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Premium member Presentation Transcript ECG: ECGECG: 21/05/2013 2 ECGECG Recording: 21/05/2013 3 ECG RecordingECG Components Diagram : 21/05/2013 4 ECG Components DiagramECG Intervals and Segments: 21/05/2013 5 ECG Intervals and SegmentsNormal ECG Recording: 21/05/2013 6 Normal ECG RecordingThe P wave: 21/05/2013 7 The P wave Represents atrial activation (atrial depolarization). Small +ve wave. Its amplitude 0.1 (up to 0.25) mv. Its duration 0.08 (up t0 0.11) seconds.Abnormalities of P- wave: 21/05/2013 8 Abnormalities of P- wave In left atrial hypertrophy (due to mitral stenosis), the P wave become broad and notched. In right atrial hypertrophy (due to pulmonary hypertension) P wave become tall. In AV nodal rhythm: P wave inverted. In atrial fibrillation: P wave disappear.The QRS complex: 21/05/2013 10 The QRS complex Represents ventricular activation (depolarization). The QRS duration is the duration of ventricular activation (0.06-0.1). Q wave: is –ve wave due to depolarization of interventricular septum. R wave : is a large +ve wave, its amplitude is 10 mm (1 mv), caused by depolarization of the apex and ventricular wall, it is + ve wave. S wave : is a –ve wave, caused by depolarization of the posterobasal part of the left ventricle and pulmonary conus.Abnormalities of QRS complex: 21/05/2013 11 Abnormalities of QRS complex In ventricular hypertrophy. Infarction. Extrasystole. Bundle branch block. Electrolyte disturbance.T wave: 21/05/2013 12 T wave It is a +ve large blunt wave. Represents ventricular activation (ventricular repolarization). Its amplitude 0.2 (up to 0.4) mv. Its duration 0.2 (up to 0.25) second.Abnormalities of T wave: 21/05/2013 13 Abnormalities of T wave Inverted: Myocardial infraction. Ventricular hypertrophy. Extrasystole . Bundle branch block. Digitalis overdosage . 6- Pericarditis Increase amplitude: Sympathetic overactivity . Muscular exercise. HyperkalemiaPowerPoint Presentation: U waveECG Intervals and Segments : 21/05/2013 15 ECG Intervals and SegmentsP-R interval: 21/05/2013 16 P-R interval - From the start of P-wave to the start of R wave. Its range from 0.12 to 0.21 second. It means conduction of cardiac impulse through A-V node. Abnormalities of P-R interval: 1- Prolonged: - First degree of heart block. - Increased vagal tone. 2 - Shortened: - A- V nodal rhythm. - Sympathetic overactivity. - Wolff- Parkinson- white syndrome.Q-T interval: 21/05/2013 17 Q-T interval Start from the onset of Q wave to the end of T wave. Its duration 0.24-0.36 second. It is called electrical systole of the heart. T- Q interval: Start from the end of the T wave to the onset of the next Q wave. It is called electrical diastole. Its duration is about 0.4 second.QT interval: QT interval Prolonged QT : Familial long QT Syndrome (LQTS) Congestive Heart Failure Myocardial Infarction Hypocalcemia & Hypokalaemia Hypomagnesemia Type I Antiarrhythmic drugs & Cispride Rheumatic Fever Myocarditis Congenital Heart Disease Short QT : Digoxin ( Digitalis ) Hypercalcemia HyperkalemiaS-T segment: 21/05/2013 19 S-T segment - Start from the end of S wave to start of T wave. Its duration is about 0.12. Abnormalities of S-T segment : Its deviation upward or downward indicates myocardial damage.PowerPoint Presentation: 21/05/2013 21PowerPoint Presentation: 21/05/2013 22Heart Rate: Heart Rate measurementsECG PAPER: ECG PAPER Light lines small squares- 1 X 1 mm Bold lines large squares 5 X 5 mm Horizontal axis=time 1. Distance across small square=0.04 sec. 2. Distance across large square=0.2 sec. Vertical axis=voltage 1. Distance across small square=0.1 mV 2. Distance across large square=0.5 mVPowerPoint Presentation: For regular H.R. 15 cmWhat is the heart rate?: What is the heart rate? (300 / 6) = 50 bpmWhat is the heart rate?: What is the heart rate? (300 / ~ 4) = ~ 75 bpmNormal H.R. 60-90 bpm Bradycardia less than 60 bpm Tachycardia less than 100 bpm: Normal H.R. 60-90 bpm Bradycardia less than 60 bpm Tachycardia less than 100 bpmRhythm: RhythmNormal Sinus Rhythm – the rules!: Normal Sinus Rhythm – the rules! P before every QRS PR interval <0.2 seconds (5 baby squares) QRS after every P wave QRS <0.12 seconds (3 baby squares) Regular and identical Rate 60-100 bpm <60 bpm – sinus bradycardia >100 bpm – sinus tachycardiaECG Abnormalities: 21/05/2013 33 ECG AbnormalitiesFirst degree AV block: First degree AV blockSecond degree AV block (mobitz I)-Wenckebach: Second degree AV block (mobitz I)-WenckebachThe ECG signs of Infarct!: The ECG signs of Infarct! Abnormal Q waves ST segment elevation (Greater than 1mm in 2 or more adjacent leads) Inverted T wavesST Elevation - Myocardial Infarction: ST Elevation - Myocardial Infarction ST elevation in two or more leads Must be at least 1mm in limb leads Must be at least 2mm in chest leadsCharacteristic changes in AMI: Characteristic changes in AMI ST segment elevation over area of damage ST depression in leads opposite infarction Pathological Q waves Reduced R waves Inverted T wavesST elevation: ST elevation R P Q ST Occurs in the early stages Occurs in the leads facing the infarction Slight ST elevation may be normal in V 1 or V 2Ventricular Fibrillation: Ventricular Fibrillation Disordered ventricular impulses with no coordinated ventricular contraction No cardiac output occurs & pt immediately loses consciousness Can occur with any type of cardiac disease, electrolyte imbalance, hypoxemia, acidosis, shock, drugs ( epi , cocaine) ECG findings Chaotic, irregular complexes; no discrete QRS waveforms Rate: 350-450 bpm Can occur spontaneously or preceded by PVCs or VT Treatment Immediate defibrillation followed by anti-arrhythmic drugs to suppress further ventricular ectopyAtrial flutter: Atrial flutterAtrial fibrillation: Atrial fibrillation You do not have the permission to view this presentation. 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