Microsoft PowerPoint - ECG Workshop
Transcript of Microsoft PowerPoint - ECG Workshop
![Page 1: Microsoft PowerPoint - ECG Workshop](https://reader037.fdocuments.us/reader037/viewer/2022103018/55a742c81a28ab5f018b48a9/html5/thumbnails/1.jpg)
Simon Simon AbouAbou JaoudJaoudééCardiology DepartmentCardiology Department
HôtelHôtel--DieuDieu
ECG reading: the common and dangerous
ECG reading: the ECG reading: the common and dangerouscommon and dangerous
![Page 2: Microsoft PowerPoint - ECG Workshop](https://reader037.fdocuments.us/reader037/viewer/2022103018/55a742c81a28ab5f018b48a9/html5/thumbnails/2.jpg)
Review essential technical aspects of ECG recordingReview essential technical aspects of ECG recording
Content and ObjectivesContent and Objectives
Distinguish between Distinguish between ““normalnormal”” and and ““abnormalabnormal”” ECG findingsECG findings
List the criteria for heart blocks and WPWList the criteria for heart blocks and WPW
Recognize arrhythmia type during sustained tachycardiaRecognize arrhythmia type during sustained tachycardia
Identify main ECG abnormalities caused by MI and ischemiaIdentify main ECG abnormalities caused by MI and ischemia
![Page 3: Microsoft PowerPoint - ECG Workshop](https://reader037.fdocuments.us/reader037/viewer/2022103018/55a742c81a28ab5f018b48a9/html5/thumbnails/3.jpg)
common technical pitfallscommon technical pitfalls
![Page 4: Microsoft PowerPoint - ECG Workshop](https://reader037.fdocuments.us/reader037/viewer/2022103018/55a742c81a28ab5f018b48a9/html5/thumbnails/4.jpg)
Lead placementLead placement
![Page 5: Microsoft PowerPoint - ECG Workshop](https://reader037.fdocuments.us/reader037/viewer/2022103018/55a742c81a28ab5f018b48a9/html5/thumbnails/5.jpg)
![Page 6: Microsoft PowerPoint - ECG Workshop](https://reader037.fdocuments.us/reader037/viewer/2022103018/55a742c81a28ab5f018b48a9/html5/thumbnails/6.jpg)
![Page 7: Microsoft PowerPoint - ECG Workshop](https://reader037.fdocuments.us/reader037/viewer/2022103018/55a742c81a28ab5f018b48a9/html5/thumbnails/7.jpg)
FFIILLTTEERR
OONN
![Page 8: Microsoft PowerPoint - ECG Workshop](https://reader037.fdocuments.us/reader037/viewer/2022103018/55a742c81a28ab5f018b48a9/html5/thumbnails/8.jpg)
![Page 9: Microsoft PowerPoint - ECG Workshop](https://reader037.fdocuments.us/reader037/viewer/2022103018/55a742c81a28ab5f018b48a9/html5/thumbnails/9.jpg)
Paper SpeedPaper Speed
50 mm/sec 25 mm/sec
![Page 10: Microsoft PowerPoint - ECG Workshop](https://reader037.fdocuments.us/reader037/viewer/2022103018/55a742c81a28ab5f018b48a9/html5/thumbnails/10.jpg)
![Page 11: Microsoft PowerPoint - ECG Workshop](https://reader037.fdocuments.us/reader037/viewer/2022103018/55a742c81a28ab5f018b48a9/html5/thumbnails/11.jpg)
0,04 sec 0,2 sec
TEMPS
VO
LT
AG
E
25mm/sec
10 m
m/m
V 0,04 sec
![Page 12: Microsoft PowerPoint - ECG Workshop](https://reader037.fdocuments.us/reader037/viewer/2022103018/55a742c81a28ab5f018b48a9/html5/thumbnails/12.jpg)
motion motion artifactartifact
--breathingbreathing
stop breathingstop breathing
Auto modeAuto mode
![Page 13: Microsoft PowerPoint - ECG Workshop](https://reader037.fdocuments.us/reader037/viewer/2022103018/55a742c81a28ab5f018b48a9/html5/thumbnails/13.jpg)
![Page 14: Microsoft PowerPoint - ECG Workshop](https://reader037.fdocuments.us/reader037/viewer/2022103018/55a742c81a28ab5f018b48a9/html5/thumbnails/14.jpg)
Lead InversionLead Inversion
![Page 15: Microsoft PowerPoint - ECG Workshop](https://reader037.fdocuments.us/reader037/viewer/2022103018/55a742c81a28ab5f018b48a9/html5/thumbnails/15.jpg)
L R
![Page 16: Microsoft PowerPoint - ECG Workshop](https://reader037.fdocuments.us/reader037/viewer/2022103018/55a742c81a28ab5f018b48a9/html5/thumbnails/16.jpg)
Normal ECG ??Normal ECG ??
