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(ECG)Electrocardiogram

Electrocardiogram, ECG)

2

(LL)(RL)

(LA)(RA)

(V1 V6)

V1:

V2:

V3: V2V4

V4:

V5:

V4V6

V6:

3

4

1mm,1mm , (25mm/sec),(1mm)0.04(25mm/secX0.04sec=1mm) ,(0.20)

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Rate

Rate (Rule of 300)

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(Autonomic nervous system)(Impulse)(SA node)(AV node)(Bundle of His)(Ventricular systole)

(Cardiac cycle)

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(P)0.1

(

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(T)0.2(5)

ST segment:

1.

2.J point ()

J pointJ point

P: QRS: T:

U :

Purkinje fiber

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1. 2. Regularity3. PP wave4. QRS5. P & QRS

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,

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1-1 () Vf Pulseless VT PEA Asystole

1-2 Normal Tachycardia Bradycardia

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()-1

()-2

Torsade de points

12

> 100 bpm

< 60 bpm

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2-1 VT

PSVT

Sinus

Junctional rhythm

Idioventricular rhythm

1st & 3rd degree A-V block)

2-2 Af

MAT

APC

JPC

VPC

2nd degree A-V block(Mobitz type I & type II)

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15

P wave

3-1 () P Sinus rhythm A-V block

3-2 P Atrial Tachycardia Atrial flutter MAT(>3P)

3-3 P Asystole Idioventricular rhythm Junctional rhythm PSVT Af

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() P

() P

First degree AV bolck

PR >5,

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() P- AV block

Second degree Mobitz type 1 AV block

PR , then block

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Second degree Mobitz type 2 AV block

PR , QRS

Third degree Mobitz type 1 AV block

P-P interval R-R interval but PQRS

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P

P ; R-R P

P-MAT

:a. P b. P . 100- 250/

1 2 3 4 5 6

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P-1

P-2

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P-3

AF (atrial flutter)

P

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Af ( atrial fibrillation )P()R-R

1. Af with RVR (>100/)(rapid ventricular response)

2. Af with SVR (

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4-1 QRS VT Idioventricular rhythm Pacemaker rhythm

4-2 QRS Sinus Atrial- Junctional rhythm PSVT

QRS(Ventricle)

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QRS-1

QRS-2

25

QRS-3

P & QRS

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P & QRS -AV block

P & QRS -AV block

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P & QRS - APC

Manage and treatment: 1. , 2.

P & QRS -VPC

DDX: 1. Normal 4. Digoxin intoxication2. IHD: MI , angina 5. Hyperkalemia3. Cardiomyopathy 6. Iatrogenic ( catheter )

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P & QRS -pacemaker

VVI

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DDD

P & QRS -pacemaker

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ST >1 mm

PR baseline

ST-segment deviation= 4.5 mm

J point

AMI

Localized changese.g. : V1-V4Reciprocal changesProgressive changes

< 2h : Hyperacute T waves < 4h : ST segment elevation 4-6h : Q waves or loss of R wave voltage 16-24h : ST back to baseline, T wave inversion Weeks : Q waves usually persist Now onset LBBB-myocardial injury (AMI)

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AMI- EKG change

4mm,0.04Q

STT

Acute MI Old MI

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Baseline

tall or inverted T wave (infarct),ST segment may be depressed (angina)

elevated ST segment, T wave may invert

()abnormal Q wave,ST segment may be elevated and T wavemay be inverted

(abnormal Q wave,ST segment and T wave returned to normal

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Location of infarction (STEMI)

Anterior wall: V1-V6anterio-septal: V1-V4anterio-lateral: V3-V6extensive anterior wall: V1-V6

Lateral wall: V5, V6, I, aVLInferior wall: II, III, aVFPosterior wall: mirror image at V1-V3RV infarction: ST elevation at V3R and V4R

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AMI, anterior wall

Acute Anterior Wall MI

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Acute Inferior Wall MI

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WPW Syndrome

Wolff-Parkinson-White Syndrome AVAV node

EKG PR interval0.12 QRSDelta

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WPW Syndrome

DeltaDelta

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Af with RVR

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WPW Syndrome with Af