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ECG at a glance
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7/25/2019 ECG at a glance
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ECG at a glance
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ACTION POTENTIALACTION POTENTIAL PolarizationPolarization
Intracellular is more negative thanIntracellular is more negative than
extracellularextracellular
DepolarizationDepolarization Intracellular becomes more positiveIntracellular becomes more positive
Infux o Na+Infux o Na+
epolarizationepolarization Intracellular restores to its resting potentialIntracellular restores to its resting potential
E!ux o "+E!ux o "+
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ACTION POTENTIALACTION POTENTIAL
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CARDIAC CELLSCARDIAC CELLS
PROPERTIESPROPERTIES
#utomaticit$#utomaticit$
Excitabilit$Excitabilit$
Con%uctivit$Con%uctivit$ Contractilit$Contractilit$
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CONDUCTION SYSTEMCONDUCTION SYSTEM
&inoatrial No%e ' No%e(&inoatrial No%e ' No%e( h$thmic rate ) * , - bpmh$thmic rate ) * , - bpm
Interno%al Path.a$Interno%al Path.a$ #nterior/ mi%%le/ posterior path.a$s#nterior/ mi%%le/ posterior path.a$s
#trioventricular No%e '#0 No%e(#trioventricular No%e '#0 No%e(
egions ) atriono%al '#N(/ no%al 'N(/egions ) atriono%al '#N(/ no%al 'N(/no%al12is 'N2( no%al12is 'N2(
Dela$s the impulseDela$s the impulse
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CONDUCTION SYSTEMCONDUCTION SYSTEM
3un%le o 2is3un%le o 2is ate ) 4 , * bpmate ) 4 , * bpm
3un%le 3ranches3un%le 3ranches 533 6 33533 6 33
533 ) anterior/ posterior/ septal533 ) anterior/ posterior/ septal
asciclesascicles Pur7in8e 9ibersPur7in8e 9ibers ate ) : , 4 bpmate ) : , 4 bpm
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CONDUCTION SYSTEMCONDUCTION SYSTEM
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CONDUCTION SYSTEMCONDUCTION SYSTEM
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LEADSLEADS
&tan%ar% 5imb 5ea%s&tan%ar% 5imb 5ea%s 5ea% I/ II/ III5ea% I/ II/ III
#ugmente% 5imb 5ea%s#ugmente% 5imb 5ea%s a05/ a0/ a09a05/ a0/ a09
Precor%ial 5ea%sPrecor%ial 5ea%s 0-/ 0:/ 0;/ 04/ 0
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LEADSLEADS
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LEADSLEADS
5E#D&5E#D& 0IE= >9 2E#?0IE= >9 2E#?
I/ a05I/ a05 5ateral5ateral
II/ III/ a09II/ III/ a09 IneriorInerior0-/ 0:0-/ 0: &eptal&eptal
0;/ 040;/ 04 #nterior#nterior
0
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ECG WAVEFORMSECG WAVEFORMS
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ECG WAVEFORMSECG WAVEFORMS P .aveP .ave
No more than :@< mm inNo more than :@< mm in
heightheight
No more than @-- sec inNo more than @-- sec in
%uration%uration
Positive ) I/II/a09/0Positive ) I/II/a09/0:1*:1*
Aa$ be positive/ negative/ orAa$ be positive/ negative/ orbiphasic ) III/a05/0biphasic ) III/a05/0--
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ECG WAVEFORMSECG WAVEFORMS P intervalP interval
@-: , @:@-: , @:secsecin a%ult/in a%ult/
ma$ be shorter in chil%renma$ be shorter in chil%ren
an% longer in el%ersan% longer in el%ers
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ECG WAVEFORMSECG WAVEFORMS B& ComplexB& Complex
@* , @- sec@* , @- sec
B ) -B ) -ststnegative %efection ater Pnegative %efection ater P
) - ) -ststpositive %efection ater Ppositive %efection ater P & ) negative %efection ater & ) negative %efection ater
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ECG WAVEFORMSECG WAVEFORMS &? &egment&? &egment
Isoelectric 'fat(Isoelectric 'fat(
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ECG WAVEFORMSECG WAVEFORMS? .ave? .ave
5imb lea% ) no more than < mm 'height(5imb lea% ) no more than < mm 'height(
Precor%ial lea% ) no more than - mmPrecor%ial lea% ) no more than - mm
'height('height(
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ECG WAVEFORMSECG WAVEFORMS
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RATE MEASUREMENTRATE MEASUREMENT
5arge 3oxes5arge 3oxes;1 interval;1 interval
&mall 3oxes&mall 3oxes-
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AXIS DEVIATIONAXIS DEVIATION
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ABNORMALABNORMAL
