practice ekg part i

8/16/2019 Practice Ekg Part i

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Copyright © 2006 by Mosby Inc. All rights reserved.

Practice ECGs

Part I


2/103


Obectives

!evelop a syste"atic approach #or in#arctrecognition on the ECG.

Gain #a"iliarity $ith %2&'ead ECG

interpretation.


3/103


(evie$ing a %2&'ead ECG

Assess the )*ality o# the tracing.

Identi#y the rate and *nderlying rhyth".

E+a"ine #or evidence o# in#arction.


4/103


(evie$ing a %2&'ead ECG

Ascertain i# in#arct i"postors are present that

"ay acco*nt #or ECG changes.

Clinical presentation. Interpret yo*r #indings.


5/103


In#arct I"postors

'e#t b*ndle branch bloc,

-entric*lar rhyth"s

'e#t ventric*lar hypertrophy

Pericarditis

Early repolariation


6/103


/ig*re &%


7/103


/ig*re &%

Poor R wave progression


8/103


/ig*re &%

Leads: Inversion III,aVF; tall V

3 – V

5

T wave changes?

Leads: II, III, aVFT!seg"entdepression?

Leads: I, aVL, V# – V

$T!seg"entelevation?

Leads: V5

Poor R waveprogression?

Leads: III?, V%, V

3Pathologic &

waves?

in's rh(th" at )3 *p"+nderl(ingrh(th"?

Interpretation:-tensive anteriorin.arction, reciprocalchanges

Low voltage over

entire tracing

/aseline wander V#/aseline wanderor arti.act?


9/103


Practice &2

12&year&old Ca*casian $o"an


10/103


Practice &2


Arti#act


11/103


Practice &2

in*s rhyth"at 34 bp"

5nderlyingrhyth"

Interpretation7

8or"al ECG

P( interval %60 "s

9( :0 "s

9;


12/103


/ig*re &1


13/103


/ig*re &1

/aseline wander /aseline wander

/aseline wander


14/103


/ig*re &1

Leads: V%, V

3;

slight in V#

T!seg"entelevation?

Leads: III, aVFPathologic &waves?

in's rh(th" at03 *p"

+nderl(ingrh(th"?

Interpretation:

1nteroseptal in.arction,previo's in.erior wallin.arction; low voltage inlead II

/aseline wander

in II, III, aVL

/aseline

wander orarti.act?


15/103


/ig*re &=


16/103


/ig*re &=

Interpretation:

in's *rad(cardia withoccasional PV2s,otherwise nor"al 2

PR interval #4% "s

&R 04 "s

&T&Tc 43$4#6 "s

P!R!T a-es $7 #4 54

in's *rad(cardia at55 *p" withoccasional PV2s

+nderl(ingrh(th"?


17/103


/ig*re &4


18/103


/ig*re &4

/aseline wander /aseline wander

/aseline wander

/aseline wander



19/103


/ig*re &4

Leads: Pea8ed T waveV

%, tallpea8ed V

3, V

4

T wave changes?

Leads: II, III, aVFT!seg"entdepression?


5T!seg"entelevation?

Leads: V%


Leads: aVLPathologic &

waves?

1trial .i* at #77 *p"+nderl(ing rh(th"?

Interpretation:

1nteroseptalin.arction with laterale-tension; reciprocalchanges noted

/aseline wander in I, II,V

#, V

$

/aseline wander orarti.act?


20/103


/ig*re &6



21/103


/ig*re &6



22/103


/ig*re &6

Leads: V4 – V

$T!seg"entdepression?

Leads: V#

– V3

T!seg"entelevation?

Interpretation:

Le.t *'ndle *ranch *loc8

PR interval #37 "s

&R #44 "s

&T&Tc 47$453 "s

P!R!T a-es #3 !#$ 5)


+nderl(ingrh(th"?


23/103


/ig*re &3

3%&year&old Ca*casian $o"an


24/103


/ig*re &3



25/103


/ig*re &3

Leads: I, aVLT wavechanges?

Leads: I, aVLT!seg"entdepression?

Leads: II, III, aVFT!seg"entelevation?

Interpretation:In.erior in.arction – age'ndeter"ined, T 9 T wavea*nor"alit( – consider lateralische"ia

PR interval #$) "s&R )) "s

&T&Tc 4%447% "s

P!R!T a-es 6 7 #7#

in's *rad(cardiaat 5$ *p"+nderl(ingrh(th"?


26/103


/ig*re &:

=2&year&old Ca*casian $o"an


27/103


/ig*re &:

Leads: Inversionin V

#

T wavechanges?

Leads: IIIT!seg"entdepression?

