EKG Interpretation .

Uploaded on:
Category: Art / Culture
Destinations. The BasicsInterpretationClinical PearlsPractice Recognition. The Normal Conduction System. Lead Placement. aVF. All Limb Leads. Precordial Leads. EKG Distributions. Anteroseptal: V1, V2, V3, V4Anterior: V1
Slide 1

EKG Interpretation UNC Emergency Medicine Medical Student Lecture Series

Slide 2

Objectives The Basics Interpretation Clinical Pearls Practice Recognition

Slide 3

The Normal Conduction System

Slide 4

Lead Placement aVF

Slide 5

All Limb Leads

Slide 6

Precordial Leads

Slide 7

EKG Distributions Anteroseptal: V1, V2, V3, V4 Anterior: V1–V4 Anterolateral: V4–V6, I, aVL Lateral: I and aVL Inferior: II, III, and aVF Inferolateral: II, III, aVF, and V5 and V6

Slide 8


Slide 9

Interpretation Develop a methodical way to deal with perusing EKGs and utilize it each time The framework we will practice is: Rate Rhythm (counting interims and squares) Axis Hypertrophy Ischemia

Slide 10

Rate Rule of 300-Divide 300 by the quantity of boxes between each QRS = rate

Slide 11

Rate HR of 60-100 every moment is typical HR > 100 = tachycardia HR < 60 = bradycardia

Slide 12

Differential Diagnosis of Tachycardia

Slide 13

What is the heart rate? www.uptodate.com (300/6) = 50 bpm

Slide 14

Rhythm Sinus Originating from SA hub P wave before each QRS P wave in same heading as QRS

Slide 15

What is this cadence? Ordinary sinus cadence

Slide 16

Normal Intervals PR 0.20 sec (short of what one extensive box) QRS 0.08 – 0.10 sec (1-2 little boxes) QT 450 ms in men, 460 ms in ladies Based on sex/heart rate Half the R-R interim with typical HR

Slide 17

Prolonged QT Normal Men 450ms Women 460ms Corrected QT (QTc) QTm/√(R-R) Causes Drugs (Na channel blockers) Hypocalcemia, hypomagnesemia, hypokalemia Hypothermia AMI Congenital Increased ICP

Slide 18

Blocks AV pieces First degree square PR interim settled and > 0.2 sec Second degree piece, Mobitz sort 1 PR step by step extended, then drop QRS Second degree piece, Mobitz sort 2 PR settled, yet drop QRS arbitrarily Type 3 piece PR and QRS separated

Slide 19

What is this mood? To begin with degree AV piece PR is settled and longer than 0.2 sec

Slide 20

What is this musicality? Sort 1 second degree square (Wenckebach)

Slide 21

What is this cadence? Sort 2 second degree AV square Dropped QRS

Slide 22

What is this mood? 3 rd degree heart square (entire)

Slide 23

The QRS Axis Represents the general course of the heart\'s action Axis of –30 to +90 degrees is typical

Slide 24

The Quadrant Approach QRS up in I and up in aVF = Normal

Slide 25

What is the hub? Ordinary QRS up in I and aVF

Slide 26

Hypertrophy Add the bigger S wave of V1 or V2 in mm, to the bigger R wave of V5 or V6. Entirety is > 35mm = LVH

Slide 27

Ischemia Usually demonstrated by ST changes Elevation = Acute dead tissue Depression = Ischemia Can show as T wave changes Remote ischemia appeared by q waves

Slide 28

What is the determination? Intense second rate MI with ST height in leads II, III, aVF

Slide 29

What do you find in this EKG? ST dejection II, III, aVF, V3-V6 = ischemia

Slide 30

Let\'s Practice The specimen EKGs were gotten from the accompanying content:

Slide 31

Normal Sinus Rhythm Mattu, 2003

Slide 32

First Degree Heart Block PR interim >200ms

Slide 33

Accelerated Idioventricular Ventricular escape cadence, 40-110 bpm Seen in AMI, a marker of reperfusion

Slide 34

Junctional Rhythm Rate 40-60, no p waves, limit complex QRS

Slide 35

Hyperkalemia Tall, restricted and symmetric T waves

Slide 36

Wellen\'s Sign ST rise and biphasic T wave in V2 and V3 Sign of vast proximal LAD injury

Slide 37

Brugada Syndrome RBBB or fragmented RBBB in V1-V3 with raised ST rise

Slide 38

Brugada Syndrome Autosomal predominant hereditary transformation of sodium channels Causes syncope, v-lie, self ending VT, and sudden cardiovascular passing Can be irregular on EKG Most regular in moderately aged guys Can be incited in EP lab Need ICD

Slide 39

Premature Atrial Contractions Trigeminy design

Slide 40

Atrial Flutter with Variable Block Sawtooth waves Typically at HR of 150

Slide 41

Torsades de Pointes Notice winding example Treatment: Magnesium 2 grams IV

Slide 42

Digitalis Dubin, fourth ed. 1989

Slide 43

Lateral MI Reciprocal changes

Slide 44

Inferolateral MI ST rise II, III, aVF ST discouragement in aVL, V1-V3 are proportional changes

Slide 45

Anterolateral/Inferior Ischemia LVH, AV junctional cadence, bradycardia

Slide 46

Left Bundle Branch Block Monophasic R wave in I and V6, QRS > 0.12 sec Loss of R wave in precordial leads QRS T wave conflict I, V1, V6 Consider cardiovascular ischemia if another discovering

Slide 47

Right Bundle Branch Block V1: RSR prime example with transformed T wave V6: Wide profound slurred S wave

Slide 48

First Degree Heart Block, Mobitz Type I (Wenckebach) PR dynamically protracts until QRS drops

Slide 49

Supraventricular Tachycardia Retrograde P waves Narrow unpredictable, standard; retrograde P waves, rate <220

Slide 50

Right Ventricular Myocardial Infarction Found in 1/3 of patients with mediocre MI Increased horribleness and mortality ST rise in V4-V6 of Right-sided EKG

Slide 51

Ventricular Tachycardia

Slide 52

Prolonged QT > 450 ms Inferior and anterolateral ischemia

Slide 53

Second Degree Heart Block, Mobitz Type II PR interim settled, QRS dropped irregularly

Slide 54

Acute Pulmonary Embolism S I Q III T III in 10-15% T-wave reversals, particularly happening in substandard and anteroseptal all the while RAD

Slide 55

Wolff-Parkinson-White Syndrome Short PR interim <0.12 sec Prolonged QRS >0.10 sec Delta wave Can reenact ventricular hypertrophy, BBB and past MI

Slide 56

Hypokalemia U waves Can likewise observe PVCs, ST sadness, little T waves

Slide 58

Thank You Any Questions?

View more...