ECG

Štěpán Havránek
 Diagnosis is based on ECG

Management is based on symptoms

or clinical significance of arrhytmia
 ECG
Complex: QRS Intervals: PQ, QRS, QT Segments: ST

PQ QT

QRSST
INTERVAL ms
R
PQ 140 – 200
QRS 60 – 100
QT < 460

P Q S T
 ECG leads
BIPOLAR LEADS

- I +
- -

II III

+ +
 ECG leads
UNIPOLAR LEADS

aVR aVL

aVF
 ECG leads
UNIPOLAR CHEST LEADS

4. ics dx parasternal 4. ics sin parast.

Btw. V2 and V4
V1 V2 btw. V4 and 6
V3
5. Ics mediokl. V4 V5 V6
sin

5. ics mid axil. sin

Other ECG leads
Right ventricle leads – marked „R“

V2R V1R
V3R
V6R V5R V4R
Other ECG leads
Posterior leads

V1 V2
V3
V4 V5 V6 V7 V8 V9

Posterior wall
 ECG – sinus rhytm
I V1

II V2

III V3

aVR V4

aVL V5

aVF V6
 How to look at ECG
1. Rhythm
1. Tachycardia / bradycardia
2. Regular / not – regular
3. QRS complex normal „narrow“ / wide
4. Morphology of P waves, Flutter waves, fibrillatory
waves

2. Morphology of QRS complex

1. Abnormal Q
2. Wide QRS – bundle branch blocks

3. Morphology of ST segments, T waves

1. ST elevation / depresion
2. T inversion
3. QT prolongation
 Rhythm
1. Tachycardia / bradycardia
2. Regular / not – regular
3. QRS complex normal „narrow“ / wide
4. Morphology of P waves, Flutter waves, fibrillatory
waves
 Rhythm - tachycardia
Normal P Sinus tachycardia
Supraventricular
Regular Abnormal P tachycardia (Atrial,
AVRT)
Normal QRS No P waves AVNRT
Regular /
Flutter waves Atrial flutter
irregular
Fibrillatory
Irregular Atrial fibrillation
waves
Ventricular
tachycardia
Monomorphic
Supraventicular with
Wide QRS bundle block
Ventricular
Polymorphic tachycardia /
V. fibrillation
→
 Rhythm - bradycardia

P normal Sinus bradycardia

P and QRS P abnormal / short
Junctional bradycardia
1:1 PQ
PR prolonged AV block 1st degree
P wave YES
Some P are
AV block 2nd degree
conducted
P > QRS
AV disociation AV block 3rd degree
Wide QRS Idioventricular rhythm
P wave NO Sinus arrest
 Abnormal QRS
1. Pathological Q
1. Duration > 40ms
2. Deep > 25% R

2. Widening
1. RSR in V1 – Right bundle branch block
2. rQS in V1 – Left bundle branch block
 Abnormal ST-T
1. Elevation of ST segments
1. Myocardial infarction

2. Depression of ST segments + inversion of T

1. Myocardial infarction / ischemia
2. Nonspecific sign of many cardiopathologies

3. Prolongation of QT interval
1. Risk for severe ventricular tachycardia
2. Congenital / acquired