Gail Walraven, Basic Arrhythmias, Sixth Edition©2006 by Pearson Education, Inc., Upper Saddle River, NJ

Appendix DBasic 12-Lead Interpretation

Gail Walraven, Basic Arrhythmias, Sixth Edition©2006 by Pearson Education, Inc., Upper Saddle River, NJ

Myocardial Damage

Caused by lack of oxygen to heart muscle Ischemia: Initial insult Injury: Damage caused by continued

hypoxia Infarction: Tissue death from prolonged

hypoxia

Gail Walraven, Basic Arrhythmias, Sixth Edition©2006 by Pearson Education, Inc., Upper Saddle River, NJ

Infarction Location

Inferior

Lateral

Anterior

Surface

II, III, aVF

I, aVL, V5, V6

V1, V2, V3, V4

Facing Leads

Gail Walraven, Basic Arrhythmias, Sixth Edition©2006 by Pearson Education, Inc., Upper Saddle River, NJ

Infarction Location

V3 & V4

V2 & V3

V1

These leads…

Anterior wall of the left ventricle

Anterior wall over the septum

Anterior wall of the right ventricle

Are directly over these surfaces

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Grades of Myocardial Damage

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Extent of Infarction

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Ischemic Changes

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Age of Infarction (Transmural MI)

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Infarction Location

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Anterior Wall Infarction (EKG)

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Anterior Wall Infarction (Surfaces)

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Lateral Wall Infarction (EKG)

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Lateral Wall Infarction (Surfaces)

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Inferior Wall Infarction (EKG)

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Inferior Wall Infarction (Surfaces)

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Atrial Enlargement

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Ventricular Enlargement

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Rule of 35

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Right Bundle Branch Block

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Left Bundle Branch Block

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Gail Walraven, Basic Arrhythmias, Sixth Edition©2006 by Pearson Education, Inc., Upper Saddle River, NJ

Gail Walraven, Basic Arrhythmias, Sixth Edition©2006 by Pearson Education, Inc., Upper Saddle River, NJ

Gail Walraven, Basic Arrhythmias, Sixth Edition©2006 by Pearson Education, Inc., Upper Saddle River, NJ

Gail Walraven, Basic Arrhythmias, Sixth Edition©2006 by Pearson Education, Inc., Upper Saddle River, NJ

Gail Walraven, Basic Arrhythmias, Sixth Edition©2006 by Pearson Education, Inc., Upper Saddle River, NJ

Gail Walraven, Basic Arrhythmias, Sixth Edition©2006 by Pearson Education, Inc., Upper Saddle River, NJ

EKG Abnormalities – P Waves

• Wide, flat P waves• No P waves

Abnormality

Hyperkalemia

Suggestive of

Gail Walraven, Basic Arrhythmias, Sixth Edition©2006 by Pearson Education, Inc., Upper Saddle River, NJ

EKG Abnormalities –QRS ComplexesAbnormality

Widening of QRS Merging QRS and T

Hyperkalemia

Suggestive of

Widening of QRS Hypokalemia

Prolonged QT interval Hypercalcemia

Short QT interval Hypocalcemia

Short QT interval Digitalis Toxicity

Gail Walraven, Basic Arrhythmias, Sixth Edition©2006 by Pearson Education, Inc., Upper Saddle River, NJ

EKG Abnormalities –ST Segments

Abnormality

Disappearing ST segments Hyperkalemia

Suggestive of

ST depression Hypokalemia

Sloping ST segments Depressed, “scooped” ST segments

Digitalis Toxicity

Elevated, concave ST segments Pericarditis

Gail Walraven, Basic Arrhythmias, Sixth Edition©2006 by Pearson Education, Inc., Upper Saddle River, NJ

EKG Abnormalities – T Waves

Abnormality

Tall, peaked T waves Hyperkalemia

Suggestive of

Flattening of T wave Hypokalemia

Diphasic or inverted T waves Digitalis Toxicity

Gail Walraven, Basic Arrhythmias, Sixth Edition©2006 by Pearson Education, Inc., Upper Saddle River, NJ

EKG Abnormalities –U Waves

Abnormality

Development of U waves Hyperkalemia

Suggestive of

Gail Walraven, Basic Arrhythmias, Sixth Edition©2006 by Pearson Education, Inc., Upper Saddle River, NJ

Analysis Format for 12-Lead EKG Interpretation

Gail Walraven, Basic Arrhythmias, Sixth Edition©2006 by Pearson Education, Inc., Upper Saddle River, NJ

Gail Walraven, Basic Arrhythmias, Sixth Edition©2006 by Pearson Education, Inc., Upper Saddle River, NJ

Gail Walraven, Basic Arrhythmias, Sixth Edition©2006 by Pearson Education, Inc., Upper Saddle River, NJ

Gail Walraven, Basic Arrhythmias, Sixth Edition©2006 by Pearson Education, Inc., Upper Saddle River, NJ

Gail Walraven, Basic Arrhythmias, Sixth Edition©2006 by Pearson Education, Inc., Upper Saddle River, NJ

Gail Walraven, Basic Arrhythmias, Sixth Edition©2006 by Pearson Education, Inc., Upper Saddle River, NJ

Gail Walraven, Basic Arrhythmias, Sixth Edition©2006 by Pearson Education, Inc., Upper Saddle River, NJ

Gail Walraven, Basic Arrhythmias, Sixth Edition©2006 by Pearson Education, Inc., Upper Saddle River, NJ

Miscellaneous Abnormalities, cont.

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Miscellaneous Abnormalities, cont.

Gail Walraven, Basic Arrhythmias, Sixth Edition©2006 by Pearson Education, Inc., Upper Saddle River, NJ

Miscellaneous Abnormalities, cont.

Gail Walraven, Basic Arrhythmias, Sixth Edition©2006 by Pearson Education, Inc., Upper Saddle River, NJ

12-Lead EKG (Practice Tracing #1)

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12-Lead EKG (Practice Tracing #2)

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12-Lead EKG (Practice Tracing #3)

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12-Lead EKG (Practice Tracing #4)

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12-Lead EKG (Practice Tracing #5)

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12-Lead EKG (Practice Tracing #6)

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12-Lead EKG (Practice Tracing #7)

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12-Lead EKG (Practice Tracing #8)

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12-Lead EKG (Practice Tracing #9)

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12-Lead EKG (Practice Tracing #10)

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12-Lead EKG (Practice Tracing #11)

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12-Lead EKG (Practice Tracing #12)

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12-Lead EKG (Practice Tracing #13)

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12-Lead EKG (Practice Tracing #14)

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12-Lead EKG (Practice Tracing #15)

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12-Lead EKG (Practice Tracing #16)

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12-Lead EKG (Practice Tracing #17)

Gail Walraven, Basic Arrhythmias, Sixth Edition©2006 by Pearson Education, Inc., Upper Saddle River, NJ

12-Lead EKG (Practice Tracing #18)