All what you need to All what you need to know about EKGknow about EKG

Each lead looks at the heartEach lead looks at the heart

Normal waves and segments Normal waves and segments

Reading ECGReading ECG

RhythmRhythm Rate Rate Axis Axis Chamber enlargement Chamber enlargement Ischemia ( ST, T, Q and LBBB)Ischemia ( ST, T, Q and LBBB) Intervals ( PR, QRS, QT) Intervals ( PR, QRS, QT) Conclusion Conclusion

Normal ECGNormal ECG Each P is followed by QRSEach P is followed by QRS P wave is + in I and AVLP wave is + in I and AVL Rate is between 60-100Rate is between 60-100 P wave is less than 2.5 mm in height and P wave is less than 2.5 mm in height and

less than 0.11 mm in width less than 0.11 mm in width PR interval 0.12-0.2 mmPR interval 0.12-0.2 mm Normal QRS less 0.12 mmNormal QRS less 0.12 mm Normal QT is 0.42 mmNormal QT is 0.42 mm Normal ST is isoelectric with PR or TP Normal ST is isoelectric with PR or TP

AxisAxis

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

Rate Rate

Or 300 divided by the Or 300 divided by the number of the large number of the large squares divided squares divided

Or number of the Or number of the QRSs multiplied by QRSs multiplied by 10 (AF)10 (AF)

Right atrial enlargementRight atrial enlargement P wave 3 mm ( 3 small P wave 3 mm ( 3 small

squares) or greater in squares) or greater in height in inferior leadsheight in inferior leads

P wave 1.5 mm (1.5 small P wave 1.5 mm (1.5 small squares ) or greater in squares ) or greater in lead V1lead V1

The P wave has a sharp The P wave has a sharp and peaked appearanceand peaked appearance

Left atrial enlargementLeft atrial enlargement

P wave notched and P wave notched and exceeds 120 ms ( 3 exceeds 120 ms ( 3 small squares) in the small squares) in the inferior leadsinferior leads

The negative terminal The negative terminal component of P wave component of P wave in V1 exceeds 40 ms in V1 exceeds 40 ms ( 1 small squares )( 1 small squares )

Left ventricular hypertrophyLeft ventricular hypertrophy

S in lead V1 plus R in S in lead V1 plus R in either V5 or V6 either V5 or V6 greater than 35 mmgreater than 35 mm

R wave in lead aVL R wave in lead aVL greater than 11 mmgreater than 11 mm

Right ventricular hypertrophyRight ventricular hypertrophy

Right axis deviationRight axis deviation

Dominant R in V1Dominant R in V1

RAERAE

R wave 7 mm ( 7 R wave 7 mm ( 7 small squares) or small squares) or greatergreater

38 y M with CP38 y M with CP

67y F HD CP at 0400am 67y F HD CP at 0400am

65 y M with 1h CP65 y M with 1h CP

45y M CP for 13 h vitals stable 45y M CP for 13 h vitals stable

59 y F with 5h CP59 y F with 5h CP

56 y M with 3h CP56 y M with 3h CP

45 y M with 3h CP 45 y M with 3h CP

62 y F with 45 min CP62 y F with 45 min CP

59 y F 4h CP and BP 65/4059 y F 4h CP and BP 65/40

63 y F 5h CP BP 64/3263 y F 5h CP BP 64/32