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ECG interpretation
Dr. Shamim NassrallyBSc (Hons) MB ChB MRCP(UK)
Clinical Teaching Fellow
Objectives
By the end of this session you should be able to:
Interpret ECGs using a systematic approach
Recognise important ECG abnormalities: acute coronary syndrome acute myocardial infarction common arrhythmias.
Framework
Basic information/Demographics Rate Rhythm Axis P wave and PR interval QRS complex ST segment
Basic information
Identifying information: name/unit number Date/time Voltage (10mm/mV) Speed (25mm/s)
Rate
300/number large squares
Normal: 60-100bpm <60 = bradycardia >100 = tachycardia
Rhythm Are there P-waves? Is each P followed by a QRS? Is each QRS preceded by a P wave?
AF/atrial flutter Supraventricular tachycardias Heart block:
1st degree 2nd degree (Mobitz type 1 and type 2) 3rd degree (complete heart block)
P wave and PR interval
Normal P wave <2.5mm high, <0.11s
Normal PR interval 0.12-0.2s (3-5 small squares)
Axis
I and II positive = normal axis I positive + III negative = left axis deviation I negative + III positive = right axis deviation
QRS complex
Normal QRS <0.12s (3 small squares)
LVH criteria
Wide QRS Left bundle branch block Right bundle branch block
ST segment
ST elevation: MI, left bundle branch block ST depression: ischaemia, posterior MI,
digoxin
T-wave: Tall – hyperkalaemia, left bundle branch block Flat – ischaemia, hypokalaemia
Quiz
Rate Rhythm P wave, PR interval Axis QRS complex ST segment T waves