Beruflich Dokumente
Kultur Dokumente
EKG 1
Basic Electrophysiology Basic heart anatomy and conduction system Normal EKG Systemic EKG interpretation
EKG 2
EKG in clinical application Cardiac chamber enlargement Myocardial ischemia (in CAD lecture) Electrolyte imbalance Intraventricular conduction disturbance Pre-excitation syndrome Miscellaneous Cardiac arrhythmia (in Arrhythmia lecture)
Myocardial cell
Electrical cell Mechanical cell
Conduction system
Sinoatrial node (SA ) Internodal pathway
Anterior internodal pathway Middle internodal pathway Posterior internodal pathway
AV node
Right bundle branch Left bundle branch
Anterior division Posterior division
Electrocardiography
Electrocardiography : ECG EKG? : Electrokardiography (German)
History : EKG
1911 Augustus Waller
(St Marry hospital,London)
heart generated electricity Capillary galvanometer
Some of the first EKG machines were bulky, table-sized apparatus built about 1920
Leads
12 leads Limb electrodes I,II,III, aVR,aVL,aVF Precordial electrodes V1 -6
P wave PR interval
atrial depolarization atrial depolarization to ventricular depolarization QRS complex ventricular depolarization T wave ventricular repolarization U wave depolarization of papillary muscle or Purkinje system
Normal EKG
P
Amplitude < 2.5 mV Duration <3 mm P from SA node
Upright in II,III,aVF Inverted in aVR
PR interval
>0.2 sec First degree AV block
Normal EKG
QRS complex
Duration 0.06-0.10 sec
ST segment T wave
Normal EKG
EKG
Rhythm
Sinus rhythm Atrial rhythm Atrial tachycardia Atrial flutter Atrial fibrillation Junctional rhythm Ventricular rhythm Ventricular tachycardia Ventricular fibrillation
Rate
Sinus bradycardia
Sinus Tachycardia
Normal P waves
Height < 2.5 mm in lead II Width < 0.11 s in lead II Abnormal P waves
RA enlargement LA enlargement Hyperkalemia
LA enlargement
RA enlargement
PR interval
Normal : 0.12 to 0.20 s (3 - 5 small squares) Short PR segment
Wolff-Parkinson-White syndrom Lown-Ganong-Levine syndrome
Long PR interval
First degree AV block Trifascicular block
Wolf-Parkinson-White syndrome
Short PR interval, less than 3 small squares (120 ms) slurred upstroke to the QRS indicating pre-excitation (delta wave) broad QRS secondary ST and T wave changes
Wolf-Parkinson-White syndrome
Lown-Ganong-Levine syndrome
short PR interval, less than 3 small squares (120 ms) no delta wave
Lown-Ganong-Levine syndrome
Trifascicular block
EKG
Axis
Axis
both I and aVF +ve = normal axis both I and aVF -ve = axis in the Northwest Territory lead I -ve and aVF +ve = Right axis deviation lead I +ve and aVF -ve lead II +ve = normal axis lead II -ve = Left axis deviation
Axis
RBBB
LBBB
Hyperkalemia
Pathologic Q wave
Normal ST segment
No elevation or depression Elevation
Acute MI LBBB Acute pericarditis
Depression
Myocardial ischaemia Digitalis effect Entricuar hypertrophy LBBB Acute posterior wall MI
Anterior wall MI
Inferior wall MI
LBBB
Digitalis effect
Posterior wall MI
Normal QT interval
Calculate the corrected QT interval (QTc) by dividing the QT interval by the square root of the preceeding R - R interval. Normal = 0.42 s.
Causes of long QT interval
myocardial infarction, myocarditis, diffuse myocardial disease hypocalcaemia, hypothyrodism subarachnoid haemorrhage, intracerebral haemorrhage drugs (e.g. sotalol, amiodarone) hereditary
Romano Ward syndrome (autosomal dominant)
Jervill + Lange Nielson syndrome (autosomal recessive) associated with sensorineural deafness
QT prolongation
QT prolongation
The QT interval normally varies with heart rate becoming shorter at faster rates It is usually corrected using the cycle length (R-R interval) as shown opposite. normal QTc = 0.42 seconds
Romano-Ward syndrome
T wave
Tall T wave Tall T waves Hyperkalemia Hyperacute MI LBBB include
T wave
Small, flattened or inverted T waves Myocardial ischemia Age Race Hyperventilation Anxiety Drinking iced water LVH Drugs (e.g. Digoxin) Pericarditis PE Intraventricular conduction delay (e.g.RBBB) Electrolyte disturbance
Hyperacute T in AMI
T wave invertion
U wave
Normal Hypokalemia
Hypokalemia
Hypokalemia
Dyskalemia