Reporting an ECG

System 1. 2. 3. 4. 5. 6. Rate Rhythm Conduction interval Cardiac axis P wave QRS com lex No. bpm = 300 no. of big sqs per wave = 60 X no. of waves in 5 big sqs Sinus rhythm? P interva! " N 3#5 sma!! sqs $ S %omp!e& " N 3 sma!! sqs '( '' ) ''' !ea*s + !ea*s Norma!s, +-, S wave . wave +5/6, wave 0 15mm ta!! +5/6, $ 0 -mm wi*e ) 01 mm *eep Norma!!y isoe!e%tri% Norma!!y inverte* on!y in + an* +- !ea*s

!. 2. 1) Rate Sinus $radycardia Sinus tachycardia %trial tachycardia

S" se#ment 3 waves

%trial rate &15'$ m %( $loc) normal QRS com lexes

2) Rhythm %* (* 0eart $loc)s

+o P wave ,rre#ular line with normal QRS "otally disor#ani-ed .CQ/ no QRS 2nd de#ree1 2 3o$it- ty e 21 constant PR interval 2 4enc)e$ach1 increasin# PR interval 5ollowed $y missed QRS com lex 2 211 6 311 3rd de#ree %trial rate & 25'$ m +o 5lat $aseline $etween P waves Saw tooth a earance Re#ular P waves with slow unrelated QRS rate %$normal QRS com lexes (entricular 5oci de olari-e at hi#h 5re7uency 4ide a$normal QRS com lexes

Sinus arrhythmia %trial 5lutter

(entricular esca e (entricular tachycardia

3) Conduction Interval P interva! 1st de#ree heart $loc) 4ol552Par)inson24hite syndrome

,ncreased PR intervals Short PR interval 8elta wave (11 8ominant R wave %nterior chest leads 9 (12(4:1 inverted " waves .# (entricular esca e; (entricular tachycardia; %ccelerated idioventricular rhythm; (entricular extrasystole; Pacema)er 4ide QRS com lex %$normal " waves Prolon#ed Q" interval Shortened Q" intervals

$ S %omp!e& wi*th (entricular rhythms

$3 interva! 0y ocalcaemia 0y ercalcaemia 4) Cardiac axis <(0 R(0

<e5t axis deviation <eads ,, = ,,, $ecome more ne#ative Ri#ht axis deviation <ead , $ecomre more ne#ative; lead ,,, $ecome more ositive

 "ransition oint shi5ted to le5t to (46(5 osition.

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5) P wave 8ar!y %trial extrasystole 7ate 9!ose to $ S %omp!e& :bsent %trial esca e >unctional extrasystole >unctional tachycardia >unctional esca e %trial 5i$rillation 3a!! ;roa* Ri#ht atrial hy ertro hy <e5t atrial hy ertro hy

.arly a$normal sha ed P wave +ormal QRS 8elayed; a$normal P wave +ormal QRS com lex P wave a$sent; or immediately $e5ore or a5ter QRS com lex +ormal QRS P waves a$sent or very close to QRS com lexes +ormal QRS +o P wave +ormal QRS com lex +o P waves ,rre#ular line with irre#ularly timed normal QRS com lexes Pea)ed P waves 9P ulmonale: ?road $i5id P waves 9P mitrale:

6) RS com!lex :bnorma! R??? patterns <???

4ol552Par)inson2 4hite syndrome

:bsent $ S %omp!e& <i*e $ S %omp!e&es

(entricular 5i$rillation (entricular esca e (entricular tachycardia %ccelerated ,dioventricular Rhythm (entricular extrasystole Pacema)er

3a!! waves in +-

R(0

Pulmonary em$olism

3a!! waves in +5/+6

<(0

:bnorma! $ wave

*ull thic)ness in5arcts

(11 RSR@ com lex (61 dee ; wide S wave (61 A3@ attern (11 inverted A3@ attern a6w inverted " waves in anterior = lateral leads 9ie (<; , = (426: Short PR interval 8elta wave (11 8ominant R wave %nterior chest leads 9 (12(4:1 inverted " waves "otally disor#ani-ed .CB +o QRS com lex Re#ular P waves with slow unrelated QRS rate %$normal; wide QRS com lexes (entricular 5oci de olari-e at hi#h 5re7uency 4ide a$normal QRS com lexes 4ide QRS com lex %$normal " waves Re#ular ventricular rhythm with rate & than in ventricular esca e .arly; a$normal and wide QRS com lex ,nverted " waves ?road QRS com lex receded $y a s i)e 9 acema)er stimuli: Cccasional P waves unrelated to QRS com lexes Ri#ht axis deviation (11 R wave & S wave (61 dee S wave (16(21 inverted " waves ea)ed P wave 9R%0: loo)s similar to R(0 Sinus tachycardia Ri#ht axis deviation Pea)ed P wave (11 "all R waves; inverted " waves R???1 RSR@ com lex <ead ,,,1 Q wave &1mm wide = &2mm dee <e5t axis deviation (16(21 dee S wave (56(61 "all R wave <ateral leads 9,; (<;(526:1 inverted " wave 8ee 9&2mm: = wide 9&1mm: Q wave in leads over area o5 in5arct 2 %nterior1 (22(465 2 %nterolateral1 (32(4 D (<; , = (52(6 2 ,n5erior1 ,,, = (* 2 Posterior le5t ventricular wall1 dominant R wave in (1 Crder o5 .CB chan#es a5ter an 3, 9occurs durin# the 24 to 4E

hrs 1. 2. 3. 4. ") S# se$ment S3 8!evation

ost23,: S" elevation Q waves a ear ermanent " wave inversions S" se#ment returns to $aseline
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=ori>onta! *epression 4own#s!oping *epression

,n recent 'nfar%t or Peri%ar*itis <eads over in5racted art o5 heart shows S" elevation 2 %nterior in5arct1 ( leads 2 ,n5erior in5arct1 (* = ,,, 2 Pericarditis1 all leads 's%haemia or angina Secondary to 4igo&in therapy. a6w " wave inversion

%) # wave a&normalities ,schaemia ,nverted " waves S" chan#es D Q waves in 5ull2thic)ness in5arcts. +o Q waves in su$endocardial in5arcts <(0 ,nverted " waves in le5t ventricular leads 9(526; ,, = (<: R(0 ,nverted " waves in ri#ht ventricular leads 9(123: ???s 7;;;1 (61 A3@ attern (11 inverted A3@ attern a6w inverted " waves in anterior = lateral leads 9ie (<; , = (426: 8i#oxin thera y " wave inversion 8own2slo in# S" se#ment 4ol552Par)inson24hite Short PR interval syndrome 8elta wave (11 8ominant R wave %nterior chest leads 9 (12(4:1 inverted " waves 0y o)alaemia " wave 5lattenin# F wave 0y er)alaemia "all; wide; ea)ed " wave 8isa earance o5 S" se#ments wide QRS com lex

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