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What is an ECG?
An EKG is a method of measuring, displaying and recording the electrical activity of a heart
Electrical stimuli is amplified to create a rhythm strip by a machine that consistently produces representations of the hearts electrical activity
Ability to initiate an impulse : Ability to respond to an impulse : Ability to transmit an impulse : Ability to respond with pumping action
BASIC TERMINOLOGY
Arrhythmia Baseline : : Abnormal rhythm Flat, straight, isoelectric line
Waveform
Segment Interval Complex
:
: : :
Components of a NSR
1. 2. 3. 4. 5.
Describe the sequence of right and left atrial Normal positif in lead I, II, aVF, and V4 V6 Normal negative in lead aVR Duration < 0,12 sec Amplitudo < 2,5 mm
1. Time needed to transmit impuls from SA node to AV node 2. Normal 0,12 0,22 sec ( 3-5,5 small box) 3. Short PR interval preeksitasion syndrome 4. Prolonged PR interval think about A-V block.
1. 2. 3. 4.
Describe activation of left and right ventrikel Duration 0,05 0,10 sec (<2,5 small box). Measure usually in limbs lead If the amplitudo less than 10 mm in all leads low voltage. 5. Abnormal complex QRS seen in conduction defect
Nomenclature of complex QRS first negative deflection named Q wave first positive deflection named R wave negative deflection after R wave called S wave R wave always above the baseline Q`and S wave always below the baseline
Q wave 1. Normal Q wave seen in lead I, aVL, and V5-6. describe activation of septum left to right 2. Q wave in V1-2 is abnormal 3. Pathologic Q : duration > 0,04 sec and/ or height > dari 1/3 complex QRS
Normal ST segment
1. Usually isoelectric, elevation < 1 mm in extremity still normal 2. Depression < 0,5 mm 3. Point at the end of QRS complex named J point
T wave criteria
1. Describe repolarization of ventricel 2. Normal positif in leads I,II and V3-V6 3. Normal negative in lead III
QT duration 1. Describe total sistolic time 2. variation according to heart rate, gender and age 3. QT interval must be < R-R interval in HR 65-90/mnt 4. Normal QT correction 0,44 + 0,02 sec 5. Prolonged QTc predispose R on T VT
Rate Determination
Paper speed is 25 mm/second : 1 small box 1 large box 6 large boxes = 1 mm = 0.04 second = 5 mm = 0.20 second = 30 mm = 1.20 second
Calculation of heart rate 1. Calculate total QRS complex in 6 large box and x 50
Rate Determination 2. Count the total small box between the 2 QRS kompleks and divide to 1500
Electrical Axis
aVR
1800
aVL
00 I
III
900 aVF
II
Use QRS complex in lead I as x axis and lead aVF as Y axis to calculate axis.
Axis Deviation
Normal
Right Axis
900
How to report
Rhythm - Axis QRS - Transisional Zone - Interval - PR - QRS - QT : : : : : :
-
- Heart rate
: : : : :
- QTc
- U wave
CONCLUSION :
MORPHOLOGICAL ABNORMALITIES
Electrocardiogram (EKG)
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a temporalily insufficient blood supply. Commonly seen during spontaneous angina and induced coronary insufficiency.
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ETIOLOGY
ATHEROSKLEROSIS : STENOSIS CORONARY ARTERY VENTRICULAR HYPERTROPHY AORTIC STENOSIS SYPHILITIC AORTITIS PULMONARY HYPERTENSION POLYCITEMIA
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ECG
POSTERIOR (POSTEROLATERAL)
RV
V7- V9
PL
V3R V5R
RCA/ RV BRANCH
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MYOCARDIAL INFARCTION
Myocardial infarction is characterized by the necrosis of a portion of the myocard resulting from a lack of sufficient blood suply to keep the muscle viable. The most common cause is complete occlusion of coronary artery by atherosclerotic coronary trombosis.
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Terminology of infarct
Acute infarct : several hours untill days ECG : ST elevation Recent infarct : several days- weeks. ECG : evolution Old infarct : more than 6 months. ECG : Q wave or QS complex or slow progression of R wave
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VENTRICULAR HYPERTROPHY
LEFT VENTRICULAR HYPERTROPHY : Etiology : - Hypertension - Aortic stenosis / Insufficiency - Mitral Insufficiency - Longstanding CAD - Nutritional and idiopathic hypertrophy - Congenital heart disease
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CRITERIA
Chest lead (Sokolow, Lyon) : S wave in V1 + R wave in V5 or V6 > 35 mm R in V5 or V6 > 26 mm. R plus S in any chest leads > 45 mm
Limb leads (Gubner, Ungerleider) : R in I + S in III > 25 mm R in aVF > 20 mm R in aVL > 11 mm R in aVR > 15 mm
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THE END
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