College...RSR’ complexes with a taller “left rabbit ear”. Positive or negative concordance in precordial leads with no RS seen Brugada’s](https://reader035.vdocuments.site/reader035/viewer/2022071411/6106d3a8ebe73846d470bf7e/html5/thumbnails/32.jpg)
![Page 33: Advanced ECG Interpretation - Boston College...RSR’ complexes with a taller “left rabbit ear”. Positive or negative concordance in precordial leads with no RS seen Brugada’s](https://reader035.vdocuments.site/reader035/viewer/2022071411/6106d3a8ebe73846d470bf7e/html5/thumbnails/33.jpg)
Left Posterior Hemiblock
Right Axis Deviation 90-180
S wave in lead I and q in III
Exclusion of RAE and/or RVH
![Page 34: Advanced ECG Interpretation - Boston College...RSR’ complexes with a taller “left rabbit ear”. Positive or negative concordance in precordial leads with no RS seen Brugada’s](https://reader035.vdocuments.site/reader035/viewer/2022071411/6106d3a8ebe73846d470bf7e/html5/thumbnails/34.jpg)
![Page 35: Advanced ECG Interpretation - Boston College...RSR’ complexes with a taller “left rabbit ear”. Positive or negative concordance in precordial leads with no RS seen Brugada’s](https://reader035.vdocuments.site/reader035/viewer/2022071411/6106d3a8ebe73846d470bf7e/html5/thumbnails/35.jpg)
Bifasicular Blocks
![Page 36: Advanced ECG Interpretation - Boston College...RSR’ complexes with a taller “left rabbit ear”. Positive or negative concordance in precordial leads with no RS seen Brugada’s](https://reader035.vdocuments.site/reader035/viewer/2022071411/6106d3a8ebe73846d470bf7e/html5/thumbnails/36.jpg)
Bifasicular Blocks
![Page 37: Advanced ECG Interpretation - Boston College...RSR’ complexes with a taller “left rabbit ear”. Positive or negative concordance in precordial leads with no RS seen Brugada’s](https://reader035.vdocuments.site/reader035/viewer/2022071411/6106d3a8ebe73846d470bf7e/html5/thumbnails/37.jpg)
Bifasicular Blocks
![Page 38: Advanced ECG Interpretation - Boston College...RSR’ complexes with a taller “left rabbit ear”. Positive or negative concordance in precordial leads with no RS seen Brugada’s](https://reader035.vdocuments.site/reader035/viewer/2022071411/6106d3a8ebe73846d470bf7e/html5/thumbnails/38.jpg)
Wide Complex Tachycardia vs. V-tach
Capture beats Fusion beats
Extreme axis deviation: Negative in I + aVF AV dissociation
Complexes > 160 ms Absence of RBBB or LBBB morphology
Josephson’s sign – Notching near the nadir of the S-wave
RSR’ complexes with a taller “left rabbit ear”.
Positive or negative concordance in precordial leads with no RS seen
Brugada’s sign- Onset of QRS to nadir of S wave >100ms
![Page 39: Advanced ECG Interpretation - Boston College...RSR’ complexes with a taller “left rabbit ear”. Positive or negative concordance in precordial leads with no RS seen Brugada’s](https://reader035.vdocuments.site/reader035/viewer/2022071411/6106d3a8ebe73846d470bf7e/html5/thumbnails/39.jpg)
![Page 40: Advanced ECG Interpretation - Boston College...RSR’ complexes with a taller “left rabbit ear”. Positive or negative concordance in precordial leads with no RS seen Brugada’s](https://reader035.vdocuments.site/reader035/viewer/2022071411/6106d3a8ebe73846d470bf7e/html5/thumbnails/40.jpg)
![Page 41: Advanced ECG Interpretation - Boston College...RSR’ complexes with a taller “left rabbit ear”. Positive or negative concordance in precordial leads with no RS seen Brugada’s](https://reader035.vdocuments.site/reader035/viewer/2022071411/6106d3a8ebe73846d470bf7e/html5/thumbnails/41.jpg)
![Page 42: Advanced ECG Interpretation - Boston College...RSR’ complexes with a taller “left rabbit ear”. Positive or negative concordance in precordial leads with no RS seen Brugada’s](https://reader035.vdocuments.site/reader035/viewer/2022071411/6106d3a8ebe73846d470bf7e/html5/thumbnails/42.jpg)
![Page 43: Advanced ECG Interpretation - Boston College...RSR’ complexes with a taller “left rabbit ear”. Positive or negative concordance in precordial leads with no RS seen Brugada’s](https://reader035.vdocuments.site/reader035/viewer/2022071411/6106d3a8ebe73846d470bf7e/html5/thumbnails/43.jpg)
![Page 44: Advanced ECG Interpretation - Boston College...RSR’ complexes with a taller “left rabbit ear”. Positive or negative concordance in precordial leads with no RS seen Brugada’s](https://reader035.vdocuments.site/reader035/viewer/2022071411/6106d3a8ebe73846d470bf7e/html5/thumbnails/44.jpg)
