ECG ConferenceECG Conference

Henry Tran, MDHenry Tran, MDJanuary 13, 2016January 13, 2016

Goals

Review basic principles of EKG RHYTHM: Identify sinus vs atrial arrhythmias

Recognize patterns of STEMI

Recognize patterns of ischemia

Distinguish Wide Complex Tachycardia: Ventricular Tachycardia vs. Aberrant Conduction

Conduction System

ECG

Positioning Precordial Leads

12 Lead ECG

Axis

ECG Interpretation Methodology #1 Rhythm: what rhythm governs the atria

Sinus or Not sinus AV Block Bundle Branch Conduction

#2 Axis: Look for LAFB or Right Axis

#3 Waveform Analysis

#4 The Big Picture

Pt #1 Bruce Stage 2

P Waves: ? Sinus or Ectopic

SINUS P WAVE IS UPRIGHT IN LEAD I and LEAD II

Pt #1 Resting ECG prior to regular exercise stress test

Pt #1 Bruce Stage 1, 2:45 min

Pt 2

Pt 3

Typical Atrial Flutter

ECG Interpretation Methodology #1 Rhythm: what rhythm governs the atria

Sinus or Not sinus AV Block Bundle Branch Conduction

#2 Axis: Look for LAFB or Right Axis

#3 Waveform Analysis

#4 The Big Picture

Mobitz I Wenckebach

• Although it is possible to syncopize due to Mobitz I, it is generally considered benign and a normal variant

• If you see it at night during sleep, not an emergency

Mobitz 2

Where’s the block?

Mobitz I

Mobitz II

Pt 3

Don’t miss this…

Conduction in AVRT

Orthodromic Antidromic

Vi / Vt

Bundle Branch Blocks

LAFP•Axis >45o

•qR in I, AVL

LPFP•Very rare• >100o

V TACH!!!

Axis Deviation: Causes

NORMAL

Northwest LEFT

RIGHTLead

I

Lead aVF

•normal finding in children and tall thin adults•RVH•COPD•ASD/VSD•PE•Anterolateral MI•left posterior hemiblock (>125 degree)

•left anterior hemiblock (>-45o)•Q waves of inferior MI•WPW-Right Pathway

LVH DOES NOT CAUSE LEFT AXIS

Pt 6

WPW

Pt 7

Pt 8: 43 yo female complains of chest tightness

55 yo male POD #1 s/p laminectomy, remains intubated

Don’t Miss This…

Don’t Miss These…

27 yo asian male complains of malignant syncope

NO TERMINAL S WAVE AS IN RBBB

Brugada Syndrome• Channelopathy: Na+ SCN5A, L-Type calcium• Increase epicardial dispersion of repolarization in the RV

44 yo male with schizophrenia and HCV complains of chest pain:

83 yo male hx of afib on coumadin brought to ER due to poor PO intake:

Accelerated junctional rhythms

33 yo male with no PMHX complains of chest pain x 3 hrs. Do you give kayexalate?

25 yo female complains of palpitations and dizziness. What imaging modality shouldbe ordered next?

Digoxin Toxicity LBBBLVH

GUESS THE REPOLARIZATION ABNORMALITY!

Summary

What’s the rhythm?????

Thanks!