•• 62 y 62 y •• emergency departmentemergency department•• chest painchest pain
![Page 17: Microsoft PowerPoint - ECG Workshop](https://reader037.fdocuments.us/reader037/viewer/2022103018/55a742c81a28ab5f018b48a9/html5/thumbnails/17.jpg)
•• 62 y 62 y •• emergency departmentemergency department•• chest painchest pain
![Page 18: Microsoft PowerPoint - ECG Workshop](https://reader037.fdocuments.us/reader037/viewer/2022103018/55a742c81a28ab5f018b48a9/html5/thumbnails/18.jpg)
T wave polarity depends on T wave polarity depends on
T wave axisT wave axis
![Page 19: Microsoft PowerPoint - ECG Workshop](https://reader037.fdocuments.us/reader037/viewer/2022103018/55a742c81a28ab5f018b48a9/html5/thumbnails/19.jpg)
I
II
III
Frontal PlaneFrontal Plane
![Page 20: Microsoft PowerPoint - ECG Workshop](https://reader037.fdocuments.us/reader037/viewer/2022103018/55a742c81a28ab5f018b48a9/html5/thumbnails/20.jpg)
T wave is always positive in leads I and IIT wave is always positive in leads I and II
may be negative in lead III.may be negative in lead III.
T wave is always positive in T wave is always positive in precordialprecordialleads.leads.
(except V1: may be negative)(except V1: may be negative)
![Page 21: Microsoft PowerPoint - ECG Workshop](https://reader037.fdocuments.us/reader037/viewer/2022103018/55a742c81a28ab5f018b48a9/html5/thumbnails/21.jpg)
• 75 y W• elective cholecystectomy• pre op ECG
Normal ECG ??Normal ECG ??
![Page 22: Microsoft PowerPoint - ECG Workshop](https://reader037.fdocuments.us/reader037/viewer/2022103018/55a742c81a28ab5f018b48a9/html5/thumbnails/22.jpg)
I
![Page 23: Microsoft PowerPoint - ECG Workshop](https://reader037.fdocuments.us/reader037/viewer/2022103018/55a742c81a28ab5f018b48a9/html5/thumbnails/23.jpg)
ExpirationExpiration InspirationInspiration
Positional Q waves (Positional Q waves (septalseptal Q waves)Q waves) often disappears with often disappears with change in heart orientation associated with deep inspiration change in heart orientation associated with deep inspiration
![Page 24: Microsoft PowerPoint - ECG Workshop](https://reader037.fdocuments.us/reader037/viewer/2022103018/55a742c81a28ab5f018b48a9/html5/thumbnails/24.jpg)
• 33 y M• ER• chest pain x 3 hours
Normal ECG ??Normal ECG ??
