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Part C : Abnormal ECG’s Alternate Day Objectives The student can recognize abnormal Electrocardiograms and relate the ECG to the underlying pathophysiology. 1. Define tachycardia and bradycardia. 2. Recognizes and characterizes arrhythmias. 3. Determines the frontal plane mean electrical axis and notes if right or left axis deviation is present. 4. Notes any abnormalities present in P waves, QRS complexes, and T waves. 5. Notes and defines any A-V blocks present. 6. Recognizes S-T depression or elevation, and the signs of myocardial infarction. 7. Identifies abnormalities of ventricular conduction, including bundle branch block and cell to cell conduction. A number of unknown ECG’s will be discussed. You should analyze each to determine any abnormalities that are present and the cause of the abnormalities. Use the following guidelines to analyze these ECG’s. 1. 2. 3. 4. 5. 6. 7. 8. 9. Rate: Normal; bradycardia (< 50bpm) ; tachycardia (>100bpm)? Rhythm: Normal; gradually increasing, then decreasing; irregular? Electrical axis: Normal; left axis deviation; right axis deviation? Description of P wave: Present; normal contour; inverted? Descriction of QRS complex: Duration; contour. Is every P wave followed by a QRS complex? Is every QRS complex preceded by a P wave? S-T segment: Isoelectric; elevated; depressed? T wave: Amplitude, direction, contour? Conduction time: P-R interval: Normal 0.12 – 0.20 seconds QRS duration: Normal 0.05 – 0.10 seconds REFERENCES Scheidt,s., Basic Electrocardiography. West Caldwell, N.J. Ciba-Geigy (Novartis), 1986. Scheidt, S., J.H.Meyers and F.H.Netter. Interactive Electrocardiography ECG. A software product. (CD-ROM). Moorestown, N.J. Ciba Medical Education and Publications (Novartis), 1996 available through the Physiology Department and the CAI Lab upon request.