WAVEFORMSWAVEFORMS PP ) tall/ notche%) tall/ notche% P intervalP interval) prolonge%/ shortene%) prolonge%/ shortene%
BB) pathologic B '@4 sec/ :
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ABNORMALABNORMAL
WAVEFORMSWAVEFORMS &? segment )&? segment ) %epression%epression'-'-mm(/mm(/ elevationelevation'- mm in limb'- mm in limb
lea%s or :mm in precor%iallea%s or :mm in precor%ial
lea%s(lea%s(
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ABNORMALABNORMAL
WAVEFORMSWAVEFORMS? .ave? .ave) pea7e%tall/ inverte%/) pea7e%tall/ inverte%/fattene%fattene%
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R-WAVE PROGRESSIONR-WAVE PROGRESSION
Poor 1.ave progression )Poor 1.ave progression )
Inarction 'anteroseptal(Inarction 'anteroseptal(
53335333
502502
&evere C>PD 'emph$sema(&evere C>PD 'emph$sema(
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ATRIAL ENLARGEMENTATRIAL ENLARGEMENT 5et #trial Enlargement5et #trial Enlargement
Notche% P .aveNotche% P .ave
ight #trial Enlargementight #trial EnlargementPea7e% P =avePea7e% P =ave
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VENTRICULARVENTRICULAR
HYPERTROPHYHYPERTROPHY 5et 0entricular 2$pertroph$5et 0entricular 2$pertroph$
& .ave in 0-0: + .ave in 0
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VENTRICULARVENTRICULAR
HYPERTROPHYHYPERTROPHY ight 0entricular 2$pertroph$ight 0entricular 2$pertroph$
#D#D
everse% 1.ave progression 'taller .aves an%everse% 1.ave progression 'taller .aves an%
smaller & .aves in 0smaller & .aves in 0--6 06 0:: %eeper & .aves 6 small %eeper & .aves 6 small
.aves in 0.aves in 0
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MYOCARDIALMYOCARDIAL
INFARCTIONINFARCTION
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MYOCARDIALMYOCARDIAL
INFARCTIONINFARCTION#cute inerior m$ocar%ial inarction#cute inerior m$ocar%ial inarction
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MYOCARDIALMYOCARDIAL
INFARCTIONINFARCTION&eptal .all m$ocar%ial inarction&eptal .all m$ocar%ial inarction
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MYOCARDIALMYOCARDIAL
INFARCTIONINFARCTIONExtensive '.hole( anteriorExtensive '.hole( anteriorm$ocar%ial inarctionm$ocar%ial inarction
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MYOCARDIALMYOCARDIAL
INFARCTIONINFARCTIONInerior .all m$ocar%ial inarctionInerior .all m$ocar%ial inarction.ith a possible posterior .all.ith a possible posterior .all
inarctioninarction
OCMYOCARDIAL
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MYOCARDIALMYOCARDIAL
INFARCTIONINFARCTION
Evolutionar$ changes inEvolutionar$ changes in
anteroseptal m$ocar%ialanteroseptal m$ocar%ial
inarctioninarction
#@#@ #t a%mission#t a%mission
3@3@ #t :4 hours#t :4 hours
C@C@ #t 4H hours#t 4H hours
MYOCARDIALMYOCARDIAL
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MYOCARDIALMYOCARDIAL
INFARCTIONINFARCTION
Evolutionar$ changes inEvolutionar$ changes in
inerior an% rightinerior an% right
ventricular inarctionventricular inarction
#@#@ #t a%mission#t a%mission
3@3@ #t -: hours#t -: hours
C@C@ ight chest lea%sight chest lea%s
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CAUSES OFCAUSES OF
DYSRHYTHMIASDYSRHYTHMIAS
Enhance% #utomaticit$Enhance% #utomaticit$
eentr$eentr$
Escape 3eatsEscape 3eats Con%uction DisturbancesCon%uction Disturbances
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SUPRAVENTRICULARSUPRAVENTRICULAR
ARRHYTHMIASARRHYTHMIAS &upraventricular ?ach$car%ia&upraventricular ?ach$car%ia
ate ) -
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SUPRAVENTRICULARSUPRAVENTRICULAR
ARRHYTHMIASARRHYTHMIAS #trial 9lutter#trial 9lutter
ate ) atrial ) :
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SUPRAVENTRICULARSUPRAVENTRICULAR
ARRHYTHMIASARRHYTHMIAS #trial 9ibrillation '#9ib(#trial 9ibrillation '#9ib(
ate ) atrial ) ;
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VENTRICULARVENTRICULAR
ARRHYTHMIASARRHYTHMIAS 0entricular ?ach$car%ia0entricular ?ach$car%ia
ate ) - , :
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VENTRICULARVENTRICULAR
ARRHYTHMIASARRHYTHMIAS 0entricular 9ibrillation0entricular 9ibrillation
ate ) in%eterminateate ) in%eterminate
h$thm ) chaotich$thm ) chaotic
P .aves ) noneP .aves ) none
P interval ) noneP interval ) none B& ) noneB& ) none
VENTRICULAR
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VENTRICULARVENTRICULAR
ARRHYTHMIASARRHYTHMIAS ?orsa%es %e Pointes?orsa%es %e Pointes
