[PDF] Methodological ECG Interpretation

ECG INTERPRETATION:ECG INTERPRETATION

Interpretation 1 Rate = Number of P’s (atrial) R’s (ventricular) per minute (6 second [30 squares] X 10 = minute rate) P rate: 8 x 10 = 80 R rate: 8 x 10 = 80 2 Rhythm = Regular or irregular Map P-P and R-R intervals

Methodological ECG Interpretation

Methodological ECG Interpretation The ECG must always be interpreted systematically Failure to perform a systematic interpretation of the ECG may be detrimental The interpretation algorithm presented below is easy to follow and it can be carried out by anyone The reader will gradually notice that ECG interpretation is markedly

Electrocardiogram (EKG) Interpretation

Electrocardiogram (EKG) Interpretation WWW RN ORG® Developed September, 2019, Expires September, 2021 Provider Information and Specifics available on our Website

PRINCIPLES OF THE ELECTROCARDIOGRAM PROCEDURE AND INTERPRETATION

interpretation The technique and interpretation of cardiac rhythms can be a combination of science and art When interpreting an ECG, a clinician is analyzing a graphic record of the electrical activity of the heart 94 Each cardiac cell generates an action potential This is as it becomes depolarized and then repolarized during a normal cycle

Basic ECG Rhythm Interpretation - RNcom

Basic ECG Rhythm Interpretation Objectives At the completion of this course the learner will be able to: 1 Identify the sequence of normal electrical activation of the heart 2 Describe the physiology of cardiac muscle contraction 3 Given a rhythm strip, identify Sinus, Atrial, Junctional and Ventricular dysrhythmias, and Atrioventricular

ECG Basics

Discuss a systematic approach to rhythm interpretation Review common cardiac arrhythmias Describe the process for interpretation of a 12 lead ECG

Basic Cardiac Rhythms Identification and Response

Objectives Describe the normal cardiac anatomy and physiology and normal electrical conduction through the heart Identify and relate waveforms to the cardiac cycle

The Basic 12 Lead Electrocardiogram

Teresa Camp-Rogers, MD Department of Emergency Medicine Virginia Commonwealth University Medical Center Richmond, Virginia The Basic 12 Lead Electrocardiogram

TD Interprétation d’un ECG

4e année médecine – Rotation 3 – 2015/2016 ISM Copy Module de Cardiologie Interprétation d’un ECGTD Introduction L'électrocardiographie est la technique d'enregistrement des courants électriques accompagnants

EKG - ECG CPT CODES - ND Portal

interpretation and report 93005 tracing only, without interpretation and report 93010 interpretation and report only COVERED DIAGNOSIS: 002 0 Typhoid fever 005 1 Botulism 017 90-017 96 Tuberculosis of specified organs 018 00-018 96 Miliary tuberculosis 020 2 Septicemic plaque 022 3 Anthrax septicemia 032 82 Diptheritic myocarditis

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ECGWAVES.COM

POCKETGUIDETO

ECGINTERPRETATION

DrArazRawshani,MD,PhD

UniversityofGothenburg

2017
PPR Q ST

UP-wave duration

PR interval

QRS duration

J pointJ 60 pointST segment

TP interval

ST-T segment

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MethodologicalECGInterpretation

speedsuptheinterpretation.

1.Rhythm

ASSESSMENTSEVALUATION

Assessventricular(RRintervals)

andatrial(PPintervals)rateand rhythm. ♥Isventricularrhythmregular?

Whatistheventricularrate

(beats/min)? ♥Isatrialrhythmregular?What istheatrialrate(beats/min)? ♥P-wavesshouldprecedeevery

QRScomplexandtheP-wave

shouldbepositiveinleadII. causescirculatorycompromiseorcollapse. withsimultaneousleftbundlebranchblock).

2.P-waveandPRinterval

ASSESSMENTSEVALUATION

♥P-wavealwayspositiveinlead

II(actuallyalwayspositiveinleads

II,IIIandaVF).

♥P-wavedurationshouldbe <0,12s(allleads). cannotbesinusrhythm. www.ecgwaves.com | Learn ECG Interpretation Online ♥P-waveamplitudeshouldbe mustbe0,12-0,22s(allleads). V1. andtheterminalpartoftheT-wave. constantPRinterval.

3.QRScomplex

ASSESSMENTSEVALUATION

♥QRSdurationmustbe<0,12s (normally0,07-0,10s). ♥Theremustbeatleastone limbleadwithR-waveamplitude >5mmandatleastonechest (precordial)leadwithR-wave amplitude>10mm;otherwise thereislowvoltage. ♥Highvoltageexistsifthe amplitudesaretoohigh,i.eifthe followingconditionissatisfied:S- waveV1orV2+R-waveV5>35 mm. ♥LookforpathologicalQ-waves.