![Page 25: Microsoft PowerPoint - ECG Workshop](https://reader037.fdocuments.us/reader037/viewer/2022103018/55a742c81a28ab5f018b48a9/html5/thumbnails/25.jpg)
““Early Repolarisation SyndromeEarly Repolarisation Syndrome”” ““High takeHigh take--off ST segmentoff ST segment””
![Page 26: Microsoft PowerPoint - ECG Workshop](https://reader037.fdocuments.us/reader037/viewer/2022103018/55a742c81a28ab5f018b48a9/html5/thumbnails/26.jpg)
TachycardiaTachycardia
![Page 27: Microsoft PowerPoint - ECG Workshop](https://reader037.fdocuments.us/reader037/viewer/2022103018/55a742c81a28ab5f018b48a9/html5/thumbnails/27.jpg)
Atrial Fibrillation
![Page 28: Microsoft PowerPoint - ECG Workshop](https://reader037.fdocuments.us/reader037/viewer/2022103018/55a742c81a28ab5f018b48a9/html5/thumbnails/28.jpg)
TachycardiaTachycardia (HR > 100/min)(HR > 100/min)
RegularRegularIrregularIrregular
Atrial Fibrillation
![Page 29: Microsoft PowerPoint - ECG Workshop](https://reader037.fdocuments.us/reader037/viewer/2022103018/55a742c81a28ab5f018b48a9/html5/thumbnails/29.jpg)
SVTSVT
![Page 30: Microsoft PowerPoint - ECG Workshop](https://reader037.fdocuments.us/reader037/viewer/2022103018/55a742c81a28ab5f018b48a9/html5/thumbnails/30.jpg)
TachycardiaTachycardia (HR > 100/min)(HR > 100/min)
RegularRegularIrregularIrregular
Atrial Fibrillation
NarrowNarrow QRS tachycardiaQRS tachycardia(< 0.12 sec)(< 0.12 sec)
WideWide QRS tachycardiaQRS tachycardia(> 0.12 sec)(> 0.12 sec)
““ SVTsSVTs ””
Sinus Tachycardia
Atrial Tachycardia
Atrial Flutter
AVNRT-AVRT(Bouveret)
VTVT
““ SVTsSVTs ””
+ WPW
+ BBB
![Page 31: Microsoft PowerPoint - ECG Workshop](https://reader037.fdocuments.us/reader037/viewer/2022103018/55a742c81a28ab5f018b48a9/html5/thumbnails/31.jpg)
VTVT
![Page 32: Microsoft PowerPoint - ECG Workshop](https://reader037.fdocuments.us/reader037/viewer/2022103018/55a742c81a28ab5f018b48a9/html5/thumbnails/32.jpg)
P wave ?
Identifying P wave: several approaches
- Spontaneous on surface ECG(compare with previous tracings)
- Lewis lead (DI on chest)- Esophageal lead- Epicardiac lead (post open heart)- CSM, ATP, AdenosineAdenosine
Analyze P wave- Morphology- Timing- Rate
““ SVTsSVTs ”” (Regular, Narrow QRS tachycardia)
![Page 33: Microsoft PowerPoint - ECG Workshop](https://reader037.fdocuments.us/reader037/viewer/2022103018/55a742c81a28ab5f018b48a9/html5/thumbnails/33.jpg)
Analyze P wave- Morphology- Timing- Rate
“sinus” morphology: positive P wave in leads I and Vf
P P wavewave
II
aVfaVf
![Page 34: Microsoft PowerPoint - ECG Workshop](https://reader037.fdocuments.us/reader037/viewer/2022103018/55a742c81a28ab5f018b48a9/html5/thumbnails/34.jpg)
Analyze P wave- Morphology- Timing- Rate
“P” wave rate
120-150 250 350 /min
Sinus Atrial Atrial Atrialtachy tachy flutter fibrillation
![Page 35: Microsoft PowerPoint - ECG Workshop](https://reader037.fdocuments.us/reader037/viewer/2022103018/55a742c81a28ab5f018b48a9/html5/thumbnails/35.jpg)
sinus tachycardia
