EKG Interpretation UNC Emergency Medicine Medical Student Lecture SeriesSlide 2
Objectives The Basics Interpretation Clinical Pearls Practice RecognitionSlide 3
The Normal Conduction SystemSlide 4
Lead Placement aVFSlide 5
All Limb LeadsSlide 6
Precordial LeadsSlide 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 V6Slide 8
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 IschemiaSlide 10
Rate Rule of 300-Divide 300 by the quantity of boxes between each QRS = rateSlide 11
Rate HR of 60-100 every moment is typical HR > 100 = tachycardia HR < 60 = bradycardiaSlide 12
Differential Diagnosis of TachycardiaSlide 13
What is the heart rate? www.uptodate.com (300/6) = 50 bpmSlide 14
Rhythm Sinus Originating from SA hub P wave before each QRS P wave in same heading as QRSSlide 15
What is this cadence? Ordinary sinus cadenceSlide 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 HRSlide 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 ICPSlide 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 separatedSlide 19
What is this mood? To begin with degree AV piece PR is settled and longer than 0.2 secSlide 20
What is this musicality? Sort 1 second degree square (Wenckebach)Slide 21
What is this cadence? Sort 2 second degree AV square Dropped QRSSlide 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 typicalSlide 24
The Quadrant Approach QRS up in I and up in aVF = NormalSlide 25
What is the hub? Ordinary QRS up in I and aVFSlide 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 = LVHSlide 27
Ischemia Usually demonstrated by ST changes Elevation = Acute dead tissue Depression = Ischemia Can show as T wave changes Remote ischemia appeared by q wavesSlide 28
What is the determination? Intense second rate MI with ST height in leads II, III, aVFSlide 29
What do you find in this EKG? ST dejection II, III, aVF, V3-V6 = ischemiaSlide 30
Let\'s Practice The specimen EKGs were gotten from the accompanying content:Slide 31
Normal Sinus Rhythm Mattu, 2003Slide 32
First Degree Heart Block PR interim >200msSlide 33
Accelerated Idioventricular Ventricular escape cadence, 40-110 bpm Seen in AMI, a marker of reperfusionSlide 34
Junctional Rhythm Rate 40-60, no p waves, limit complex QRSSlide 35
Hyperkalemia Tall, restricted and symmetric T wavesSlide 36
Wellen\'s Sign ST rise and biphasic T wave in V2 and V3 Sign of vast proximal LAD injurySlide 37
Brugada Syndrome RBBB or fragmented RBBB in V1-V3 with raised ST riseSlide 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 ICDSlide 39
Premature Atrial Contractions Trigeminy designSlide 40
Atrial Flutter with Variable Block Sawtooth waves Typically at HR of 150Slide 41
Torsades de Pointes Notice winding example Treatment: Magnesium 2 grams IVSlide 42
Digitalis Dubin, fourth ed. 1989Slide 43
Lateral MI Reciprocal changesSlide 44
Inferolateral MI ST rise II, III, aVF ST discouragement in aVL, V1-V3 are proportional changesSlide 45
Anterolateral/Inferior Ischemia LVH, AV junctional cadence, bradycardiaSlide 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 discoveringSlide 47
Right Bundle Branch Block V1: RSR prime example with transformed T wave V6: Wide profound slurred S waveSlide 48
First Degree Heart Block, Mobitz Type I (Wenckebach) PR dynamically protracts until QRS dropsSlide 49
Supraventricular Tachycardia Retrograde P waves Narrow unpredictable, standard; retrograde P waves, rate <220Slide 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 EKGSlide 51
Ventricular TachycardiaSlide 52
Prolonged QT > 450 ms Inferior and anterolateral ischemiaSlide 53
Second Degree Heart Block, Mobitz Type II PR interim settled, QRS dropped irregularlySlide 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 RADSlide 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 MISlide 56
Hypokalemia U waves Can likewise observe PVCs, ST sadness, little T wavesSlide 58
Thank You Any Questions?
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