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Chapter 17 : 

Chapter 17 Putting It All Together

New Ground : 

New Ground Here is the secret of electrocardiographic universe: Know what a normal ECG is supposed to look like. If ECG does NOT fit that pattern, a pathology is present!

10 Questions of the Gram : 

10 Questions of the Gram Systematic approach to examining ECG is best. These are the basic steps of electrocardiography: What is my general impression? Is there anything that sticks out? What is the rate? What are the intervals? What is the rhythm? What is the axis? Is there any hypertrophy? Is there any ischemia or infarction? What is the differential diagnosis of abnormality? How can I put it all together with the patient?

General Impression : 

General Impression Look at ECG, come up with main problem. Mentally compare ECG in question to normal ECG. Note QRS complexes. Note how P waves interact with QRS complexes. T waves: Are they upright? Look at intervals: Longer or shorter than normal? Check axis: Is it in normal quadrant? Check transition in precordial leads. Don’t let details overwhelm you!

Obvious Abnormalities and the Rate : 

Obvious Abnormalities and the Rate Does anything stand out? Any obvious abnormality on ECG? Localize ECG to smaller areas. Use your evaluation to guide your investigation. What is the rate? Don’t come up with just a simple number. Tie the rate to the patient.

Intervals : 

Intervals 1. Intervals are crucial to correct diagnosis. 2. Always measure widest interval and use that to gauge other complexes and leads. 3. Measure PR interval, QRS complex, and QT interval.

PR Interval Presentations : 

PR Interval Presentations

QRS Complex Presentations : 

QRS Complex Presentations

QT Interval Presentations : 

QT Interval Presentations

Rhythm (1 of 2) : 

Rhythm (1 of 2) General: Is rhythm fast or slow? Is rhythm regular or irregular? If irregular, is it regularly irregular or irregularly irregular? P waves 3. Do you see any P waves? 4. Are all P waves the same? 5. Does each QRS complex have a P wave? 6. Is PR interval constant?

Rhythm (2 of 2) : 

Rhythm (2 of 2) QRS complexes: 7. Are P waves and QRS complexes associated with one another? 8. Are QRS complexes narrow or wide? 9. Are QRS complexes grouped or not grouped?

Axis : 

Axis What is the axis? Is axis shifted? Always calculate axis as completely as possible. Is there an increased R:S ratio in V1 or V2?

Differential Diagnosis : 

Differential Diagnosis

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