2nd Presentation

By

Dr. Abdelsalam SherifMD Cardiology

September, 17, 2014( RNH)

Time

Vo

ltag

e0.2

seconds

1 m

illi

Vo

lt

0.1 mV

Method" of ECG Interpretation

1. Measurements.

2. Rhythm Analysis.

3. Conduction Analysis.

4. Waveform description.

5. ECG interpretation.

6. Comparison with previous ECG ( if any ).

1st Method

2nd Method

Axis in Normal range

Normal ECGHeart Rate: 60 - 90 bpmPR Interval: 0.12 - 0.20 secQRS Duration: 0.06 - 0.10 secQT Interval (QTc ≤ 0.40 sec)

ECG Conduction Abnormalities

Conduction system

Short PR Interval

WPW Syndrome

AV block and Intraventricular

Blocks

ECG Rhythm Abnormalities

PAC

PVC

PJC

Atrial Enlargement and

Ventricular Hypertrophy

Atrial Enlargement

Left Ventricular Hypertrophy

(LVH)General ECG features include:• ≥ QRS amplitude (voltage criteria; i.e., tall R-waves in LV leads,

deep S-waves in RV leads)

• Delayed intrinsicoid deflection in V6 (i.e., time from QRS onset to peak R is ≥ 0.05 sec)

• Widened QRS/T angle (i.e., left ventricular strain pattern, or ST-T oriented opposite to QRS direction)

• Leftward shift in frontal plane QRS axis

• Evidence for left atrial enlargement (LAE).

1. ESTES Criteria for LVH

2. CORNELL Voltage Criteria for LVH

3. Other Voltage Criteria for LVH:-

a. Limb-lead voltage criteria

b. Chest-lead voltage criteria

Right Ventricular Hypertrophy(

RVH)

General ECG features include:

• Right axis deviation (> 90 degrees)

• Tall R-waves in RV leads; deep S-waves in LV leads

• Slight increase in QRS duration

• ST-T changes directed opposite to QRS direction (i.e., wide QRS/T angle)

• May see incomplete RBBB pattern or qR pattern in V1

• Evidence of right atrial enlargement (RAE).

Any one or more of the following (if QRS duration <

0.12 sec):Right axis deviation (> 90 degrees) in presence of disease capable of

causing RVH

R in aVR ≥ 5 mm, or

R in aVR > Q in aVR

Any one of the following in lead V1:R/S ratio > 1 and negative T wave

qR pattern

R gt; 6 mm, or S < 2mm, or rSR' with R' > 10 mm

Other chest lead criteria:R in V1 + S in V5 (or V6) 10 mm

R/S ratio in V5 or V6 < 1

R in V5 or V6 < 5 mm

S in V5 or V6 > 7 mm

ST-Segment Abnormalities

Measurement of ST-elevation

DD Of ST-Segment Elevation

1. Early Repolarization Phenomenon

2. Ischemic Heart Disease (usually convex upwards,

or straightened

DD Of ST-Segment Depression

1. Normal variants Or Artifacts

2. Ischemic Heart Disease

3.Non Ischemic Causes Of ST-Segment Depression

RVH (right precordial leads) or LVH (left precordial leads, I, aVL)

Digoxin effect on ECG

Hypokalemia

Mitral valve prolapse (some cases)

CNS disease

Secondary ST segment changes with IV conduction abnormalities (e.g., RBBB,

LBBB, WPW, etc)

Myocardial Infarction

Evaluation Of Myocardial Infarction

Inferior Myocardial Infarction

Old Inferior Wall MI

RV Infarction

Anterior Wall Myocardial Infarction

T Wave Abnormalities

Normal T Waves

DD Of T-Waves Inversions

Myocardial Infarction

CNS Diseases

RVH Or LVH with Strains

Thanks