![Page 36: Microsoft PowerPoint - ECG Workshop](https://reader037.fdocuments.us/reader037/viewer/2022103018/55a742c81a28ab5f018b48a9/html5/thumbnails/36.jpg)
Regular narrow QRS tachycardia at 150/minRegular narrow QRS tachycardia at 150/min AdenosineAdenosine
![Page 37: Microsoft PowerPoint - ECG Workshop](https://reader037.fdocuments.us/reader037/viewer/2022103018/55a742c81a28ab5f018b48a9/html5/thumbnails/37.jpg)
Regular P waves at 150/minRegular P waves at 150/minAdenosineAdenosine
1/1 Atrial Tachycardia
![Page 38: Microsoft PowerPoint - ECG Workshop](https://reader037.fdocuments.us/reader037/viewer/2022103018/55a742c81a28ab5f018b48a9/html5/thumbnails/38.jpg)
ATPATP Regular P waves at 300/minRegular P waves at 300/min
Regular tachycardia at 150 / minRegular tachycardia at 150 / min 2/1 Atrial Flutter
![Page 39: Microsoft PowerPoint - ECG Workshop](https://reader037.fdocuments.us/reader037/viewer/2022103018/55a742c81a28ab5f018b48a9/html5/thumbnails/39.jpg)
![Page 40: Microsoft PowerPoint - ECG Workshop](https://reader037.fdocuments.us/reader037/viewer/2022103018/55a742c81a28ab5f018b48a9/html5/thumbnails/40.jpg)
![Page 41: Microsoft PowerPoint - ECG Workshop](https://reader037.fdocuments.us/reader037/viewer/2022103018/55a742c81a28ab5f018b48a9/html5/thumbnails/41.jpg)
AVNRT
AdenosineAdenosine
![Page 42: Microsoft PowerPoint - ECG Workshop](https://reader037.fdocuments.us/reader037/viewer/2022103018/55a742c81a28ab5f018b48a9/html5/thumbnails/42.jpg)
Adenosine
2003 ACC/AHA/ESC Guidelines for Management of SVA
![Page 43: Microsoft PowerPoint - ECG Workshop](https://reader037.fdocuments.us/reader037/viewer/2022103018/55a742c81a28ab5f018b48a9/html5/thumbnails/43.jpg)
![Page 44: Microsoft PowerPoint - ECG Workshop](https://reader037.fdocuments.us/reader037/viewer/2022103018/55a742c81a28ab5f018b48a9/html5/thumbnails/44.jpg)
ECG in CADECG in CAD
![Page 45: Microsoft PowerPoint - ECG Workshop](https://reader037.fdocuments.us/reader037/viewer/2022103018/55a742c81a28ab5f018b48a9/html5/thumbnails/45.jpg)
![Page 46: Microsoft PowerPoint - ECG Workshop](https://reader037.fdocuments.us/reader037/viewer/2022103018/55a742c81a28ab5f018b48a9/html5/thumbnails/46.jpg)
definedefine
-- typetype of ischemic changesof ischemic changes-- localizationlocalization of ischemic changesof ischemic changes
ECG in CADECG in CAD
![Page 47: Microsoft PowerPoint - ECG Workshop](https://reader037.fdocuments.us/reader037/viewer/2022103018/55a742c81a28ab5f018b48a9/html5/thumbnails/47.jpg)
Q waveQ wave
ST changesST changes
T wave T wave changeschanges
depolarization depolarization abnormalitiesabnormalitiesirreversibleirreversibleInfarction:Infarction:
1/ elevated ST1/ elevated ST
2/ depressed ST2/ depressed STrepolarisation repolarisation abnormalitiesabnormalitiesreversiblereversibleInjury :Injury :
1/ inverted T wave1/ inverted T wave
2/ Peaked T wave2/ Peaked T waverepolarisation repolarisation abnormalitiesabnormalitiesreversiblereversibleIschemia :Ischemia :
-- typetype of ischemic changesof ischemic changes
ECG in CADECG in CAD