PathologicalQ-wavesare≥0,03s

and/oramplitude≥25%ofR-wave amplitudeinsamelead,inatleast

2anatomicallycontiguousleads.

♥IstheR-waveprogressionin thechestleads(V1-V6)normal? (Wolff-Parkinson-Whitesyndrome). individuals. www.ecgwaves.com | Learn ECG Interpretation Online ♥Istheelectricalaxisnormal?

Electricalaxisisassessedinlimb

leadsandshouldbebetween-30° to90°.

Acutecorpulmonale.Myxoma.

(mostlyduetoinfarction). block.Pre-excitation.

Rightbundlebranchblock.Pre-excitation.

deviationhavebeenexcluded.

4.STsegment

ASSESSMENTSEVALUATION

♥TheST-segmentshouldbeflat andisoelectric(inlevelwiththe baseline).Itmaybeslightly upslopingatthetransitionwith theT-wave. • ♥STsegmentdeviation (elevationanddepression) ismeasuredintheJpoint. below). • ♥ST-segmentdepressionisuncommonamonghealthy segmentdepressionbeacceptedinallleads. www.ecgwaves.com | Learn ECG Interpretation Online • ♥CausesofST-segmentelevation:Ischemia.STsegment • ♥CausesofST-segmentdepression:Ischemia.Non-ST failure.Tachycardia. • ♥Causesofwaves/deflectionsintheJpoint(Jwave

5.T-wave

ASSESSMENTSEVALUATION

• ♥Shouldbeconcordantwiththe

QRScomplex.Shouldbepositive

inmostleads. • ♥T-waveprogressionshouldbe normalinchestleads. • ♥Inlimbleadstheamplitudeis highestinleadII,andinthechest leadstheamplitudeishighestin

V2-V3.

inversion(V1-V6). • ♥T-waveinversionwithoutsimultaneousST-segment perimyocarditis).Cardiomyopathy. • ♥T-waveinversionwithsimultaneousST-segment • ♥HighT-waves:Normalvariant.Earlyrepolarization. www.ecgwaves.com | Learn ECG Interpretation Online

6.QTcintervalandU-wave

ASSESSMENTSEVALUATION

♥ProlongedQTcdurationmay causemalignantarrhythmias (torsadedepointes,whichisa typeofventriculartachycardia). s)israre,butmayalsocause malignantventricular arrhythmias. ♥TheU-waveisseen occasionally,especiallyinwell- trainedindividuals,andduring lowheartrate.ItislargestinV3-

V4.AmplitudeisonefourthofT-

waveamplitude. • ♥CongenitalQTprolongation:geneticdiseaseofwhich thereareapproximately15variants. arrhythmia. • ♥NegativeU-wave:highspecificityforheartdisease (includingischemia).

7.ComparewithearlierECGtracings

andmayindicatepathology.

8.Clinicalcontext

symptomssuggestiveofischemia.

Theguidecontinuesonthenextpage.

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Thecardiacconductionsystem

Waves,intervalsanddurationsontheECG

www.ecgwaves.com | Learn ECG Interpretation Online thesewalls

TheECGleads

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P-wavechanges

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STsegmentdepressions

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STsegmentelevations

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T-wavechanges

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Electricalaxisoftheheart

IandII.Thefollowingrulesapply:

• Normalaxis:NetpositiveQRScomplexinleadsIandII. • Rightaxisdeviation:NetnegativeQRScomplexinleadIbutpositiveinleadII. • Leftaxisdeviation:NetpositiveQRScomplexinleadIbutnegativeinleadII. • Extremeaxisdeviation(-90°to180°):NetnegativeQRScomplexinleadsIandII. www.ecgwaves.com | Learn ECG Interpretation Online www.ecgwaves.com | Learn ECG Interpretation Online www.ecgwaves.com | Learn ECG Interpretation Online narrowQRScomplex www.ecgwaves.com | Learn ECG Interpretation Online wideQRScomplex www.ecgwaves.com | Learn ECG Interpretation Online

Intraventricularconductiondefects

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Hypertrophyanddilatation

www.ecgwaves.com | Learn ECG Interpretation Online www.ecgwaves.com | Learn ECG Interpretation Online • Menage≥40years:≥2mminV2-V3and≥1mminallotherleads. • Menage<40years:≥2,5mminV2-V3and≥1mminallotherleads. • Women(anyage):≥1,5mminV2-V3and≥1mminallotherleads. • Men&womenV4RandV3R:≥0,5mm,exceptfrommen<30yearsinwhomthecriteriais≥1mm. • Men&womenV7-V9:≥0,5mm. infarction:NSTEMIandunstableangina • NewhorizontalordownslopingSTsegmentdepressions≥0,5mminatleasttwoanatomically contiguousleads. • Twaveinversion≥1mminatleasttwoanatomicallycontiguousleads.Theseleadsmusthavequotesdbs_dbs5.pdfusesText_9