7/27/2019 Ekgworksheet PRINT

1/1

12LeadEKG.NET Worksheet (MarriottsCriteria)1. Rate (< 60 = Brad y, > 100 = Tachy )

2. Rhyth m (Regular Or irregular- Reg Irreg. / irreg irreg)

3. P Waves Present, if sinu s m easure PR (120-200 mS)

4. QRS ( 60-100 mS)

5. QTc (390-440 mS)

6. Axis (left of -30 = LAD, > +110 = RAD)

7. Blocks (SA blocks, AVHB, RBBB, LBB B, LAFB, LPFB)

8. Ischem ia (T inversio ns, ST depr ession )9. Acute Injury (ST elevation)

10. Infarct (signif ic ant Q or Q equiv alents)

11. Hypertroph y: (RA, LA, RV, LV)

12. Other (WPW, LGL , high o r low K/Ca/Mg, hyp oth ermia, Brugadas)

CHAMBER ENLARGEMENTLeft Atrial Enlargement

1)P-terminal force in V1 (depth x duration ofterminal neg deflection) > 0.04 mm-sec

2)Notched P > 0.12 secs (II)3)P-wave LAD (+15 to90)

Right Atrial Enlargement1)Tall (>2.5mm) peaked P in lead II, III, F, nl

duration

2)P axis > +753)V1 or V2 P > 1.5 mm high

Biatrial Enlargement1)Large diphasic P in V1 > 1.5 up and 1 down2)Tall peaked P V1-3, & wide notched P in limb

leads or V5-63)Increase in amplitude (>2.5) and duration (>0.12)

in limb leads.Left Ventricular Hypertrophy

Quick:S in V1 + R in V6 > 35mmRomhilt & Estes (5 pts or greater = LVH)1) Amplitude ........................................................ 5

Any of the following:a. largest R or S in l imbs>20b. S in V1 or V2 > 30

c. R in V5 or V6 > 302) Strain pattern (V5-6 ST depressions)

without digitalis ............................................... 3with digitalis ........................................ ............ 1

3) Left atrial involvement (terminal neg in V1 P-wave> 1mm down, 0.04 wide) ............................ 3

4)LAD (>-30) ...................................................... 25)QRS > 0.09 ..................................................... 16)Intrinsicoid deflection V5-6 > 0.05sec ............. 1

Right Ventricular Hypertrophy1)RAD > +1102)R > S in V13)R in V1 > 7mm4)S in V1 < 2mm5)QR in V16)RSR in V1, R > 10 mm7)ST deps/T inversions V1-3

Combined Ventricular Hypertrophy1)ECG meets either LVH or RVH criteria2)LVH in precordials, but QRS > +903)R > Q in aVR, S > R in V5, T-inversion V1

PULMONARY EMBOLISM1)S1Q3T3 pattern2)RAD3)Incomplete RBBB, RBBB, transient4)T-wave inversions, V1-V35)Sinus tachycardia6)Inverted Ts in inferior leads

BLOCKSLeft Bundle Branch Block

1)QRS > 0.12 sec2)Broad, monophasic R in I, V5, V6, usually

notched or slurred3)No Q in I, V5, V64)Delayed onset of intrinsicoid deflection (R

peak time) in V5 and V65)ST depressions laterally

Right Bundle Branch Block1)QRS > 0.11 secs2)rSR, rsR in V13)Delayed OID > 0.05 secs4)Wide S in I, V5-6

Left Anterior Fascicular Block1)LAD (> -30)2)qR in I, aVL, rS in II, III, aVF3) QRS < 110mS or 20 mS > than baseline

Left Posterior Fascicular Block1)RAD > +90 {Rule out all other causes first}2)Deep S in I3)Q in III4)QRS < 110mS or 20 mS > than baseline

Bifascicular Block (RBBB + LAFB)

1)QRS > 0.11 secs2)RSR in V1, with broad, slurred R3)Wide, slurred S in I, V5-64)First half of QRS has LAD5)Initial r in inferior leads

LOCATION CRITERIA

Anteroseptal: V1-2Anterior:V3-4Anterolateral:V5-6, I, aVLLateral:I, aVL,V6Inferior: II, III, aVFInferolateral II, III, aVF, V5, V6Posterior:R > S in V1, V2 & R > 0.04 sec

Ischemia- inverted Ts, 0.5 mm ST depressionInjury - ST elevation 1mm, 2-3mm in V1-2Infarct - significant Q, poor R waveprogression in V leads

Right Ventricular:1)Signs of acute inferior or inf/post infarct.2)ST elevation in V1-33)ST elevation in V3R/V4R of 1 mm or more

Myocardial Infarction In LBBB1)Q waves in I, V5 or V62)R-wave progression reversed V1-43)Primary ST/T wave changes

DIFFERENTIALS, ETCRAD

Normal young adults

COPD without cor pulmonale

Lateral MI

LPFB

R > S in V1

Occa. Normal variant in young adults

Posterior infarct

Displacement of heart / CCW Rotation

WPW

R