Beruflich Dokumente
Kultur Dokumente
MOONLIGHT
MEDICINE
Diana Tamondong-Lachica, MD, FPCP
ELECTROCARDIOGRAM
• Lead placement
• Normal ECG
• Important morphologies
• Important rhythms
LEAD
PLACEMENT
LEAD PLACEMENT
NORMAL ECG
NORMAL MORPHOLOGY
• PR interval: 0.12-0.20
• PR segment: 0.05-0.12
• QRS complex: 0.08-0.12
• QT interval: ≤ 0.45 in males,
≤ 0.47 in females
• Corrected QT
• QT/√(R-R)
NORMAL SINUS RHYTHM
NORMAL SINUS RHYTHM
• Heart Rate
• 300/number of big
boxes
• 1500/number of small
boxes
• 1 big box = 5 small
boxes
• 1 small box =
• Normal: 60-100 bpm
• 3 to 5 big boxes
• 15 to 25 small boxes
NORMAL AXIS
• Axis calculation
• 90 x aVF
| I+aVF |
• Sign is determined by aVF
• Normal axis is -30 to +110
• Leaving: LEFT axis deviation
• Returning: RIGHT axis deviation
ABNORMAL AXIS
• Widened QRS
QRS COMPLEX
• Pathologic Q waves
• Any Q wave in V2-V3
• Q wave ≥ 0.03 s or > 0.1 mV deep in I, II, aVL, aVF, V4-V6
(contiguous leads)
• Lead III often shows Q waves alone – NORMAL
ST SEGMENT
• Concordant leads
• Anterior wall: V2 to V5
• Anteroseptal wall: V1 to V3
• Anterolateral wall: V4 to V6
• High lateral wall: I and aVL
• Inferior wall: II, III and aVF
• Posterior wall: V1 to V3 depression
• Right ventricle: Right-sided leads
ST SEGMENT
• Depression = ischemia
• Take the segment 2-3 small boxes away from QRS
• Should be > 0.1 mV V5-V6, or1.5 mm aVF, III
• Reciprocal leads
• Other causes
• RVH/LVH
• Digoxin
• Hypokalemia
• LBBB/RBBB
ST SEGMENT
• Elevation = infarct
• Take the segment 2-3 small boxes away from QRS
• Should be > 0.1 mV in limb leads, or> 0.2 mV in chest leads
• Reciprocal leads
• Other causes
• Early repolarization
• Pericarditis
• LVH, LBBB
• Hyperkalemia
T WAVE AND U WAVE
• T wave inversion
• Myocardial infarction
• Subacute pericarditis
• Subarachnoid hemorrhage
PATHOLOGIES
IN RHYTHM
R-R INTERVAL
PAC vs PVC
Supraventricular tachycardia
Ventricular tachycardia
Ventricular fibrillation
Clues Supporting the Diagnosis of VT
AV dissociation
Atrial capture, Fusion beats
Widened QRS at V1
LBBB > 0.16, RBBB > 0.14
Axis -90 to +180