logging in or signing up part II sayedsileem Download Post to : URL : Related Presentations : Share Add to Flag Embed Email Send to Blogs and Networks Add to Channel Uploaded from authorPOINT lite Insert YouTube videos in PowerPont slides with aS Desktop Copy embed code: (To copy code, click on the text box) Embed: URL: Thumbnail: WordPress Embed Customize Embed The presentation is successfully added In Your Favorites. Views: 21 Category: Science & Tech.. License: All Rights Reserved Like it (0) Dislike it (0) Added: January 12, 2012 This Presentation is Public Favorites: 0 Presentation Description ecg part ii Comments Posting comment... Premium member Presentation Transcript Simplified ECG part II : Simplified ECG part II Sayed Syleem, MSc Cardiologist Kafr Saad central hospital 2010و في الأرضِ آياتٌ للموقنينَ * و في أنفُسِكم أفلا تُبْصِرونَ * : و في الأرضِ آياتٌ للموقنينَ * و في أنفُسِكم أفلا تُبْصِرونَ * الذاريات 20 و 21ECG Monitoring: ECG Monitoring Unipolar Leads 1 positive electrode 1 negative “reference point” calculated by using summation of 2 negative leads Augmented Limb Leads aVR, aVF, aVL vertical plane Precordial or Chest Leads V1-V6 horizontal planePowerPoint Presentation: P Wave first upward deflection represents atrial depolarization usually 0.10 seconds or less usually followed by QRS complexPowerPoint Presentation: PR Interval time impulse takes to move through atria and AV node from beginning of P wave to next deflection on baseline (beginning of QRS complex) normally 0.12 - 0.2 sec may be shorter with faster ratesPowerPoint Presentation: Q Wave first negative deflection after P wave depolarization of septum not always seen R Wave first positive deflection following P or Q waves subsequent positive deflections are R’, R”, etc S Wave Negative deflection following R wave subsequent negative deflections are S’, S”, etc may be part of QS complex absent R wave in aberrant conductionPowerPoint Presentation: QRS Complex Composition of 3 Waves Q, R & S represents ventricular depolarization much variability usually < 0.12 secPowerPoint Presentation: QRS Interval time impulse takes to depolarize ventricles from beginning of Q wave to beginning of ST segment usually < 0.12 sec J Point point where QRS complex returns to isoelectric line beginning of ST segment critical in measuring ST segment elevationPowerPoint Presentation: T Wave repolarization of ventricles concurrent with end of ventricular systolePowerPoint Presentation: ST Segment early repolarization of ventricles measured from J point to onset of T wave elevation or depression may indicate abnormalityComponents of a NSR: Components of a NSRPaper Speed: Paper SpeedDetermining heart rate: Determining heart rate Regular beats Rapid [ 1500 / number of small squares () RR] Slow [ 300 / number of large squares () RR] Irregular beats Rapid [number of QRS in 10 LS x 30 ] Slow [number of QRS in 30 LS x 10 ]Determine the HR in A, B, & C: Determine the HR in A, B, & CDetermining AXIS : Determining AXIS Rough method From I & avF Hexagonal method From I & avFPowerPoint Presentation: The normal QRS axis lies between -30 o and +90 o . 0 o 30 o -30 o 60 o -60 o -90 o -120 o 90 o 120 o 150 o 180 o -150 o A QRS axis that falls between -30 o and -90 o is abnormal and called left axis deviation . A QRS axis that falls between +90 o and +150 o is abnormal and called right axis deviation . A QRS axis that falls between +150 o and -90 o is abnormal and called superior right axis deviation .PowerPoint Presentation: Each frontal lead corresponds to a location on the circle. 0 o 30 o -30 o 60 o -60 o -90 o -120 o 90 o 120 o 150 o 180 o -150 o I II avF avL avR Limb leads I = +0 o II = +60 o III = +120 o Augmented leads avL = -30 o avF = +90 o avR = -150 o I II IIIPowerPoint Presentation: 0 o 30 o -30 o 60 o -60 o -90 o -120 o 90 o 120 o 150 o 180 o -150 o Since lead I is orientated at 0 o a wave of depolarization directed towards it will result in a positive QRS axis. Therefore any mean QRS vector between -90 o and +90 o will be positive. IPowerPoint Presentation: 0 o 30 o -30 o 60 o -60 o -90 o -120 o 90 o 120 o 150 o 180 o -150 o Since lead I is orientated at 0 o a wave of depolarization directed towards it will result in a positive QRS axis. Therefore any mean QRS vector between -90 o and +90 o will be positive. Similarly, since lead II is orientated at 60 o a wave of depolarization directed towards it will result in a positive QRS axis. Therefore any