ECG BY Dr.MOHAMED RAMADAN
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this is a simple work to understand how to read an ECG for medical students by M.RAMADAN
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ECG BY Dr.MOHAMED RAMADAN
- 1. http://emergencymedic.blogspot.com Basics of ECG by Mohamed Ramadan
- 2. بسم الله الرحمن الرحيم
- 15. NORMAL ECG
- 17. ECG Leads which measure the difference in electrical potential between two points 1. Bipolar Leads: Two different points on the body 2. Unipolar Leads : One point on the body and a virtual reference point with zero electrical potential, located in the center of the heart
- 18. ECG Leads The standard ECG has 12 leads: 3 Standard Limb Leads 3 Augmented Limb Leads 6 Precordial Leads
- 22. All Limb Leads
- 23. Precordial Leads
- 24. Precordial Leads
- 25. Right Sided & Posterior Chest Leads
- 26. Arrangement of Leads on the ECG
- 27. Anatomic Groups (anterior wall ):
- 29. Anatomic Groups (Lateral Wall )
- 30. Anatomic Groups (Inferior Wall)
- 33. RULE 1 P-R interval should be 3 to 5 little squares
- 34. RULE 2 The width of the QRS complex should not exceed 3 small squares
- 35. RULE 3 The QRS complex should be dominantly upright in leads I and II
- 36. RULE 4 QRS and T waves tend to have the same general direction in the limb leads
- 37. RULE 5 All waves are negative in lead aVR
- 38. RULE 6 The R wave must grow from V1 to at least V4 The S wave must grow from V1 to at least V3 and disappear in V6
- 39. RULE 7 The ST segment should start isoelectric except in V1 and V2 where it may be elevated
- 40. RULE 8 The P waves should be upright in I, II, and V2 to V6
- 41. RULE 9 There should be no Q wave or only a small q less than 0.04 seconds in width in I, II, V2 to V6
- 42. RULE 10 The T wave must be upright in I, II, V2 to V6
- 46. P Pulmonale P Mitrale
- 54. QRS in LVH & RVH
- 58. Conditions with Tall R in V1
- 70. Goldberger AL. Goldberger: Clinical Electrocardiography: A Simplified Approach. 7th ed: Mosby Elsevier; 2006. Variable Shapes Of ST Segment Elevations in AMI
- 72. T wave
- 74. QT Interval
- 77. Count the number of “big boxes” between two QRS complexes, and divide this into 300. (smaller boxes with 1500) for regular rhythms . Rule of 300
- 78. (300 / 6) = 50 bpm What is the heart rate?
- 79. (300 / ~ 4) = ~ 75 bpm What is the heart rate?
- 80. (300 / 1.5) = 200 bpm What is the heart rate?
- 81. It may be easiest to memorize the following table: The Rule of 300 No of big boxes Rate 1 300 2 150 3 100 4 75 5 60 6 50
- 82. ECGs record 6 seconds of rhythm per page, Count the number of beats present on the ECG Multiply by 10 For irregular rhythms. 6 Second Rule
- 83. 20 x 10 = 200 bpm What is the heart rate?
