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IP SimClip 2013

EKG BASICS

Miha Kodela

Andrej Markota

Basics

● recording of heart's

electrical current

● changes in normal

electrical patterns –

diagnostic tool

● cheap and very useful

Conduction system

● spontaneous depolarisations

● synchronus contraction

Waves

+

-

Segments, intervals QRS configurations

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ECG LEADS

STANDARD ECG – 12 leads

Standard and augmented

leads

Precordial leads

SIN

Lead placement

Lead placement

Location on wall

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Vessels

LCX LAD

RCA LCX

LCX LAD

LAD

Standard settings ●Paper speed 25 mm/s

● amplitude 0,1 mV/mm

●

ANALYSIS

● rhythm

● frequency

● axis

● intervals

● QRS morphology

● ST segment , T wave

RYTHM

● P waves?

●QRS following each P wave?

● regularity?

I

aVF

II

V1

HEART RATE

● normal 60-99/min

● tahycardia > 100/min

● bradycardia < 59/min

Axis

•Direction of mean electrical vector

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INTERVALS

● PQ 0,12-0,2s (5 mm)

● QRS 0,12 s (3 mm)

● QTc 450 ms

CONDUCTION BLOCKS

● AV I

● AV II

● Mobitz I / Wenkebach

● Mobitz II

●AV III

QRS MORPHOLOGY

● pathologic Q (width > 1 mm, depth > 1/3 QRS)?

●LBB/RBB, hemiblocks

● R wave progression V1<V2<V3<V4<V5

ST segment, T waves

● normally in baseline

● can be elevated in young healthy inviduals (J point

elevation), with no other pathological changes

●All other elevations or deppresions are pathological!

Normal EKG

sinus rhythm fr. 75/min, normal axis

Case 1

sinus rhythm fr. 75/min,left axis deviation, LBB

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Case 2

sinus tachycardia fr. 130/min, normal axis

Case 3

AF , fr. 80/min, normal axis

Case 4

sinus rhythm fr. 60/min, normal axis, ST eleavtions in II, III, aVF

●Literature:

●http://www.youtube.com/user/umemergencymed

●The Only EKG Book You'll Ever Need; Malcolm

S. Thaler

● Rapid Interpretation of EKG's; Dale Dubin

● Marriott's Practical Electrocardiography; Galen

S. Wagner

HVALA!