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Interpretation
Module 1 of 2
• ECG Basics
• How to Analyze a Rhythm
• Normal Sinus Rhythm
• Cardiac Dysrhythmias
• Diagnosing a Myocardial Infarction
• Horizontally
– One small box - 0.04 s
– One large box - 0.20 s
• Vertically
– One large box - 0.5 mV
AV node
Bundle of His
Bundle Branches
Purkinje fibers
AV node
Bundle of His
Bundle Branches
Purkinje fibers
Tao Le T and Bhushan V, Cardiovascular, In: First Aid for the USMLE Step 1 2017. New York, NY: McGraw-Hill ,2017; 271.
Interpretation? 9 x 10 = 90 bpm
R wave
• Option 2 (cont.)
– Memorize the sequence:
300 - 150 - 100 - 75 - 60 - 50
Interpretation? Approx. 1 box less than 100 = 95 bpm
• Sinus Rhythms
• Premature Beats
• Supraventricular Arrhythmias
• Ventricular Arrhythmias
• AV Junctional Blocks
• Sinus Bradycardia
• Sinus Tachycardia
• Sinus Arrest
• Normal Sinus Rhythm
• Rate? 30 bpm
• Regularity? regular
• P waves? normal
• PR interval? 0.12 s
• QRS duration? 0.10 s
Interpretation? Sinus Bradycardia
Marc Imhotep Cray, M.D. 42
Sinus Bradycardia
• Rate? 70 bpm
• Regularity? occasionally irreg.
• P waves? 2/7 different contour
• PR interval? 0.14 s (except 2/7)
• QRS duration? 0.08 s
Interpretation? NSR w PAC
Marc Imhotep Cray, M.D. 50
Premature Atrial Contractions
(PACs)
• Rate? 60 bpm
• Regularity? occasionally irreg.
• P waves? none for 7th QRS
• PR interval? 0.14 s
• QRS duration? 0.08 s (7th wide)
Interpretation? Sinus Rhythm with 1 PVC
Marc Imhotep Cray, M.D. 54
Premature ventricular
contractions (PVCs)
Normal Abnormal
Signal moves rapidly Signal moves slowly
through ventricles through ventricles
Marc Imhotep Cray, M.D. 58
Supraventricular dysrhythmias
• Atrial Fibrillation
• Atrial Flutter
• Paroxysmal Supraventricular Tachycardia
(PSVT)
• Rate? 70 bpm
• Regularity? regular
• P waves? flutter waves
• PR interval? none
• QRS duration? 0.06 s
Interpretation? Atrial Flutter
Marc Imhotep Cray, M.D. 63
Atrial Flutter
• Rate? 60 bpm
• Regularity? regular
• P waves? normal
• PR interval? 0.36 s
• QRS duration? 0.08 s
Interpretation? 1st Degree AV Block
Marc Imhotep Cray, M.D. 69
1st Degree AV Block
• Rate? 50 bpm
• Regularity? regularly irregular
• P waves? nml, but 4th no QRS
• PR interval? lengthens
• QRS duration? 0.08 s
Interpretation? 2nd Degree AV Block, Type I
Marc Imhotep Cray, M.D. 72
2nd Degree AV Block, Type I
Mobitz type I (Wenckebach)
• Rate? 40 bpm
• Regularity? regular
• P waves? nml, 2 of 3 no QRS
• PR interval? 0.14 s
• QRS duration? 0.08 s
Interpretation? 2nd Degree AV Block, Type II
Marc Imhotep Cray, M.D. 75
2nd Degree AV Block, Type II
Mobitz type II
• Rate? 40 bpm
• Regularity? regular
• P waves? no relation to QRS
• PR interval? none
• QRS duration? wide (> 0.12 s)
Interpretation? 3rd Degree AV Block
Marc Imhotep Cray, M.D. 77
3rd Degree AV Block
Rhythm Strip
Taylor GJ. 150 practice ECGs: Interpretation and Review, 3rd ed. Malden, Mass: Blackwell Publishing, 2006.
Correlating ECG findings w knowledge of coronary circulation
The 12-Leads
12-leads include:
–3 Limb leads
(I, II, III)
–3 Augmented leads
(aVR, aVL, aVF)
–6 Precordial leads
(V1- V6)
• Elevation of ST segment
(greater than 1 small box)
in 2 leads is consistent w a
myocardial infarction
See next slide for links to tools and resources for further study.
Companion study tools
Video Playlist:
ECG Interpretation
Reading:
Olivieri , B et al. Ch. 28 ECG (Pgs. 820-28). In: USMLE Step 1
Secrets 3rd. Ed. (Eds. Brown TA and Shah SJ) Saunders, 2013.
ECG eBook: