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Basic ECG

Basic Electrocardiogram

1 ECG
ECG 25 mm/sec 1 mm (1 )
1 / 25 = 0.04 sec 1 ( 5 ) = 0.2 sec
SA node AV node atrial depolarization atrium
ECG P wave atrium P wave
P wave atium
(ectopic foci) P wave Atrial fibrillation (AF)
AV node delay bundle of His
ventricle ECG PR interval AV node PR interval
first degree AV block AV node PR interval
bundle branch depolarization ventricle
QRS complex ventricle bundle branch block QRS complex
pathologic Q wave wfh
repolarization ventricle ECG T wave U wave Hypo K

Intervals
1 PR interval :- P wave Q wave 0.12-0.20 sec
1. Short PR interval:- high cathecholamine delta wave WolffParkinson-White Syndrome PR interval

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Basic ECG

2. Prolonged PR interval vagal tone

first-degree atrioventricular (AV) block P wave
QRS complex PR

A
2 A short PR interval delta wave ()
B prolonged PR interval

2 QRS interval :- Q wave S wave 0.06 - 0.1 sec (2.5 )

Widened QRS bundle branch block, ventricular premature beat, severe
hypokalemia, toxic drug quinidine,
3 QT interval Q wave T wave 0.32 - 0.48 sec (12 )
1. Prolonged QT interval

2. Shortened QT interval

3 prolong QT interval

Q Wave
small Q waves septal depolarization
pathologic Q wave > 0.04 sec >25% R wave lead

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4 pathologic Q wave ()
ST segment
1 ST segment elevation:
concave () upward ST segment elevation pericarditis (
tachycardia)
convex () ST segment elevation acute myocardial infarction (MI), coronary
spasm, ventricular aneurysm ST elevation Q wave myocardial infarction

A
B
5 A ST elevation concave () pericarditis
B ST elevation convex () acute myocardial injury

6 transmural subendocardial infarction

2 ST segment depression nontransmural MI, ischemia, digitalis effect
3

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Basic ECG

ST elevation depression myocardial injury ST elevation transmural

injury coronary artery ST depression subendocardial injury

7 A ST depression subendocardial injury

B ST elevation transmural injury
T Wave
1 T wave inversion myocardial ischemia, non Q wave MI, digitalis effect, hypokelemia,
hypocalcemia, increase intracranial pressure ( subarachnoid hemorrhage)
2 Tall peak T hyperkalemia ()
3 Hyperacute T acute MI ()

A
8 A tall peak T hyperkalemia

B
B hyperacute T acute MI

Myocardial Injury
(acute myocardial infarction) (Ac MI)
coronary
right coronary artery (RCA) acute inferior wall MI / posterior right
ventricular MI

Basic ECG

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left main coronary artery (sudden death)

(massive infarction)

9 coronary
left anterior descending artery anterior wall infarction
left circumflex artery lateral wall infarction 10%
inferior wall posterior wall left ventricle

10 ECG myocardial injury

( 1. inferior lead = II, III, aVF 2. lateral lead = I, aVL, V5 V6 3. anterior = V1-4
lead area )
coronary artery injury
3 ECG
1. ischemia ECG T wave change ( inverted T wave)
2. injury ECG ST change
3. infarction ECG QRS change ( pathologic Q wave)
5

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Basic ECG

11 ECG myocardial injury

Arrhythmia
1. Atrial fibrillation (AF)
ectopic foci atrium atrium depolarization
P wave baseline (f wave) ventricle
ectopic foci ventricle

12 atrial fibrillation (f = fibrillation wave)

2. Ventricular tachycardia (VT)
ventricle 100-200 /min
ventricular fibrillation

13 A. ventricular tachycardia B. ventricular fibrillation

6

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Basic ECG

3. Ventricular fibrillation (VF)

ventricle depolarization
repolarization ventricle cardiac output
cardiac arrest

Electrolyte imbalance
hypokalemia U wave ()
hyperkalemia tall peak T()

A
14

A. U wave () hypokalemia
B. tall peak T () hyperkalemia

Hypocalcemia QT interval 0.32 - 0.48 sec (8 - 12 )

Hypercalcemia QT interval

15 ECG hypocalcemia, normal hypercalcemia

Good Luck for a Good Doctor