T Waves
Shape
Polarity
Size
![Page 45: Advanced ECG Interpretation - Boston College...RSR’ complexes with a taller “left rabbit ear”. Positive or negative concordance in precordial leads with no RS seen Brugada’s](https://reader035.vdocuments.site/reader035/viewer/2022071411/6106d3a8ebe73846d470bf7e/html5/thumbnails/45.jpg)
![Page 46: Advanced ECG Interpretation - Boston College...RSR’ complexes with a taller “left rabbit ear”. Positive or negative concordance in precordial leads with no RS seen Brugada’s](https://reader035.vdocuments.site/reader035/viewer/2022071411/6106d3a8ebe73846d470bf7e/html5/thumbnails/46.jpg)
![Page 47: Advanced ECG Interpretation - Boston College...RSR’ complexes with a taller “left rabbit ear”. Positive or negative concordance in precordial leads with no RS seen Brugada’s](https://reader035.vdocuments.site/reader035/viewer/2022071411/6106d3a8ebe73846d470bf7e/html5/thumbnails/47.jpg)
![Page 48: Advanced ECG Interpretation - Boston College...RSR’ complexes with a taller “left rabbit ear”. Positive or negative concordance in precordial leads with no RS seen Brugada’s](https://reader035.vdocuments.site/reader035/viewer/2022071411/6106d3a8ebe73846d470bf7e/html5/thumbnails/48.jpg)
ST segments
![Page 49: Advanced ECG Interpretation - Boston College...RSR’ complexes with a taller “left rabbit ear”. Positive or negative concordance in precordial leads with no RS seen Brugada’s](https://reader035.vdocuments.site/reader035/viewer/2022071411/6106d3a8ebe73846d470bf7e/html5/thumbnails/49.jpg)
![Page 50: Advanced ECG Interpretation - Boston College...RSR’ complexes with a taller “left rabbit ear”. Positive or negative concordance in precordial leads with no RS seen Brugada’s](https://reader035.vdocuments.site/reader035/viewer/2022071411/6106d3a8ebe73846d470bf7e/html5/thumbnails/50.jpg)
AMI Location Correlation
aVF Inferior III Inferior V3 Anterior V6 Lateral
aVL Lateral II Inferior V2 Septal V5 Lateral
aVR I Lateral V1 Septal V4 Anterior
![Page 51: Advanced ECG Interpretation - Boston College...RSR’ complexes with a taller “left rabbit ear”. Positive or negative concordance in precordial leads with no RS seen Brugada’s](https://reader035.vdocuments.site/reader035/viewer/2022071411/6106d3a8ebe73846d470bf7e/html5/thumbnails/51.jpg)
Reciprocal
• Mirror image when 2 electrodes viewing the MI from opposite angles
II, III, aVF I, aVL
V1, V2 V7, V8, V9
![Page 52: Advanced ECG Interpretation - Boston College...RSR’ complexes with a taller “left rabbit ear”. Positive or negative concordance in precordial leads with no RS seen Brugada’s](https://reader035.vdocuments.site/reader035/viewer/2022071411/6106d3a8ebe73846d470bf7e/html5/thumbnails/52.jpg)
![Page 53: Advanced ECG Interpretation - Boston College...RSR’ complexes with a taller “left rabbit ear”. Positive or negative concordance in precordial leads with no RS seen Brugada’s](https://reader035.vdocuments.site/reader035/viewer/2022071411/6106d3a8ebe73846d470bf7e/html5/thumbnails/53.jpg)
![Page 54: Advanced ECG Interpretation - Boston College...RSR’ complexes with a taller “left rabbit ear”. Positive or negative concordance in precordial leads with no RS seen Brugada’s](https://reader035.vdocuments.site/reader035/viewer/2022071411/6106d3a8ebe73846d470bf7e/html5/thumbnails/54.jpg)
![Page 55: Advanced ECG Interpretation - Boston College...RSR’ complexes with a taller “left rabbit ear”. Positive or negative concordance in precordial leads with no RS seen Brugada’s](https://reader035.vdocuments.site/reader035/viewer/2022071411/6106d3a8ebe73846d470bf7e/html5/thumbnails/55.jpg)
![Page 56: Advanced ECG Interpretation - Boston College...RSR’ complexes with a taller “left rabbit ear”. Positive or negative concordance in precordial leads with no RS seen Brugada’s](https://reader035.vdocuments.site/reader035/viewer/2022071411/6106d3a8ebe73846d470bf7e/html5/thumbnails/56.jpg)
![Page 57: Advanced ECG Interpretation - Boston College...RSR’ complexes with a taller “left rabbit ear”. Positive or negative concordance in precordial leads with no RS seen Brugada’s](https://reader035.vdocuments.site/reader035/viewer/2022071411/6106d3a8ebe73846d470bf7e/html5/thumbnails/57.jpg)
• How do we determine what is happening with the posterior wall of the heart?