![Page 48: Microsoft PowerPoint - ECG Workshop](https://reader037.fdocuments.us/reader037/viewer/2022103018/55a742c81a28ab5f018b48a9/html5/thumbnails/48.jpg)
Inverted T waveInverted T wave
Peaked T wavePeaked T wave
Elevated STElevated ST
Depressed STDepressed ST
IschemiaIschemia
InjuryInjury
![Page 49: Microsoft PowerPoint - ECG Workshop](https://reader037.fdocuments.us/reader037/viewer/2022103018/55a742c81a28ab5f018b48a9/html5/thumbnails/49.jpg)
antero-apical postero-inferior
antero-lateral
anterior
antero-septal
RV
postero-basal
Lateral Lateral viewview
Localization of ischemic changesLocalization of ischemic changes
anterioranteriorviewview
![Page 50: Microsoft PowerPoint - ECG Workshop](https://reader037.fdocuments.us/reader037/viewer/2022103018/55a742c81a28ab5f018b48a9/html5/thumbnails/50.jpg)
V1V1V2V2 V3V3
V4V4
V5V5
V6V6
VL VL leadlead I I
II III VFII III VF
V4rV4rV3rV3r
++
++antero-septal : V1 V2
apical : V3 V4
lateral : V5 V6
high lateral : I -VL
anterior : V1 - V6
postero-inferior : II -III -VF
postero-basal : V7 V8 V9
RV : V3r V4r
Localization of ischemic changesLocalization of ischemic changes
![Page 51: Microsoft PowerPoint - ECG Workshop](https://reader037.fdocuments.us/reader037/viewer/2022103018/55a742c81a28ab5f018b48a9/html5/thumbnails/51.jpg)
![Page 52: Microsoft PowerPoint - ECG Workshop](https://reader037.fdocuments.us/reader037/viewer/2022103018/55a742c81a28ab5f018b48a9/html5/thumbnails/52.jpg)
![Page 53: Microsoft PowerPoint - ECG Workshop](https://reader037.fdocuments.us/reader037/viewer/2022103018/55a742c81a28ab5f018b48a9/html5/thumbnails/53.jpg)
![Page 54: Microsoft PowerPoint - ECG Workshop](https://reader037.fdocuments.us/reader037/viewer/2022103018/55a742c81a28ab5f018b48a9/html5/thumbnails/54.jpg)
![Page 55: Microsoft PowerPoint - ECG Workshop](https://reader037.fdocuments.us/reader037/viewer/2022103018/55a742c81a28ab5f018b48a9/html5/thumbnails/55.jpg)
![Page 56: Microsoft PowerPoint - ECG Workshop](https://reader037.fdocuments.us/reader037/viewer/2022103018/55a742c81a28ab5f018b48a9/html5/thumbnails/56.jpg)
![Page 57: Microsoft PowerPoint - ECG Workshop](https://reader037.fdocuments.us/reader037/viewer/2022103018/55a742c81a28ab5f018b48a9/html5/thumbnails/57.jpg)
![Page 58: Microsoft PowerPoint - ECG Workshop](https://reader037.fdocuments.us/reader037/viewer/2022103018/55a742c81a28ab5f018b48a9/html5/thumbnails/58.jpg)
![Page 59: Microsoft PowerPoint - ECG Workshop](https://reader037.fdocuments.us/reader037/viewer/2022103018/55a742c81a28ab5f018b48a9/html5/thumbnails/59.jpg)
![Page 60: Microsoft PowerPoint - ECG Workshop](https://reader037.fdocuments.us/reader037/viewer/2022103018/55a742c81a28ab5f018b48a9/html5/thumbnails/60.jpg)
![Page 61: Microsoft PowerPoint - ECG Workshop](https://reader037.fdocuments.us/reader037/viewer/2022103018/55a742c81a28ab5f018b48a9/html5/thumbnails/61.jpg)
![Page 62: Microsoft PowerPoint - ECG Workshop](https://reader037.fdocuments.us/reader037/viewer/2022103018/55a742c81a28ab5f018b48a9/html5/thumbnails/62.jpg)
