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ECG Interpretation Amanda Scully Professional Practice Fellow – Otago University [email protected] Beware of the elephant! Sinus rhythm Impulse Formation In SA Node Atrial Depolarization Delay At AV Node Conduction Through Bundle Branches Conduction Through Purkinje Fibers Ventricular Depolarization Plateau Phase of Repolarization Repolarization (Phase 3) Einthovens Triangle Structured Approach • • • • • • • Check Patient, Check Technical Details Rate Rhythm P wave and PR interval QRS Complex ST segment T wave Technical Detail Rate Heart Rhythm • Regular vs Irregular • Relationship between p waves and QRS complexes. – Is there a p wave followed by a QRS followed by a T wave for every beat on the rhythm strip? P wave and PR interval • P wave – normal upright? • Is there a p wave before every QRS complex? • PR interval – Normal 120 – 200ms. QRS Complex • Narrow or Wide? – Normal < 120ms • Fragmented? – Bundle branch block • Large? – hypertrophy • Axis? – Left or Right Axis Deviation ST segments • Look for signs of ischeamia • Are the ST segments elevated? – Two small squares (2mm) for V1-V3 – One small square (1mm) for all other – Indicative of subepicardial (transmural) ischaemia ST segments • Are the ST segments depressed? Indicative of supendocardial ischeamia • Is there T wave inversion? • Is there a Q wave? Ischaemic Changes
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