Interpretation:

or"al 2

PR interval #$4 "s

&R $$ "s&T&Tc 30%4#4 "s

P!R!T a-es )# )4$#

in's arrh(th"iaat $6 *p"

+nderl(ingrh(th"?


28/103


/ig*re &


29/103


/ig*re &


30/103


/ig*re &

Leads: Tall in V%!V

4;

pea8ed in II, aVF, V%!V

$;

inverted in aVL

T wave changes?

Leads: V5, V$T!seg"entdepression?

Leads: V#, V

%, V


Leads: V5, V

$; & wave

approaching 47 "s in V4

Pathologic &

waves?

in's rh(th" at 66 *p"+nderl(ingrh(th"?

Interpretation:1nteroseptal in.arction,possi*le previo's lateralin.arction earingvoltage criteria .or LV


31/103


/ig*re &%0

4:&year&old Ca*casian "an


32/103


/ig*re &%0

4:&year&old Ca*casian "an


33/103


/ig*re &%0

Interpretation:

-tensive anteriorin.arction

PR interval #)4 "s

&R 0% "s

&T&Tc 4#$470 "s

P!R!T a-es 30 #$ #$Leads: II, III,

aVF

Leads: I, aVL,V

% – V

$

in's*rad(cardia at5) *p"

T!seg"ent

depression?

T!seg"entelevation?

+nderl(ingrh(th"?


34/103


/ig*re &%%

=2&year&old Ca*casian "an


35/103


/ig*re &%%

Interpretation:

in's *rad(cardia,otherwise nor"al 2

PR interval #%$ "s

&R #77 "s

&T&Tc 43%4#$ "s

P!R!T a-es 5# %4 %0

in's*rad(cardia at5$ *p"

+nderl(ingrh(th"?


36/103


37/103


/ig*re &%2


38/103


/ig*re &%2

Interpretation:

1nteroseptalin.arction, reciprocalchanges present

Leads: Tallpea8edV

% – V

4; inverted in III

Leads: II, III, aVF

Leads: I, aVL, V# –V

5

in's tach(cardia at#76 *p"

T wavechanges?

T!seg"entdepression?

T!seg"entelevation?

+nderl(ingrh(th"?


39/103


/ig*re &%1


40/103


/ig*re &%1


41/103


/ig*re &%1

Interpretation:

In.erior in.arction; low&R voltage >75 "V@in li"* leads

PR interval #44 "s&R #7) "s

&T&Tc 36$30) "s

P!R!T a-es 43 44 3)Leads: V

# – V

4

Leads: II, III,aVF

in's rh(th"at 6# *p"


T!seg"entelevation?

+nderl(ingrh(th"?


42/103


/ig*re &%=


43/103


/ig*re &%=


44/103


/ig*re &%=

Interpretation:In.erior in.arction;"ar8ed T depressionconsistent withs'*endocardial inA'r(

PR interval 7 "s

&R #74 "s

&T&Tc 44)43$ "s

P!R!T a-es 000 5) )4

Leads: Inverted inaVL, V

#


4

Leads: II, III, aVF

B'nctional rh(th" at55 *p"

T wavechanges?


T!seg"ent

elevation?

+nderl(ingrh(th"?


45/103


/ig*re &%4



46/103


/ig*re &%4



47/103


/ig*re &%4

Interpretation:Right *'ndle *ranch*loc8, in.erior in.arction –age 'ndeter"ined

PR interval #$) "s

&R #37 "s

&T&Tc 3))437 "s

P!R!T a-es $7 !%# 4$

Leads: InvertedV

#, V

%

Leads: III, aVF


1rti.act V#,*aseline wanderV

%

T wavechanges?

Pathologic &waves?

+nderl(ingrh(th"?

/aselinewander orarti.act?


48/103


/ig*re &%6


49/103


/ig*re &%6


50/103


51/103


52/103


/ig*re &%3


53/103


/ig*re &%3

T wavechanges?

T!seg"ent

depression?

T!seg"entelevation?

Interpretation:

In.erior in.arction

PR interval ##$ "s

&R 6$ "s

&T&Tc %%)37$ "sP!R!T a-es 50 % 66

Leads: Invertedin aVL, V

#

Leads: I, aVL

Leads: II, III, aVF

in's tach(cardia

with short PRinterval, short &Tinterval

+nderl(ing

rh(th"?


54/103


55/103


/ig*re &%:

Interpretation:in's *rad(cardia,otherwise nor"al 2

PR interval #%% "s&R )$ "s

&T&Tc 4#$47) "s

P!R!T a-es 4# 54 %%

in's*rad(cardia at5) *p"

+nderl(ingrh(th"?


