7. ecg 1 final.pptx

ECG PART 1 CHEST LEADS Waves and intervals on ECG ECG event Cardiac event P wave Atrial depolarization PR Interval: Start of atrial depolarization to ventricular depolarization QRS complex ventricular depolarization ST segment Pause in electrical activity before repolarisation T wave Ventric...

ECG PART 1 CHEST LEADS Waves and intervals on ECG ECG event Cardiac event P wave Atrial depolarization PR Interval: Start of atrial depolarization to ventricular depolarization QRS complex ventricular depolarization ST segment Pause in electrical activity before repolarisation T wave Ventricular repolarisation QT interval : Total time for ventricular depolarisation & repolarisation While analyzing 12 Lead ECG • Look at the P waves – present/absent • Size and morphology • Size of the QRS complex [Width of the complex] • ST segment and T wave morphology • U waves if any Normal 12 lead ECG Rate Rhythm Axis 1500/No.of small squares between 2 consecutive R 300/no.of large squares between 2 R waves Rhythm State basic rhythm ex - sinus,AF etc Look at rhythm strip[ long lead II or V] P preceding all R [i.e. P waves should be paired with QRS complex always in a sinus rhythm ] ECG - IHD Normal ST ST Depression ST elevation IHD - ST segment Depression Note the arrows pointing ST depression Q waves in myocardial infarction Acute Anteriolateral wall MI Inf. wall MI Acute anteroseptal MI AMI - changes The pathological Q waves seen in V1 - V6 indicate that this patient has had an anterior MI in the past. This patient also has evidence of an acute inferior MI as shown by the ST segment elevation in leads III and aVF. Non STEMI P wave Normal P duration < 0.12 sec Normal P amplitude < 2.5 mm [height] P wave morphology PR Interval and P wave P MITRALE - LA HYPERTROPHY P Pulmonale & P Mitrale Tall P [Pulmonale ] • Causes of RA hypertrophy • Pulmonary hypertension • Cor Pulmonale Right Atrial Hypertrophy RVH Tall R wave in V1 R:S ratio in V1 >1 Deep S waves in V6 Right axis deviation Right atrial enlargement ST-T:inversion in V1 RVH – to know few causes • R/S ratio more than 1 • ie.tall R waves in V1 • Sloping of ST segment is strain pattern due to RVH • Causes: MS Cor pulmonale RVH L V H-Voltage Criteria In adult with normal chest wall SV1+RV5 >35 mm or SV1 >20 mm or RV6 >20 mm LEFT VENTRICULAR HYPERTROPHY RT.BUNDLE BRANCH BLOCK LEFT BUNDLE BRANCH BLOCK THANK YOU