mean QRS vector between -30 o and +150 o will be positive. I IIPowerPoint Presentation: 0 o 30 o -30 o 60 o -60 o -90 o -120 o 90 o 120 o 150 o 180 o -150 o Since lead I is orientated at 0 o a wave of depolarization directed towards it will result in a positive QRS axis. Therefore any mean QRS vector between -90 o and +90 o will be positive. Similarly, since lead II is orientated at 60 o a wave of depolarization directed towards it will result in a positive QRS axis. Therefore any mean QRS vector between -30 o and +150 o will be positive. Therefore, if the QRS complex is positive in both leads I and II the QRS axis must be between -30 o and 90 o (where leads I and II overlap) and, as a result, the axis must be normal. I IIPowerPoint Presentation: 0 o 30 o -30 o 60 o -60 o -90 o -120 o 90 o 120 o 150 o 180 o -150 o 0 o 30 o -30 o 60 o -60 o -90 o -120 o 90 o 120 o 150 o 180 o -150 o Now using what you just learned fill in the following table. For example, if the QRS is positive in lead I and negative in lead II what is the QRS axis? (normal, left, right or right superior axis deviation) QRS Complexes I Axis I II + + + - normal left axis deviation IIPowerPoint Presentation: 0 o 30 o -30 o 60 o -60 o -90 o -120 o 90 o 120 o 150 o 180 o -150 o 0 o 30 o -30 o 60 o -60 o -90 o -120 o 90 o 120 o 150 o 180 o -150 o … if the QRS is negative in lead I and positive in lead II what is the QRS axis? (normal, left, right or right superior axis deviation) QRS Complexes I Axis I II + + + - - + normal left axis deviation right axis deviation IIPowerPoint Presentation: 0 o 30 o -30 o 60 o -60 o -90 o -120 o 90 o 120 o 150 o 180 o -150 o … if the QRS is negative in lead I and negative in lead II what is the QRS axis? (normal, left, right or right superior axis deviation) QRS Complexes I Axis I II + + + - - + - - normal left axis deviation right axis deviation right superior axis deviation 0 o 30 o -30 o 60 o -60 o -90 o -120 o 90 o 120 o 150 o 180 o -150 o IIPowerPoint Presentation: Is the QRS axis normal in this ECG? No, there is left axis deviation. The QRS is positive in I and negative in II.Rotation: RotationThe END next..( Part III ): The END next..( Part III ) You do not have the permission to view this presentation. In order to view it, please contact the author of the presentation.
part II sayedsileem Download Post to : URL : Related Presentations : Share Add to Flag Embed Email Send to Blogs and Networks Add to Channel Uploaded from authorPOINT lite Insert YouTube videos in PowerPont slides with aS Desktop Copy embed code: (To copy code, click on the text box) Embed: URL: Thumbnail: WordPress Embed Customize Embed The presentation is successfully added In Your Favorites. Views: 21 Category: Science & Tech.. License: All Rights Reserved Like it (0) Dislike it (0) Added: January 12, 2012 This Presentation is Public Favorites: 0 Presentation Description ecg part ii Comments Posting comment... Premium member Presentation Transcript Simplified ECG part II : Simplified ECG part II Sayed Syleem, MSc Cardiologist Kafr Saad central hospital 2010و في الأرضِ آياتٌ للموقنينَ * و في أنفُسِكم أفلا تُبْصِرونَ * : و في الأرضِ آياتٌ للموقنينَ * و في أنفُسِكم أفلا تُبْصِرونَ * الذاريات 20 و 21ECG Monitoring: ECG Monitoring Unipolar Leads 1 positive electrode 1 negative “reference point” calculated by using summation of 2 negative leads Augmented Limb Leads aVR, aVF, aVL vertical plane Precordial or Chest Leads V1-V6 horizontal planePowerPoint Presentation: P Wave first upward deflection represents atrial depolarization usually 0.10 seconds or less usually followed by QRS complexPowerPoint Presentation: PR Interval time impulse takes to move through atria and AV node from beginning of P wave to next deflection on baseline (beginning of QRS complex) normally 0.12 - 0.2 sec may be shorter with faster ratesPowerPoint Presentation: Q Wave first negative deflection after P wave depolarization of septum not always seen R Wave first positive deflection following P or Q waves subsequent positive deflections are R’, R”, etc S Wave Negative deflection following R wave subsequent negative deflections are S’, S”, etc may be part of QS complex absent R wave in aberrant conductionPowerPoint Presentation: QRS Complex Composition of 3 Waves Q, R & S represents ventricular depolarization much variability usually < 0.12 secPowerPoint Presentation: QRS Interval time impulse takes to depolarize ventricles from beginning of Q wave to beginning