- 84. Calculation of Heart Rate
- 87. Normal QRS axis from -30 ° to +90 ° . -30 ° to -90 ° is referred to as a left axis deviation (LAD) +90 ° to +180 ° is referred to as a right axis deviation (RAD) The QRS Axis
- 88. Determining the Axis The Quadrant Approach The Equiphasic Approach
- 89. Determining the Axis Predominantly Positive Predominantly Negative Equiphasic
- 91. Negative in I, positive in aVF RAD Quadrant Approach: Example 1
- 92. Positive in I, negative in aVF LAD Quadrant Approach: Example 2
- 101. Junctional Rhythm
- 106. Mobitz type 1 (Wenckebach Phenomenon)
- 107. P waves may blocked somewhere in the AV junction, the His bundle. Mobitz type 2
- 109. 3rd degree AV block with a left ventricular escape rhythm, 'B' the right ventricular pacemaker rhythm is shown. Third Degree Heart Block
- 134. Bundle Branch Blocks
- 139. RBBB
- 145. HYPERKALEMIA
- 146. HYPERKALEMIA
- 148. SEVERE HYPERKALEMIA
- 149. HYPOKALEMIA
- 150. HYPOKALEMIA
- 151. HYPOKALEMIA
- 153. ACUTE PERICARDITIS
- 154. ACUTE PERICARDITIS
- 155. Thank you
Editor's Notes
- Atrial depolarisation Electrically both atria act almost as one. They have relatively little muscle and generate a single, small P wave. P wave amplitude rarely exceeds two and a half small squares (0.25 mV). The duration of the P wave should not exceed three small squares (0.12 s). The wave of depolarisation is directed inferiorly and towards the left, and thus the P wave tends to be upright in leads I and II and inverted in lead aVR. Sinus P waves are usually most prominently seen in leads II and V1. A negative P wave in lead I may be due to incorrect recording of the electrocardiogram (that is, with transposition of the left and right arm electrodes), dextrocardia, or abnormal atrial rhythms. Normal P waves may have a slight notch, particularly in the precordial (chest) leads. Bifid P waves result from slight asynchrony between right and left atrial depolarisation. A pronounced notch with a peaktopeak interval of > 1 mm (0.04 s) is usually pathological, and is seen in association with a left atrial abnormality—for example, in mitral stenosis.
- The R wave in lead V6 is smaller than the R wave in V5, since the V6 electrode is further from the left ventricle. The depth of the S wave, generally, should not exceed 30 mm in a normal individual (although > 30 mm are occasionally recorded in normal young male adults) In another website it is also shown that small q wave seen in leads III and aVF Normal q-waves reflect normal septal activation (beginning on the LV septum); they are narrow (<0.04s duration) and small (<25% the amplitude of the R wave). They are often seen in leads I and aVL when the QRS axis is to the left of +60o, and in leads II, III, aVF when the QRS axis is to the right of +60o. Septal q waves should not be confused with the pathologic Q waves of myocardial infarction (http://medstat.med.utah.edu/kw/ecg/ecg_outline/Lesson3/index.html)
- Sokolow + Lyon (Am Heart J, 1949;37:161) S V1+ R V5 or V6 > 35 mm Cornell criteria (Circulation, 1987;3: 565-72) SV3 + R avl > 28 mm in men SV3 + R avl > 20 mm in women Framingham criteria (Circulation,1990; 81:815-820) R avl > 11mm, R V4-6 > 25mm S V1-3 > 25 mm S V1 or V2 + R V5 or V6 > 35 mm R I + S III > 25 mm Romhilt + Estes (Am Heart J, 1986:75:752-58) Point score system
- Sokolow + Lyon (Am Heart J, 1949;37:161) S V1+ R V5 or V6 > 35 mm Cornell criteria (Circulation, 1987;3: 565-72) SV3 + R avl > 28 mm in men SV3 + R avl > 20 mm in women Framingham criteria (Circulation,1990; 81:815-820) R avl > 11mm, R V4-6 > 25mm S V1-3 > 25 mm S V1 or V2 + R V5 or V6 > 35 mm R I + S III > 25 mm Romhilt + Estes (Am Heart J, 1986:75:752-58) Point score system
- ST segment depression is always an abnormal finding, although often nonspecific (http://medstat.med.utah.edu/kw/ecg/ecg_outline/Lesson3/index.html)
- As a general rule, T wave amplitude corresponds with the amplitude of the preceding R wave, though the tallest T waves are seen in leads V3 and V4. Tall T waves may be seen in acute myocardial ischaemia and are a feature of hyperkalaemia.
- Poor Man's Guide to upper limits of QT: For HR = 70 bpm, QT<0.40 sec; for every 10 bpm increase above 70 subtract 0.02 sec, and for every 10 bpm decrease below 70 add 0.02 sec. For example: QT < 0.38 @ 80 bpm QT < 0.42 @ 60 bpm