Heart blocks and WPWHeart blocks and WPW
![Page 63: Microsoft PowerPoint - ECG Workshop](https://reader037.fdocuments.us/reader037/viewer/2022103018/55a742c81a28ab5f018b48a9/html5/thumbnails/63.jpg)
AV node
His
-- Sinus dysfunctionSinus dysfunction
-- AV BlockAV Block
Heart blocksHeart blocks
![Page 64: Microsoft PowerPoint - ECG Workshop](https://reader037.fdocuments.us/reader037/viewer/2022103018/55a742c81a28ab5f018b48a9/html5/thumbnails/64.jpg)
![Page 65: Microsoft PowerPoint - ECG Workshop](https://reader037.fdocuments.us/reader037/viewer/2022103018/55a742c81a28ab5f018b48a9/html5/thumbnails/65.jpg)
PR > 0,2 secPR > 0,2 sec
1st degree AV block
![Page 66: Microsoft PowerPoint - ECG Workshop](https://reader037.fdocuments.us/reader037/viewer/2022103018/55a742c81a28ab5f018b48a9/html5/thumbnails/66.jpg)
![Page 67: Microsoft PowerPoint - ECG Workshop](https://reader037.fdocuments.us/reader037/viewer/2022103018/55a742c81a28ab5f018b48a9/html5/thumbnails/67.jpg)
«« progressiveprogressive »» AV blockAV block
Mobitz 1 AV block
![Page 68: Microsoft PowerPoint - ECG Workshop](https://reader037.fdocuments.us/reader037/viewer/2022103018/55a742c81a28ab5f018b48a9/html5/thumbnails/68.jpg)
![Page 69: Microsoft PowerPoint - ECG Workshop](https://reader037.fdocuments.us/reader037/viewer/2022103018/55a742c81a28ab5f018b48a9/html5/thumbnails/69.jpg)
constant PRconstant PRblocked P waveblocked P wave
Mobitz 2 AV block
![Page 70: Microsoft PowerPoint - ECG Workshop](https://reader037.fdocuments.us/reader037/viewer/2022103018/55a742c81a28ab5f018b48a9/html5/thumbnails/70.jpg)
![Page 71: Microsoft PowerPoint - ECG Workshop](https://reader037.fdocuments.us/reader037/viewer/2022103018/55a742c81a28ab5f018b48a9/html5/thumbnails/71.jpg)
P waveP wave
QRSQRS
Complete AV block
AV dissociationAV dissociation
![Page 72: Microsoft PowerPoint - ECG Workshop](https://reader037.fdocuments.us/reader037/viewer/2022103018/55a742c81a28ab5f018b48a9/html5/thumbnails/72.jpg)
![Page 73: Microsoft PowerPoint - ECG Workshop](https://reader037.fdocuments.us/reader037/viewer/2022103018/55a742c81a28ab5f018b48a9/html5/thumbnails/73.jpg)
sinus arrestsinus arrest
junctionaljunctional escape rhythmescape rhythm
Sinus dysfunction
![Page 74: Microsoft PowerPoint - ECG Workshop](https://reader037.fdocuments.us/reader037/viewer/2022103018/55a742c81a28ab5f018b48a9/html5/thumbnails/74.jpg)
![Page 75: Microsoft PowerPoint - ECG Workshop](https://reader037.fdocuments.us/reader037/viewer/2022103018/55a742c81a28ab5f018b48a9/html5/thumbnails/75.jpg)
KENTKENT
Wolf Parkinson White Syndrome Wolf Parkinson White Syndrome
![Page 76: Microsoft PowerPoint - ECG Workshop](https://reader037.fdocuments.us/reader037/viewer/2022103018/55a742c81a28ab5f018b48a9/html5/thumbnails/76.jpg)
Zone ventriculaire préexcitée
Zone excitée normalement
Wolf Parkinson White Syndrome Wolf Parkinson White Syndrome
![Page 77: Microsoft PowerPoint - ECG Workshop](https://reader037.fdocuments.us/reader037/viewer/2022103018/55a742c81a28ab5f018b48a9/html5/thumbnails/77.jpg)