56/103


/ig*re &%


57/103


58/103


/ig*re &%

Interpretation:

In.erior in.arction

PR interval #)4 "s

&R 0% "s

&T&Tc 35%3)0 "s

P!R!T a-es $7 %3 #7$

Leads: Inverted in I,

aVL

Leads: I, aVL, V5, V$

Leads: II, III, aVF

Leads: III

in's rh(th"

at )# *p"

T wave

changes?

T!seg"ent

depression?

T!seg"ent

elevation?

Pathologic &

waves?

+nderl(ing

rh(th"?


59/103


/ig*re &20


60/103


/ig*re &20


/i 20


61/103


/ig*re &20

Leads: Flattened Twave aVL

T wavechanges?

Leads: IIT!seg"entdepression?

Leads: V# – V


Leads: V3;

no initial R

wave in V#


Leads: II?, III, aVFPathologic &

waves?

in's rh(th" at 0# *p"+nderl(ingrh(th"?

Interpretation:

1nteroseptalin.arction,possi*le previo'sin.erior in.arction

/aseline wander and

arti.act in lead I, arti.actin II, III, aVL

/aseline wander

or arti.act?


62/103


/ig*re &2%


63/103


/ig*re &2%

/i 2%


64/103


/ig*re &2%

Interpretation:

eptal in.arction,possi*le anteriorepicardial inA'r(

PR interval #$4 "s

&R 0$ "s

&T&Tc 3)7433 "s

P!R!T a-es $% !$%)3

Leads: Inverted inaVL

Leads: II, III, V5, V

$

Leads: V# – V

3

in's rh(th"at 05 *p"

/aseline wander

V5, V$

T wavechanges?

T!seg"ent

depression?

T!seg"entelevation?

+nderl(ingrh(th"?

/aseline

wander orarti.act?


65/103


/ig*re &22

::&year&old Ca*casian "an


66/103


/ig*re &22

::&year&old Ca*casian "an


67/103


/ig*re &22

Interpretation:In.erolateral ische"ia

ote: This is the sa"e

patient as in .ig're 0!%$ –

%0 "in'tes a.ter the 2 in

.ig're 0!%$ was o*tained

PR interval #)% "s

&R )% "s

&T&Tc 4#74%$ "s

P!R!T a-es 6$ 5% !60

Leads: II, III,

aVF, V5 – V

$

Leads: II, III,

aVF, V4 – V$

in's rh(th" at$5 *p"

T wave

changes?

T!seg"ent

depression?

+nderl(ingrh(th"?


68/103


/ig*re &21


69/103


/ig*re &21


70/103


/ig*re &21

Interpretation:Low voltagethro'gho'ttracing In.eriorin.arction, lateral

e-tension

Leads: Pea8ed in II, III,aVF, V

3, V

4

Leads: V#

Leads: II, III, aVF, V4 – V

$

Leads: V%!V4

in's rh(th" at )) *p"

/aseline wander lead I

T wavechanges?

T!seg"ent

depression?

T!seg"entelevation?

Pathologic &waves?

+nderl(ingrh(th"?

/aseline wanderor arti.act?


71/103


Practice &2=

6=&year&old Ca*casian $o"an Arti#act


72/103


Practice &2=

Interpretation:or"al 2

PR interval #54 "s

&R )7 "s

&T&Tc 304440 "s

P!R!T a-es 66 6) 55

in's rh(th" at6) *p"

1rti.act in V#

+nderl(ingrh(th"?



73/103


74/103


/ig*re &24

Arti#act

Arti#act


75/103


/ig*re &24

Interpretation:RR >&R@ in V#V%consistent with rightventric'lar cond'ctiondela(

PR interval #6% "s

&R #74 "s

&T&Tc 4774%7 "s

P!R!T a-es 64 $0 44

in's rh(th" at$0 *p" withoccasional PV2s

+nderl(ingrh(th"?


76/103


/ig*re &26


77/103


/ig*re &26

/aseline wander


78/103


/ig*re &26

Interpretation:Lateral ische"ia

Leads: V5, V$

/aseline wanderV%

T wavechanges?


+nderl(ingrh(th"?


in's rh(th" at$6 *p" with

occasionalPV2s

PR interval #07 "s

&R )% "s

&T&Tc 47)43#"s

P!R!T a-es 6$ 53###

Leads: II,aVF, V3!V$

2


79/103


/ig*re &23

/i 23


80/103


/ig*re &23

/i 23


81/103


/ig*re &23

Interpretation:In.erior in.arction

PR interval #)7 "s

&R 0$ "s&T&Tc 3)743$ "s

P!R!T a-es 63 35 )4

Leads: aVL

Leads: aVL

Leads: II, III, aVF

Leads: III

in's rh(th" at#77 *p"

T wavechanges?


