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A Simplified ECG Guide

A prolonged QT interval on an electrocardiogram may indicate a risk for a dangerous heart arrhythmia called Torsades de Pointes. Causes of a prolonged QT interval include certain medications, electrolyte abnormalities, central nervous system diseases, and congenital heart defects. Right or left bundle branch block is identified on an ECG by a widened QRS complex, as the electrical signal takes longer to pass through the blocked part of the heart. Bundle branch blocks can suggest underlying heart disease or pressure on the heart.

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Marian Ioan-Lucian
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145 views4 pages

A Simplified ECG Guide

A prolonged QT interval on an electrocardiogram may indicate a risk for a dangerous heart arrhythmia called Torsades de Pointes. Causes of a prolonged QT interval include certain medications, electrolyte abnormalities, central nervous system diseases, and congenital heart defects. Right or left bundle branch block is identified on an ECG by a widened QRS complex, as the electrical signal takes longer to pass through the blocked part of the heart. Bundle branch blocks can suggest underlying heart disease or pressure on the heart.

Uploaded by

Marian Ioan-Lucian
Copyright
© Attribution Non-Commercial (BY-NC)
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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Basic:

Rate:

-4c
QT interval to eart rate! "aster eart #eats "aster ventricles '!e!( )normal* QT varies wit Intervals:
re$olari%e & orter QT interval! eart rate!

"or eac eart rate( calc+late an ad,+sted QT interval( called t e-

PR
0.12 - 0.20 seconds (3 - 5 boxes)
< 0.12 s !i"# $%&% states 'ol((-Par)inson-'#ite 0.12-0.20 s $or*al 0.20 s +, nodal bloc)s

5corrected -46 (-4c)

$or*al 7 < 0.// s 8on" -4 : 0.// s

WPW syndrome (delta-wave)

1st Degree AV Block

4i0: -4

#al( RR interval 9 lon".

-R.
0.0/ - 0.12 seconds. (1 - 3 boxes)
< 0.10 s 0.10-0.12 s 0.12 s Inco*0lete BBB $or*al B1ndle Branc# P,2 Bloc) (BBB) ,entric1lar r#3t#*
'ncom$lete #+ndle #ranc #lock .rd degree AV #lock wit ventric+lar esca$e r yt m A prolonged QT may predispose a type of ventricular tachycardia called Torsades de Pointes. Causes include drugs, electrolyte abnormalities, CNS disease, post-M , and congenital heart disease.

!eart +rr#3t#*ias
1. .in1s R#3t#*s .in1s 4ac#3cardia .in1s Brad3cardia Rate: 100 b0* Rate: < :0 b0*

2. Pre*at1re 2ontraction & Beats


+trial (P+2s) ,entric1lar (P,2s) 2onto1r o( P; PR interval; ti*in" di((er /rom normal $+lse /rom &A node and -R. <ill be narro< (0.0/ 0.12 s) (nor*al i*01lse cond1ction in ventricles) 'ide and bi=arre -R. co*0lex(es). a! 0ni/orm - look alike( b. 1+lti/orm - look di//erent

3. .10raventric1lar +rr#3t#*ias

a. +trial >ibrillation (+>)


2o normal P waves( >l1tter <ave. (2o organi%ed atrial de$olari%ation( im$+lses are not /rom sin+s)( atrial activity is c aotic (irreg+lar rate)! 3ommon( a//ects 4-56( +$ to 7-186 i/ 9 :8 years old! D+e to m+lti$le reentry #etween ;A and <A! b. Parox3s*al .10raventric1lar4ac#3cardia (P.,4) !R s1ddenl3 s0eeds 10; o/ten d+e to PA3 and t e P waves are lost! D+e to reentry in AV node! c. +trial >l1tter 2o P waves( 5sa< toot#6 0attern at 250 - 350 b0*. ?nl3 some im$+lses cond+ct t ro+g AV node (+s+ally every ot er im$+lse)! D+e to reentry in <A wit every 4nd( .rd or 5t im$+lse generate a Q<& (ot ers are #locked in AV node as node re$olari%es)! /. ,entric1lar +rr#3t#*ias a. ,entric1lar >ibrillation 2o*0letel3 abnor*al. Ventric+lar cells are e=cita#le and de$olari%ing randomly! 3a+ses ra$id dro$ in 3> and deat b. ,entric1lar 4ac#3cardia 'm$+lse originates in ventricles (no P <aves; <ide -R.). D+e to reentry in ventricle. 5. +, @1nctional Bloc)s a. 1st Ae"ree +, Bloc) PR Interval: 0.20 s; Prolonged cond+ction delay in t e AV node or B+ndle o/ ?is!

