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ECGs

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How to read ECGs

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Start to determining:

Heart rate

Rhythm

Electrical axis

Ventricular hypertrophy

Systematically PR interval,RSinterval,! interval,P waves,! waves

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Rule o" thum#

$ne large s%uare &''(min

!wo large s%uare )*'(min

!hree large s%uare )''(min

+our large s%uare *(min

+ive large s%uare -'(min

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.nterpreating ECG :

Patients age

Cardiovacular drug

Electrolite im#alance

.ndication o" ECG

Previous ECG Clinical diagnosis

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!he )/ views o" the heart

!he heart is a three dimensional organ

Six lim# leads and six precordial leads

0eads V),V/,V&,V1 : anterior 

.,2V0,V*,V- : le"t lateral

..,...,2V+ : in"erior 

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!he heart rate o" pediatric varies w age

3ew #orn ))'4)*'

/ years 5*4)/*

1 years *4))*

- years -*4)'' $lder than - years -'4)''

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!achycardia may #e caused #y

Sinus tachycardia

SV!

Ventricular tachycardia

 2trial "i#rilation

 2trial "lutter 

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6radycardia may #e caused #y

Sinus #radycardia

3odal rhythm

/nd degree 2V #loc7

&rd degree 2V #loc7

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Rhythm

P wave in "ront o" each RS

P axis ' to 89' degree

pright in .,..,aV+

 2#normal rhythm: );a#sence o"

P;/;

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 2#normal PR interval

Prolongation o" PR

=myocarditis,2S>,toxicity

digitalis,hyper7alemia,ischaemia? Short PR =@P@,glycogen storage disease

,lown ganong levine syndrome?

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 2#normal RS axis

0e"t axis deviation 02> i" RS Alower limit

R2> : RS greater than the upper limit

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Ventricular hypertrophy

RVH:R2>,RBS in V),SBR in

V-

0VH:R8S in V),V- B&*mm

R in 2V0 B)&mm

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