T!seg"entelevation?

Pathologic &waves?

+nderl(ingrh(th"?

/i 2:


82/103


/ig*re &2:

::&year&old Ca*casian $o"an

/i 2:


83/103


/ig*re &2:

::&year&old Ca*casian $o"an

/i 2:


84/103


/ig*re &2:

Interpretation:eptal in.arction,possi*le anteriorepicardial inA'r(

/aseline wanderV5, V$

T wavechanges?

T!seg"entelevation?

+nderl(ingrh(th"?



PR interval #$4 "s

&R 0$ "s

&T&Tc 3)7433"s

P!R!T a-es $% !$%)3

Leads: II, III, V5,

V$

Leads: V#! V3


Leads: Invertedin aVL

/i 2


85/103


/ig*re &2

/i 2


86/103


/ig*re &2

Interpretation:lectronic atrial pace"a8er

PR interval $%$ "s

&R 0% "s&T&Tc 35)4#% "s

P!R!T a-es 7 5% #$

lectronic atrialpace"a8er at )7*p"

+nderl(ingrh(th"?

/i 10


87/103


/ig*re &10

1&year&old Ca*casian "an

/i 10


88/103


/ig*re &10

Interpretation:in's tach(cardia withnoncond'cted>*loc8ed@ pre"at'reatrial co"ple-es,

otherwise nor"al 2

PR interval #5$ "s

&R )) "s

&T&Tc 3%$473 "sP!R!T a-es 54 %$ 54

in's tach(cardiawith noncond'cted>*loc8ed@ pre"at'reatrial co"ple-es at 0%*p"

+nderl(ingrh(th"?

/i 1%


89/103


/ig*re &1%

/i 1%


90/103


/ig*re &1%

/ig*re &1%


91/103


/ig*re 1%Interpretation:1nterolateral in.arction;"eets "ini"al voltagecriteria .or LV


92/103


/ig*re &12


/ig*re 12


93/103


/ig*re &12


/ig*re 12


94/103


/ig*re &12

PR interval #3$ "s

&R 0$ "s

&T&Tc 3))453 "s

P!R!T a-es $% #% %6

Inco"plete right*'ndle *ranch *loc8

Interpretation:

Leads: II, III,aVF, V

5, V

$

Leads: V#

in's rh(th" at)% *p"


T!seg"ent

elevation?

+nderl(ingrh(th"?

/ig*re 11


95/103


/ig*re &11

/ig*re 11


96/103


/ig*re &11

/ig*re &11


97/103


/ig*re 11Interpretation:In.erior in.arction,

reciprocal changespresent

PR interval %$7 "s

&R #74 "s

&T&Tc 44445) "s

P!R!T a-es 07 !65#75

Leads: Tall in II, III, aVF;depressed in I, aVL,V

# – V

3

Leads: I, aVL, V# – V$

Leads: II, III, aVF

Leads: II, III, aVF

in's rh(th" with .irst!degree 1V *loc8 at $$*p" with occasionals'praventric'larpre"at're co"ple-es

/aseline wander II, III,aVL, aVF

T wavechanges?


T!seg"entelevation?

Pathologic &waves?

+nderl(ingrh(th"?

/aselinewander or

arti.act?

/ig*re 1=


98/103


/ig*re &1=

:6&year&old Ca*casian $o"an

/ig*re 1=


99/103


/ig*re &1=

Baseline wander

Baseline wander

Baseline wander

:6&year&old Ca*casian $o"an

/ig*re &1=


100/103


/ig*re 1=Interpretation:

1trial .i*rillation withrapid ventric'lar response

PR interval one

&R 07 "s

&T&Tc 374475 "s

P!R!T a-es one $0 #6

Leads: Tall in V%

Leads: V$

1trial .i*rillation

at #76 *p"

/aseline wander

V4 – V$

T wavechanges?


+nderl(ing

rh(th"?

/aseline

wander orarti.act?

/ig*re 14


101/103


/ig*re &14


/ig*re 14


102/103


/ig*re &14


/ig*re 14


103/103

/ig*re &14

PR interval #3$ "s

&R #44 "s

&T&Tc 43)4)% "s

P!R!T a-es %) !5 %3)

Interpretation:Le.t *'ndle *ranch *loc8

Leads: I, II, aVL,aVF, V

5 – V

$

Leads: V# – V

%



T!seg"ent

elevation?

+nderl(ingrh(th"?

practice ekg part i

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