EKG Interpretation .


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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
Transcripts
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

Waveforms

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

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

Slide 12

Differential Diagnosis of Tachycardia

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

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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

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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

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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

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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

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

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

Slide 22

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

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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

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

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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

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

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

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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

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First Degree Heart Block PR interim >200ms

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

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

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Hyperkalemia Tall, restricted and symmetric T waves

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

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

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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

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

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

Slide 42

Digitalis Dubin, fourth ed. 1989

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Lateral MI Reciprocal changes

Slide 44

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

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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

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

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

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

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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

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Ventricular Tachycardia

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Prolonged QT > 450 ms Inferior and anterolateral ischemia

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

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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

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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?

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