ECGs (again!)

Mary L. Dohrmann, MDProfessor of Clinical Medicine

Division of Cardiovascular Medicine

ECG Interpretation

Practice!

Practice!

Practice!

http://ecg.bidmc.harvard.edu/maven/mavenmain.asp

What is ECG Wave-Maven?Proficiency in electrocardiogram (ECG) interpretation is an essential skill for medical students, housestaff, and clinicians. However, medical school and postgraduate resources to develop and upgrade the necessary high level of "ECG literacy" are severely limited. Further, current textbook and classroom instructional materials do not adequately integrate ECG interpretation into specific contexts where waveform findings must be correlated with other clinical data. We have begun to address the limitations in traditional approaches to ECG pedagogy by creating the infrastructure for a unique web-based tutorial.

ECG Interpretation

Observation

Conclusion

Clinical context/significance

Rhythm

Sinus Not sinus

VentricularSupravent.Morphology

Morphology Hierarchy

WPW > LBBB > LVH > MI

The Normal ECG

The Normal ECG

Sinus rhythm (P before @ QRS)

Rate 50 – 100 bpm

Axis +90o to –30o

Intervals: PR .12-.21 sec

QRS <.10 sec

QTc <.46 sec (observed QT⁄ √ (RR) interval)

51 y/o male with chest pain100% occlusion of a diagonal

(also had 3 vessel disease, normal LVEF)

29 y/o with chest painDiffuse ST elevation c/w pericarditis,

?PR segment depression

47 y/o male with chest painAcute inferior MI – culprit vessel RCA

41 y/o male with severe SOBExtensive anterior/anterolateral MI

54 y/o male with exertional chest painAMI, indeterminate age; RBBB and left axis

60 y/o comatose s/p MVALow voltage

Simple cifferential of low voltage: air, fat, fluid, no muscle

60 y/o with chest painLVH with LAD, ST-T abn, & LAE

In patient with angina and LVH, always think of aortic stenosis and hypertrophic cardiomyopathy in differential diagnosis

40 y/o with chest pain & palpitationsshort PR/delta wave c/w preexcitation

(WPW) – note pseudo-Qs inferiorly

70 y/o with exertional chest painLBBB

If need stress test in this patient, use pharmacologic stress with adenosine combined with imaging modality (sestamibi or cardiac MRI)