Download ECG read

ABC in
ECG
SAAD A. SHETA
MBChB, MA, MD
Assoc. Prof.
MDS Department
KSU
How To Read ECG
 Rate?
 QRS Duration?
 Stability?
Anatomy of Heart and ECG signal
Normal ECG signal
Conducting System of Heart
Measurements
Small square = 0.04 sec.
Large square = 5 small square = 0.2 sec.
One second
= 5 large square
One minute = 300 large square
Remember This
3, 3, 3 and 5
P duration
= 3 small sqs = 0.12 sec.
P height
= 3 small sqs = 0.12 sec.
QRS duration = 3 small sq = 0.12 sec.
P-R interval = 5 small sqs = 0.2 sec.
Three Levels:
SAN:
60 - 100
AVN :
40 - 60
Bundle Branch:
20 - 40
Rate:
If regular : Divide 300/ number of large squares between 2 Rs = HR
If irregular: Count number of complexes in 6 sec. and multiply by 10
RATE may be:
Normal 60 -100
P
Bradycardia < 60
No P = Non sinus
Tachycardia > 100
= Sinus
QRS Duration:
Slim lady
Obese lady
Stability:
* Stable patient: think of drug therapy
* Unstable patient: think of electric therapy
Supraventricular Rhythm
Rate > 100.
Rate < 60.
QRS: Narrow.
QRS: Narrow.
Stable or unstable
Stable or unstable
Sinus tachycardia
Sinus bradycardia
Atrial flutter
1st degree HB
Atrial fibrillations
2nd degree HB
PAT, PNT
Complete HB
Supraventricular Rhythm: Tachycardia
Sinus Tachycardia
Supraventricular Rhythm: Tachycardia
Atrial Flutter
Supraventricular Rhythm: Tachycardia
Atrial Fibrillations
Supraventricular Rhythm: Tachycardia
Paroxysmal SVT
Supraventricular Rhythm: Bradycardia
Normal Sinus Rhythm
Sinus Bradycardia
Supraventricular Rhythm: Bradycardia
1st Degree HB
Supraventricular Rhythm: Bradycardia
2nd Degree HB: Mobitz 1 Wenckebach.
Progressive lengthening of the P-R interval with intermittent dropped beat
Supraventricular Rhythm: Bradycardia
2nd Degree HB: Mobitz 2
Sudden drop of QRS without prior P-R changes
Supraventricular Rhythm: Bradycardia
3rd Degree HB
Ventricular Rhythm
Idioventricular Rhythm.
Ventricular Rhythm
Accelerated Idioventricular Rhythm.
Ventricular Rhythm
Ventricular Rhythm
Ventricular Rhythm
Pacer Rhythm
Treatment
Supraventricular Rhythm:
Stable = Drugs = Alii
A denosine
L anoxine
I soptin
I nderal
Unstable = Electric
DC with 25 joules, +++
Treatment
Ventricular Rhythm:
Stable = Drugs = AlP
A miodarone.
L idocaine.
P rocainamide.
Unstable = Electric
DC with 200 joules, 300, 3600.
Myocardial Ischemia
Due to lack of adequate blood flow to the
myocardium
 Ischemia is reversible.
 Changes in ECG:
T wave peaking
Symmetric T wave inversion
ST segment elevation

Different ECG Signals
Normal Signal
ECG with T wave inversion
ST segment elevated signal
ECG Signal with peak T waves
THANK YOU