dr. taj ecg basics. outline 1.review of the conduction system 2.ecg waveforms and intervals 3.ecg...
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Dr. Taj
ECG BASICS
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OUTLINE
1. Review of the conduction system
2. ECG waveforms and intervals
3. ECG leads
4. Determining heart rate
5. Determining heart axis
6. Determining heart rhythm
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THE NORMAL CONDUCTION SYSTEM
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WHAT IS AN ECG?
The electrocardiogram (ECG) is a representation of the sum of all the electrical events of the cardiac cycle.
Each event has a distinctive waveform, the study of which can lead to greater insight into a patient’s cardiac pathophysiology.
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WHAT TYPES OF INFORMATION CAN WE OBTAIN FROM AN ECG?
• Heart rate• Heart Rhythem• Myopathies• Electrolyte disturbances (i.e. hyperkalemia, hypokalemia)• Drug toxicity (i.e. digoxin and drugs which prolong the QT
interval)
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WAVEFORMS AND INTERVALS
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WAVEFORMS AND INTERVALS
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ECG LEADS
Leads are electrodes which measure the difference in electrical potential between either:
1. 1. Two different points on the body (bipolar leads)
2. One point on the body and a virtual reference point with zero electrical potential, located in the center of the heart (unipolar leads)
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ECG LEADS
The standard ECG has 12 leads: 3 Standard Limb Leads
3 Augmented Limb Leads
6 Precordial (chest) Leads
The axis of a particular lead represents the viewpoint from which it looks at the heart.
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STANDARD LIMB LEADS
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PRECORDIAL LEADS
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SUMMARY OF LEADS
Limb LeadsLimb Leads Precordial LeadsPrecordial Leads
BipolarBipolar I, II, IIII, II, III(standard limb leads)(standard limb leads)
--
Unipolar Unipolar (V leads)(V leads)
aVR, aVL, aVF aVR, aVL, aVF (augmented limb leads)(augmented limb leads)
VV11-V-V66
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CALIBRATION OF ECG PAPER
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DETERMINING THE HEART RATE
Take the number of “smallest boxes moved by the machine per minute” i.e. (1500) , and divide by the number of boxes between adjacent “R”-”R” waves.
H.R. = 1500 / # of squares b/w 2 “R - R” waves
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RULE OF 1500
Take the number of “smallest boxes moved by the machine per minute” i.e. (1500) , and divide by the number of boxes between adjacent “R”-”R” waves.
H.R. = 1500 / # of squares b/w 2 “R - R” waves
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WHAT IS THE HEART RATE?
(1500 / 30) = 50 bpm
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WHAT IS THE HEART RATE?
(1500 / ~18) = ~ 83 bpm
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WHAT IS THE HEART RATE?
(1500 / 8) = 187 bpm
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THE RULE OF 1500
It may be easiest to memorize the following table:
# of big # of big boxesboxes
RateRate
11 300300
22 150150
33 100100
44 7575
55 6060
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THE RULE OF 1500
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The Rhythem is defined as the time interrelationship between 2 (adjacent) “R” waves.
The rhythm of the heart can be regular or irregular.
RHYTHM
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AXIS (Rule of the thumb)
Leads I and III are used (but I and AVf can also be used )
•Both +ve (Normal axis)
•I +ve and III –ve (Left axis deviation)
•I –ve and III +ve (Right axis deviation)
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THANK YOU