no 5 - basic ecg reading (april 2011).pdf-2108213324
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7/25/2019 NO 5 - Basic ECG Reading (April 2011).PDF-2108213324
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Basic ECG Reading1 April 2006
Basic ECGBasic ECGReadingReading
Basic ECG Reading1 April 2006
Basic ECG Reading1 April 2006
ECG terminology
Basic ECG Reading1 April 2006
Normal ECG
Basic ECG Reading
1 April 2006
Approach to Interpretat ion of the ECG
Rate
Regularity Axis
PQRSTU
Basic ECG Reading
1 April 2006
Determining the Heart Rate
The number of large squares between 2
consecutive R waves = X
Heart Rate = 300 / X
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Basic ECG Reading1 April 2006
1 small square =
0.04 s
1 large square =
0.2 s
5 large squares =1s
1 QRS per s
Heart rate = 60 per minCount the number of large
squares between 2 RR
intervals and divide into 300
Basic ECG Reading1 April 2006
Is there any electrical activity?
If there is no activity,
Check - connections
QRS gain
In 2 other Leads, eg Lead I & II
If still no activity -ASYSTOLE
Basic ECG Reading1 April 2006
Asystole
Complete absence of QRS
P waves may occur
If no organised QRS complex is seen and the patient has a pulse
then the ECG is improperly connected, turned off or improperly
calibrated
VF may masquerade as asystole; it is best always to check 2 leads
perpendicular to each other to make sure that asystole is not VF
Basic ECG Reading1 April 2006
Ventricular Fibrillation
Totally disorganised pattern
No distinguishable QRS complexes
Continuous erratic movement of the baseline
Rate is very rapid and too disorganised to count
Coarse VF vs Fine VF
Management : Immediate defibrillation
Basic ECG Reading
1 April 2006
Pulseless Electrical Activity
Basic ECG Reading
1 April 2006
Pulseless electrical activity
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Basic ECG Reading1 April 2006
What is the rhythm?
Analyse P-QRS
Assess:
P wave - present / absent
morphology
QRS morphology and width
Relation between P wave and QRS
Basic ECG Reading1 April 2006
Complete heart block
Basic ECG Reading1 April 2006
Sinus tachycardia
Basic ECG Reading1 April 2006
What is the width of QRS?
Widened QRS Complex
(> 0.12s)
Narrow QRS Complex
Basic ECG Reading
1 April 2006
Irregular narrow complex
tachycardia
Basic ECG Reading
1 April 2006
Narrow complex tachycardia
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Basic ECG Reading1 April 2006
Wide complex tachycardia
Basic ECG Reading1 April 2006
Electrocardiogram of ACS
May be normal when pain free
Subtle features
- Horizontality of the ST segment
- Squaring of the ST-T wave angle
Ideal to do ECG at time of symptoms
Basic ECG Reading1 April 2006
Ischaemia - ST depression
Basic ECG Reading1 April 2006
Acute Ischemia
Basic ECG Reading
1 April 2006
Acute anteroseptal MI
Basic ECG Reading
1 April 2006
Evolved Anterior MI
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Basic ECG Reading1 April 2006
Acute Anterior MI
Basic ECG Reading1 April 2006
Acute inferior + RV Mi
Basic ECG Reading1 April 2006
Pericarditis
Basic ECG Reading1 April 2006
69 years old female Hyperkalemia
Basic ECG Reading
1 April 2006
Acute pulmonary embolism