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Cardiac Anatomy
Cardiac Cycle
Step 1: Rapid filling of ventricles
Cardiac Cycle
Step 2: Atrial systole P wave occurs Atrial contraction Pushed 10-30% more blood into ventricle
Cardiac Cycle
Step 3: Isovolumetric contraction QRS just occurred Contraction of the ventricles causes ventricular pressure to rise above atrial pressure, AV valves close Ventricular pressure is still less than aortic pressure Semilunar valves are closed Volume of blood in the ventricle is EDV
Cardiac Cycle
Step 4: Ejection Contraction of the ventricles causes ventricular pressure to rise above aortic pressure, Semilunar valves open Ventricular pressure is still greater than atrial pressure AV valves are still closed Volume of blood ejected by the ventricles: stroke volume (SV)
Cardiac Cycle
Step 5:
T-wave occurs
Ventricular pressure drops below aortic pressure
Cardiac Cycle
QRS P T
Interpretation Sequence
Check the patient details - is the ECG correctly labelled? What is the rate? Is this sinus rhythm? If not, what is going on? What is the mean frontal plane QRS axis (You may wish at this stage to glance at the P and T wave axes too) Are the P waves normal (Good places to look are II and V1) What is the PR interval?
Interpretation Sequence
Are the QRS complexes normal? Specifically, are there:
significant Q waves? voltage criteria for LV hypertrophy? predominant R waves in V1? widened QRS complexes?
Are the ST segments normal, depressed or elevated? Quantify abnormalities. Are the T waves normal? What is the QT interval? Are there abnormal U waves?
Using leads I and aVF the axis can be calculated to within one of the four quadrants at a glance.
Causes of AV Blocks
Autonomic Carotid sinus hypersensitivity Drug-related Beta blockers Adenosine Ca channel blockers Antiarrhythmics (class I & III) Digitalis Lithium
Causes of AV Blocks
Infectious Endocarditis Tuberculosis Lyme disease Diphtheria Chagas disease Toxoplasmosis Syphilis Heritable/congenital Congenital heart disease Maternal SLE Kearns-Sayre syndrome Emery-Dreifuss MD Myotonic dystrophy Progressive familial heart block
Causes of AV Blocks
Inflammatory SLE MCTD Rheumatoid arthritis Scleroderma Infiltrative Amyloidosis Hemochromatosis Sarcoidosis Coronary artery disease Acute MI Neoplastic/traumatic Lymphoma Radiation Mesothelioma Catheter ablation Melanoma Degenerative Lev disease Lengre disease
c.
P wave duration equal or more than 0.12 sec. Notched, slurred P wave in lead I and II (P mitrale). Biphasic P wave in lead V1 with a wide deep and negative terminal component.
c.
Ventricular Hypertrophy
b.
c. d.
e. Time of onset of the intrinsicoid deflection ( time from the beginning of the QRS to the peak of the R wave ) equal or more than 0.05 sec in lead V5 or V6.
Localization of Infarction
Anterior wall V1 through V6 V1 through V3 II, III, aVF V4R, V3R V7 through V9 V1 through V3 ( ST depression)