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P wave

Rounded
Height 2.5 sm .sq
Width 2.5 sm.sq
PR interval
0.12-0.20 s(maximum 5 sm. sq)

Q wave
Absent in most leads
Height(Depth) 2 sm. sq
Width 1 sm. sq

R wave
Height : AVL <13mm , AVF<20mm , V5-6<25mm
R wave progression-Amplitude of R wave gradually increases from
V1-V6(S wave decreases with R wave)
Poor progression R wave-Amplitude of R wave gradually decreases
from V1-V6
QRS complex
0.08-0.11 s
Height <25mm
Width <3 mm(2.5 sm sq.)
ST segment
In isoelectric line
Considered normal upto 1mm in limb lead and 2mm in chest lead above isoelectric line
0.5mm below isoelectric line
T wave
Rounded
Upright in all leads except AVR
Height>2mm
May be inverted in V1&2

QT interval
0.34-0.43s
Best seen in AVL as there is no U wave

Side and surface

Anterior surface
V1,V2-RV
V3,V4-IV septum
Lateral surface
V5,V6-Low lateral
Lead 1 ,avL-High lateral
Inferior surface
Lead 2 , lead 3 ,avF
Extensive anterior surface
Anterior+lateral

Rhythm strip

Lead 2 is rhythm strip


If irregular R-R interval>Find rhythm strip>(No. of R wave within 30
large sq.)10 =HR

Abnormality of waves/complex with interpretation

P wave(Absent ,tall ,small ,wide ,inverted ,variable ,multiple)


Absent-AF(f wave replacement) ,AF(Saw tooth appearance) ,VT, VE ,
SVT
Tall/P pulmonale-RAE
Small-AT
Wide and notched/P mitrale-LAE
Inverted-Dextrocardia ,incorrect lead placement
Variable-Wandaring pacemaker

PR interval-(Prolonged ,short ,variable)


Prolonged-1st degree HB ,IHD
Short-WPWS(Wolff parkison white syndrome-Re entry circuit via
accessory pathway from ventricle to atria with normal impulse from
atria to ventricle.Delta wave is found) ,LGLS(lown ganong levine
syndrome-No delta wave)
Variable Wenckebach phenomenon/MT1-Progressive lengthening followed
by drop beat

MT2-Fixed and prolonged


2:1-2 wave complex and 1 drop beat
3:1-3 wave complex and 1 drop beat
Complete HB-No relation between P wave and QRS complex
Q wave
Pathological Q wave-MI ,LBBB
R wave(Tall ,small)
Tall-LVH ,RVH
Small-Pericardial effusion
RVH------------------------------------------------

V1: R>/=S wave


Right axis deviation(Opposite)

LVH------------------------------------------------

avL: R>13mm
avF: R>20mm
SV1+RV6>35 mm
Left axis deviation(tR1 ,dS3)

Dilated cardiomyopathy>No LVH feat.


Hypertrophied cardiomyopathy>LVH feat.

tR1-tall R in lead 1
dS3-deep S in lead 3

QRS complex(Wide ,narrow ,variable)


Wide-Ventricular ectopics , ventricular ectopic ,VT
Narrow-SVT
Variable-VF
Ventricular ectopic

Wide QRS <3

VT

3/more consequetive wide QRS

Ventricular ectopics

Many wide QRS but not consequet

Multifocal ventricular ectopics

Many wide QRS complex


Different shaped

Multiple ventricular ectopics

Many wide QRS complex


All same shaped

VT/VE/SVT

Very high pulse rate ,so do ECG

Cardioversion

To return abnormal heart rhythm bac


sinus rhythm e.g.
Chemical cardioversion(Lignocaine)
Electrical cardioversion(DC shock)

When cardioversion fails>Radio freq


catheter ablation>Chance of HB>Pa

Arrhythmia
Abnormality in rate/rhythm/both.
Abnormality in initiation and propagation of cardiac impulse

Slow AF=Rate<60
Fast AF=Rate>100
Atrial fibrillation
Absent P wave ,may be replaced by f wave
RR interval irregular
Causes
Chronic rheumatic heart disease specially MS
Coronary artery disease specially MI
HTN
Thyrotoxicosis
Complication
Systemic embolism(LH)
Pulmonary embolism(RH)
HF
Types
Paroxysmal
Persistent-Long duration ,Rx response
Permanent-Long duration ,difficult to control even with cardioversion
ST segment(Elevation ,depression)
Elevation-Recent MI(Convexity upward) ,acute pericarditis(Concavity
upward)
Depression-Subacute MI ,angina ,digoxin toxicity(Thumb
impression/reverse tick)

T wave(Inversion ,tall ,small)


Inversion-Subendocardial MI(Non Q wave MI) ,acute pericarditis
Tall-Hyperkalemia ,hyperacute MI
Small-Hypokalemia ,pericardial effusion

U wave(Inversion ,prominent)
Inversion-IHD ,hypertensive heart disease
Prominent-Hypokalemia
QT interval(Short ,prolonged)

Short-Hypercalcemia
Prolonged-Hypocalcemia , acute myocarditis