of ST segment usually < 0.12 sec J Point point where QRS complex returns to isoelectric line beginning of ST segment critical in measuring ST segment elevationPowerPoint Presentation: T Wave repolarization of ventricles concurrent with end of ventricular systolePowerPoint Presentation: ST Segment early repolarization of ventricles measured from J point to onset of T wave elevation or depression may indicate abnormalityComponents of a NSR: Components of a NSRPaper Speed: Paper SpeedDetermining heart rate: Determining heart rate Regular beats Rapid [ 1500 / number of small squares () RR] Slow [ 300 / number of large squares () RR] Irregular beats Rapid [number of QRS in 10 LS x 30 ] Slow [number of QRS in 30 LS x 10 ]Determine the HR in A, B, & C: Determine the HR in A, B, & CDetermining AXIS : Determining AXIS Rough method From I & avF Hexagonal method From I & avFPowerPoint Presentation: The normal QRS axis lies between -30 o and +90 o . 0 o 30 o -30 o 60 o -60 o -90 o -120 o 90 o 120 o 150 o 180 o -150 o A QRS axis that falls between -30 o and -90 o is abnormal and called left axis deviation . A QRS axis that falls between +90 o and +150 o is abnormal and called right axis deviation . A QRS axis that falls between +150 o and -90 o is abnormal and called superior right axis deviation .PowerPoint Presentation: Each frontal lead corresponds to a location on the circle. 0 o 30 o -30 o 60 o -60 o -90 o -120 o 90 o 120 o 150 o 180 o -150 o I II avF avL avR Limb leads I = +0 o II = +60 o III = +120 o Augmented leads avL = -30 o avF = +90 o avR = -150 o I II IIIPowerPoint Presentation: 0 o 30 o -30 o 60 o -60 o -90 o -120 o 90 o 120 o 150 o 180 o -150 o Since lead I is orientated at 0 o a wave of depolarization directed towards it will result in a positive QRS axis. Therefore any mean QRS vector between -90 o and +90 o will be positive. IPowerPoint Presentation: 0 o 30 o -30 o 60 o -60 o -90 o -120 o 90 o 120 o 150 o 180 o -150 o Since lead I is orientated at 0 o a wave of depolarization directed towards it will result in a positive QRS axis. Therefore any mean QRS vector between -90 o and +90 o will be positive. Similarly, since lead II is orientated at 60 o a wave of depolarization directed towards it will result in a positive QRS axis. Therefore any mean QRS vector between -30 o and +150 o will be positive. I IIPowerPoint Presentation: 0 o 30 o -30 o 60 o -60 o -90 o -120 o 90 o 120 o 150 o 180 o -150 o Since lead I is orientated at 0 o a wave of depolarization directed towards it will result in a positive QRS axis. Therefore any mean QRS vector between -90 o and +90 o will be positive. Similarly, since lead II is orientated at 60 o a wave of depolarization directed towards it will result in a positive QRS axis. Therefore any mean QRS vector between -30 o and +150 o will be positive. Therefore, if the QRS complex is positive in both leads I and II the QRS axis must be between -30 o and 90 o (where leads I and II overlap) and, as a result, the axis must be normal. I IIPowerPoint Presentation: 0 o 30 o -30 o 60 o -60 o -90 o -120 o 90 o 120 o 150 o 180 o -150 o 0 o 30 o -30 o 60 o -60 o -90 o -120 o 90 o 120 o 150 o 180 o -150 o Now using what you just learned fill in the following table. For example, if the QRS is positive in lead I and negative in lead II what is the QRS axis? (normal, left, right or right superior axis deviation) QRS Complexes I Axis I II + + + - normal left axis deviation IIPowerPoint Presentation: 0 o 30 o -30 o 60 o -60 o -90 o -120 o 90 o 120 o 150 o 180 o -150 o 0 o 30 o -30 o 60 o -60 o -90 o -120 o 90 o 120 o 150 o 180 o -150 o … if the QRS is negative in lead I and positive in lead II what is the QRS axis? (normal, left, right or right superior axis deviation) QRS Complexes I Axis I II + + + - - + normal left axis deviation right axis deviation IIPowerPoint Presentation: 0 o 30 o -30 o 60 o -60 o -90 o -120 o 90 o 120 o 150 o 180 o -150 o … if the QRS is negative in lead I and negative in lead II what is the QRS axis? (normal, left, right or right superior axis deviation) QRS Complexes I Axis I II + + + - - + - - normal left axis deviation right axis deviation right superior axis deviation 0 o 30 o -30 o 60 o -60 o -90 o -120 o 90 o 120 o 150 o 180 o -150 o IIPowerPoint Presentation: Is the QRS axis normal in this ECG? No, there is left axis deviation. The QRS is positive in I and negative in II.Rotation: RotationThe END next..( Part III ): The END next..( Part III )