• Reciprocal changes will occur in what leads?
• Can perform a posterior ECG with leas V7 to V10
Posterior MI
![Page 58: Advanced ECG Interpretation - Boston College...RSR’ complexes with a taller “left rabbit ear”. Positive or negative concordance in precordial leads with no RS seen Brugada’s](https://reader035.vdocuments.site/reader035/viewer/2022071411/6106d3a8ebe73846d470bf7e/html5/thumbnails/58.jpg)
![Page 59: Advanced ECG Interpretation - Boston College...RSR’ complexes with a taller “left rabbit ear”. Positive or negative concordance in precordial leads with no RS seen Brugada’s](https://reader035.vdocuments.site/reader035/viewer/2022071411/6106d3a8ebe73846d470bf7e/html5/thumbnails/59.jpg)
Posterior MI
![Page 60: Advanced ECG Interpretation - Boston College...RSR’ complexes with a taller “left rabbit ear”. Positive or negative concordance in precordial leads with no RS seen Brugada’s](https://reader035.vdocuments.site/reader035/viewer/2022071411/6106d3a8ebe73846d470bf7e/html5/thumbnails/60.jpg)
![Page 61: Advanced ECG Interpretation - Boston College...RSR’ complexes with a taller “left rabbit ear”. Positive or negative concordance in precordial leads with no RS seen Brugada’s](https://reader035.vdocuments.site/reader035/viewer/2022071411/6106d3a8ebe73846d470bf7e/html5/thumbnails/61.jpg)
RV infarct
• Complicates an estimated 40% of inferior MI’s
• Very uncommon to have isolated RV infarct
• Very preload sensitive
• ST elevation in V1
• ST elevation in lead II>III
• How can we look at the right side of the heart?
![Page 62: Advanced ECG Interpretation - Boston College...RSR’ complexes with a taller “left rabbit ear”. Positive or negative concordance in precordial leads with no RS seen Brugada’s](https://reader035.vdocuments.site/reader035/viewer/2022071411/6106d3a8ebe73846d470bf7e/html5/thumbnails/62.jpg)
![Page 63: Advanced ECG Interpretation - Boston College...RSR’ complexes with a taller “left rabbit ear”. Positive or negative concordance in precordial leads with no RS seen Brugada’s](https://reader035.vdocuments.site/reader035/viewer/2022071411/6106d3a8ebe73846d470bf7e/html5/thumbnails/63.jpg)
![Page 64: Advanced ECG Interpretation - Boston College...RSR’ complexes with a taller “left rabbit ear”. Positive or negative concordance in precordial leads with no RS seen Brugada’s](https://reader035.vdocuments.site/reader035/viewer/2022071411/6106d3a8ebe73846d470bf7e/html5/thumbnails/64.jpg)
Inferior-RV-Posterior
![Page 65: Advanced ECG Interpretation - Boston College...RSR’ complexes with a taller “left rabbit ear”. Positive or negative concordance in precordial leads with no RS seen Brugada’s](https://reader035.vdocuments.site/reader035/viewer/2022071411/6106d3a8ebe73846d470bf7e/html5/thumbnails/65.jpg)
RVH with Strain
![Page 66: Advanced ECG Interpretation - Boston College...RSR’ complexes with a taller “left rabbit ear”. Positive or negative concordance in precordial leads with no RS seen Brugada’s](https://reader035.vdocuments.site/reader035/viewer/2022071411/6106d3a8ebe73846d470bf7e/html5/thumbnails/66.jpg)
![Page 67: Advanced ECG Interpretation - Boston College...RSR’ complexes with a taller “left rabbit ear”. Positive or negative concordance in precordial leads with no RS seen Brugada’s](https://reader035.vdocuments.site/reader035/viewer/2022071411/6106d3a8ebe73846d470bf7e/html5/thumbnails/67.jpg)
LVH with Strain
![Page 68: Advanced ECG Interpretation - Boston College...RSR’ complexes with a taller “left rabbit ear”. Positive or negative concordance in precordial leads with no RS seen Brugada’s](https://reader035.vdocuments.site/reader035/viewer/2022071411/6106d3a8ebe73846d470bf7e/html5/thumbnails/68.jpg)