ate ) : , :
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EXTRASYSTOLEEXTRASYSTOLE #trial Extras$stole '#E&( Premature #trial#trial Extras$stole '#E&( Premature #trial
Contraction 'P#C(Contraction 'P#C( h$thmh$thm ) irregular %ue to the premature beat) irregular %ue to the premature beat
ateate ) %epen%s on its basic rh$thm) %epen%s on its basic rh$thm
PP.ave.ave ) unusual compare to basic rh$thm) unusual compare to basic rh$thmP intervalP interval ) normal/ ma$be shorten) normal/ ma$be shorten
B&B& ) normal) normal
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EXTRASYSTOLEEXTRASYSTOLE 0entricular Extras$stole '0E&( Premature0entricular Extras$stole '0E&( Premature
0entricular Contraction 'P0C(0entricular Contraction 'P0C( h$thmh$thm ) irregular %ue to the premature beat) irregular %ue to the premature beat
ateate ) %epen%s on its basic rh$thm) %epen%s on its basic rh$thm
PP
.ave.ave
) none) none
P intervalP interval ) none) none
B&B& ) @-: sec) @-: sec
?hreatening 0E& )?hreatening 0E& )
LL on ?M 0E& on ?M 0E&
0E& * timesmin0E& * timesmin3igemini 0E&3igemini 0E&
Aultiocal 0E&Aultiocal 0E&
Consecutive 0E&Consecutive 0E&
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EXTRASYSTOLEEXTRASYSTOLE
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BLOCKSBLOCKS --ststDegree #0 3loc7Degree #0 3loc7
ate ) normalate ) normal
h$thm ) regularh$thm ) regular
P .aves ) normalP .aves ) normal
P interval ) prolonge% '@: sec( but constantP interval ) prolonge% '@: sec( but constant B& ) usuall$ @- sec or lessB& ) usuall$ @- sec or less
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BLOCKSBLOCKS ::n%n%Degree #0 3loc7 ?$pe IAobitz ?$peDegree #0 3loc7 ?$pe IAobitz ?$pe
I=enc7ebachI=enc7ebach ate ) atrial ventricularate ) atrial ventricular
h$thm ) atrial regular ventricular irregularh$thm ) atrial regular ventricular irregular
P .ave ) normalP .ave ) normal P interval ) lengthen .ith each c$cle until P .aveP interval ) lengthen .ith each c$cle until P .ave
appears .ithout a B& complexappears .ithout a B& complex
B& ) usuall$ @- sec or lessB& ) usuall$ @- sec or less
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BLOCKSBLOCKS ::n%n%Degree #0 3loc7 ?$pe IIAobitz ?$pe IIDegree #0 3loc7 ?$pe IIAobitz ?$pe II
ate ) atrial ventricularate ) atrial ventricular
h$thm ) atrial regular ventricular irregularh$thm ) atrial regular ventricular irregular
P .ave ) normalP .ave ) normal
P interval ) normal or slightl$ prolonge% but constantP interval ) normal or slightl$ prolonge% but constantor the con%ucte% beats there ma$be some shorteningor the con%ucte% beats there ma$be some shortening
o the P interval that ollo.s a non1con%ucte% P .aveo the P interval that ollo.s a non1con%ucte% P .ave
B& ) usuall$ @- sec or lessB& ) usuall$ @- sec or less
Con%uction ratio :)-/ ;)-/ 4)-Con%uction ratio :)-/ ;)-/ 4)-
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BLOCKSBLOCKS ;;r%r%Degree #0 3loc7Complete #0 3loc7?otal 2eartDegree #0 3loc7Complete #0 3loc7?otal 2eart
3loc73loc7 ate ) atrial ventricular@ate ) atrial ventricular@
h$thm ) atrial regular ventricular regular '#0h$thm ) atrial regular ventricular regular '#0
%issociation(%issociation( P .ave ) normalP .ave ) normal
P interval ) none the atria an% ventricles beatP interval ) none the atria an% ventricles beat
in%epen%entl$in%epen%entl$
B& ) narro. or .i%eB& ) narro. or .i%e
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BLOCKSBLOCKS 5et 3un%le 3ranch 3loc7 '5333(5et 3un%le 3ranch 3loc7 '5333(
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BLOCKSBLOCKS ight 3un%le 3ranch 3loc7 '333(ight 3un%le 3ranch 3loc7 '333(
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BLOCKSBLOCKS 9ascicular 3loc72emibloc79ascicular 3loc72emibloc7
5et #nterior 9ascicular 3loc7 '5#93( )5et #nterior 9ascicular 3loc7 '5#93( )
5#D5#D
5et Posterior 9ascicular 3loc7 '5P93( )5et Posterior 9ascicular 3loc7 '5P93( )#D#D
PULSELESS ELECTRICALPULSELESS ELECTRICAL
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PULSELESS ELECTRICALPULSELESS ELECTRICAL
ACTIVITY (PEA)ACTIVITY (PEA)
Electrical activit$ is seen in ECG butElectrical activit$ is seen in ECG but
no pulse is %etecte% .hen palpatingno pulse is %etecte% .hen palpating
the arter$the arter$
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Dan7e Dan7e