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Normal Waveforms The Grid: each 1mm (sm) block= 0.04 sec / 0.1 mV each 5mm (Lg) block= 0.20 sec / 0.5 mV rate: each large block represents .2 second interval. Thus a QRS every 1 lg block= a beat every .2 seconds. 60sec/min / 0.2 sec=300 bpm. This formula yields 1 block=300, 2 block=150, 3 block=100, 4 block=75, 5 block=60, 6 block=50 The Intervals: (P)- <0.12 sec (3 sm blocks)- represents R L atrialdepol| (PR)- <0.20 sec (5 sm blocks)- represents conduction SA AV Bundle of His (QRS)- <0.10 sec (2.5 sm blocks)- represents ventricular depolarization (ST)- isoelectric. representscardioelectric silence following depol and preceding repol. Begins @ j point (T)- Ventricular repolarization- T wave direction = major deflection of the QRS on same lead. (QT)- <0.44 sec (11 sm blocks) corrected.rate dependant. Represents membrane repolarization The Axis: Determined by QRS vector in lead I and lead AVF=Normal Axis Lead Regions: =Left Axis =Right Axis =Indeterminate Axis

Lead I II III

Region Lateral Inferior Inferior

Lead AVR AVL AVF

Region Anterior Lateral Inferior

Lead V1 V2 V3

Region Septal Septal Anterior

Lead V4 V5 V6

Region Anterior Lateral Lateral

Pathologic waveform sites Pathologicregion Vessel Affected Associated Leads Reciprocal Leads Anterior LAD V3, V4 none Septal LAD septal V1, V2 none Lateral Circum. I, AVL, V5, V6 II, III AVF Anteroseptal LAD V1-V4 none Anterolateral LAD (varient) I, AVL V3-V6 none Inferior RCA (marginal) II, III, AVF I, AVL V5, V6 Lg. Anterior L. Main V1-V5 none Posterior RCA (P.Decend) V7-V9 V1, V2

Pathologic Waveforms Hypertrophy:LA- inverted (biphasic) portion of P wave in Leads V1 and V2. RA- narrow P wave w/ increased amplitude LV-oamplitude S wave in lead V1 + R wave in V5 or V6 35 mm. RV- Right axis deviation (>+90). RV1 >7mm or RV1 + SV5 or V6 >10 mm.R/S ratio in V1 >1 or S/R ratio in V6 >1 Ishemia: partial- New horizontal or down-sloping ST depression 0.05 mV in two contiguous leads; and/or T inversion 0.1 mVin two contiguous leads with prominent R-wave or R/S ratio >1 Transmural- New ST elevation at the J-point in two contiguous leads with the cut-off points: 0.2 mV in men or 0.15 mV in women in leads V2-V3 and/or 0.1 mV in other leads

Infarct: Hypokalemia HyperKalemia Hyponatremia Hypernatremia Pathologic Rates and Rhythms Conductive Ab: Blocks- 1st- PR>0.20sec. D/T- uniform conduction delay.2nd- type I- progressive >PR until QRS is dropped.D/T- in vagal tone= impulse reaches AV when it is still partially refractory, causing lengthening intervals until finally Impulse reaches AV when it is completely refractory and the AV fails to send impulse at all. Type II- dropped QRS w/o lengthening PR. D/T- structural dx. Irreg. unpredicatable blocks. 3rd-Full dissociation of P to QRS rhythm. D/T- Nodaldx RBBB- prolonged QRS. qRS or qrS in I, V6; rsR' or qR in V1. ST depression and T inversion in right precordial leads, upright in left precordial and limb leads LBBB- Loss of the normal q waves in I, avL, and V6, and sometimes the appearance of a QS complex in V1 and V2. A large, positive, and widened R wave without q or s waves in I, aVL, and V6. Arrhythmias:SVT- D/T abnormal conduction of atria and the ventricles. A. flutter- D/T a large reentrant circuit formed within the right atrium A. FibV. Tach- D/T a reentrant circuit formed w/in the ventricles V. Flutter-