b. 2nd Ae"ree +, Bloc); 430e I (Bobit= I& 'enc)ebac#)


PR interval 0ro"ressivel3 len"t#ens; t#en i*01lse is co*0letel3 bloc)ed (P <ave not (ollo<ed b3 -R.). @ac atrial im$+lse ca+ses longer delay in AV node +ntil one im$+lse (+s+ally .rd or 5t ) /ails to cond+ct to AV node!

c. 2nd Ae"ree +, Bloc); 430e II & Bobit= II


is ?ccasional P <aves are co*0letel3 bloc)ed (P <ave not (ollo<ed b3 -R.). 3ond+ction all or not ing (no $rolongation o/ P< interval)A ty$ically #lock occ+rs in t e B+ndle o/ ?is!

d. 3rd Ae"ree +, Bloc)

P <aves are co*0letel3 bloc)ed in t e AV ,+nctionA -R. ori"inate inde$endently (ro* belo< t#e C1nction. (Ventricles $acemaker: aro1nd 30-/5 b0*; cond+ction t ro+g ventricles is ine//icient and t e Q<& will #e wide and #i%arre!)

+xis
A=is re/ers to t e mean -R. axis (or vector) d+ring ventric+lar de$olari%ation! An a#normal a=is can s+ggest disease s+c as $+lmonary y$ertension /rom a $+lmonary em#olism! T e Q<& a=is is determined #y overlying a circle(in t e /rontal $lane! By convention( t e degrees o/ t e circle are as s own! A D+ick way to determine t e Q<& a=is is to look at t e Q<& com$le=es in leads ' and ''! -R. 2o*0lexes I (8) II (R) +xis B B normal B le/t a=is deviation B rig t a=is deviation rig t s+$erior a=is deviation Aia"nosin" a B3ocardial In(arction (BI) >ne way to diagnose an ac+te 1' is to look /or elevation o/ t e &T segment! BI 8ocation BI 8ead Anterior V1 - V5 ;ateral '( aV;( V7 - VC 430es o( BI: 'n/erior ''( ''' aV" .4 (Transm+ral E Q wave) $on-.4 (&+#endocardial E 2on-Q-wave) Isc#e*ia &T de$ression( $eaked T-waves( t en T-wave &T de$ression F T-wave inversion inversion In(arct .4 elevation F a$$earance o/ Q-waves >ibrosis &T and T-waves normali%e( Q-waves $ersist &T normali%e( #+t T-wave inversion $ersists

!eart !30ertro0#3
8e(t atrial enlar"e*ent (8+%)
P wave - atrial de$olari%ation '' - P 9 8!85 s (1 #o=) #etween notc ed $eaks( or

V1 - P 2eg! de/lection 9 1 =1 #o=


3a+se - ;V? /rom y$ertension!

Ri"#t atrial enlar"e*ent (R+%)


'' - P 94!7mm( or V1EV4 - P 91!7mm


3a+se - <V? /rom $+lmonary y$ertension

8e(t ventric1lar #30ertro0#3 (8,!)

< in V7 (or VC) B & in V1 (or V4) 9 .7 mm( or av;- < 9 1. mm


3a+se- y$ertension!

Ri"#t ventric1lar #30ertro0#3 (R,!)


< wave is normally small in V1( V4 #eca+se <V does not ave a lot o/ m+scle mass! B+t in <V? t e < wave is tall in V1( V4! <ig t a=is deviation( and V1 - < 9Gmm tall
3a+se- le/t eart /ail+re!

B1ndle Branc# Bloc)s (BBB)


-R. co*0lex <iden #eca+se w en t e
cond+ction $at way is #locked it will take longer /or t e electrical signal to $ass t ro+g o+t t e ventricles!

8e(t B1ndle Branc# Bloc)s (8BBB)


V1-V4 - Broad( dee$ & waves E W wave

Ri"#t B1ndle Branc# Bloc)s (RBBB)


V1-V4 - )<a##it @ars* E 1 wave

Bi(ascic1lar bloc) H <BBB B le/t #+ndle emi#lock( mani/est as an a=is deviation( eg ;AD in t e case o/ le/t ant! emi#lock! 4ri(ascic1lar bloc) H #i/ascic+lar #lock B 1st degree eart #lock!

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