![Page 69: Advanced ECG Interpretation - Boston College...RSR’ complexes with a taller “left rabbit ear”. Positive or negative concordance in precordial leads with no RS seen Brugada’s](https://reader035.vdocuments.site/reader035/viewer/2022071411/6106d3a8ebe73846d470bf7e/html5/thumbnails/69.jpg)
Osborn Waves Notching
• Sever hypothermia
• Large deflection at the end of the QRS complex
• Can also cause ST dep. and flipped T waves
Miscellaneous Abnormalities
![Page 70: Advanced ECG Interpretation - Boston College...RSR’ complexes with a taller “left rabbit ear”. Positive or negative concordance in precordial leads with no RS seen Brugada’s](https://reader035.vdocuments.site/reader035/viewer/2022071411/6106d3a8ebe73846d470bf7e/html5/thumbnails/70.jpg)
Pericarditis
![Page 71: Advanced ECG Interpretation - Boston College...RSR’ complexes with a taller “left rabbit ear”. Positive or negative concordance in precordial leads with no RS seen Brugada’s](https://reader035.vdocuments.site/reader035/viewer/2022071411/6106d3a8ebe73846d470bf7e/html5/thumbnails/71.jpg)
Osborn Waves
![Page 72: Advanced ECG Interpretation - Boston College...RSR’ complexes with a taller “left rabbit ear”. Positive or negative concordance in precordial leads with no RS seen Brugada’s](https://reader035.vdocuments.site/reader035/viewer/2022071411/6106d3a8ebe73846d470bf7e/html5/thumbnails/72.jpg)
Hypocalcemia
• Prolongation of the ST segment with lengthening of the QTc interval
• At risk for the development of torsades de pointes
• ST segment depression in inferior leads ? ischemia
• This ECG also shows LVH with possible strain. Flipped symmetrical T waves in lateral leads.
![Page 73: Advanced ECG Interpretation - Boston College...RSR’ complexes with a taller “left rabbit ear”. Positive or negative concordance in precordial leads with no RS seen Brugada’s](https://reader035.vdocuments.site/reader035/viewer/2022071411/6106d3a8ebe73846d470bf7e/html5/thumbnails/73.jpg)
Hypokalemia
• Mild ST depression
• Mild decreased amplitude of T waves
• Minimal prolongation of the QRS interval
• Prominent U wave
![Page 74: Advanced ECG Interpretation - Boston College...RSR’ complexes with a taller “left rabbit ear”. Positive or negative concordance in precordial leads with no RS seen Brugada’s](https://reader035.vdocuments.site/reader035/viewer/2022071411/6106d3a8ebe73846d470bf7e/html5/thumbnails/74.jpg)
Drugs Possible Toxic Effects
Class I antiarrhythmics • Lengthened QRS and QTc intervals
• Possible AV blocks • Slowed or completely blocked SA
node • Arrhythmias
Calcium Channel Blockers • Blocked AV node
Beta-blockers • Slowed automaticity of the SA node
• Blocked AV node
Amiodarone • Slowed conduction everywhere: SA node, atrium, AV node, ventricles
Phenothizines and tricyclic antidepressants
• Widened QRS and QTc interval • T wave abnormalities
![Page 75: Advanced ECG Interpretation - Boston College...RSR’ complexes with a taller “left rabbit ear”. Positive or negative concordance in precordial leads with no RS seen Brugada’s](https://reader035.vdocuments.site/reader035/viewer/2022071411/6106d3a8ebe73846d470bf7e/html5/thumbnails/75.jpg)
Digoxin Effects
![Page 76: Advanced ECG Interpretation - Boston College...RSR’ complexes with a taller “left rabbit ear”. Positive or negative concordance in precordial leads with no RS seen Brugada’s](https://reader035.vdocuments.site/reader035/viewer/2022071411/6106d3a8ebe73846d470bf7e/html5/thumbnails/76.jpg)
References ECG Library Life in the Fast Lane Retrieved from: http://lifeinthefastlane.com/ecg-library/ Garcia, T. B. (2015). 12_Lead ECG The Art of Interpretation. Jones & Bartlett Learning Burlington, MA Malcolm, T. S. (2012). The Only EKG Book You’ll Ever Need. Lipincott Williams & Wilkins. Philadelphia, PA Walraven, G. (2011) Basic Arrhythmias Seventh Edition. Pearson Education Upper Saddle River, NJ