Principles of ECG Interpretation
48
ECG Conference ECG Conference Henry Tran, MD Henry Tran, MD January 13, 2016 January 13, 2016
-
Upload
henry-tran -
Category
Science
-
view
600 -
download
10
Transcript of Principles of ECG Interpretation
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
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!
