Supraventricular
Narrow QRS
tachycardia
No discernable pattern, no Patient is very likely to lose consciousness – thus the
Ventricular fibrillation diagnosis is easy!
QRS, no P, no T
Accessory pathway, usually from the left atria to the
Delta waves present, right left ventricle allows direct transition of the signal,
Wolff-Parkinson-White bypassing the AV node, hence the shortened PR
axis deviation, short PR interval. It has a risk of mortality as it can cause re-
SYndrome
interval, short QRS entry tachycardia; however, most patients are
symptomless and live with no problems.
This causes a sloping ST segment that has a
‘reversed tick’ look. This occurs because digoxin
Depression of ST, inverted T widespre blocks the na/K pump, which increases intracellular
The digoxin effect ad Ca2+ concentrations. (similarly, ischaemia causes
waves
reduced production of ATP, and thus reduced pump
activity)
If ST elevation does occur, then the ST waves will
appear ‘saddle shaped’ thus helping you to
T wave inversion (rare: also Widespre
Pericarditis ad
differentiate it from MI. also, the elevation in MI tends
ST elevation) to be confined to a certain area, but in pericarditis, it is
widespread
Seen in cor pulmonale, or pretty much anything that
Tall ,peaked T waves, p wave
P pulmonale Lead II causes right atrial enlargement (or hypertrophy) –
height >2mm in lead II such as tricuspid stenosis or pulmonary hypertension
P waves with two peaks,
Bifid P waves (‘P-
broad – looks like an ‘M’; ? Left ventricular hypertrophy
Mitrale’)
hence the name ‘Mitrale’
Bi-phasic T waves T waves with t peaks Can occur as a result of MI
The corrected QT, is the QT interval as it would be at
60bpm. if this is long, then there is a risk of sudden
Prolonged QT interval Prolonged QT cardiac death. It can be congenital, but also caused
by drugs
Wide, tall, ‘tented’ T waves,
shortened/absent ST
Hyperkalaemia ? Can lead to VF and AF
segment, small or absent p
waves, wide QRS
S wave in V1 or V2 >35mm AND R wave in V5 or V6 >35mm R in aVF >20mm
Left ventricular R in aVL >11mm Any chest lead
hypertrophy >45mm
R in lead I >12mm
Occasional P waves, not
The large spike is pacemaker stimulus.
related to QRS, QRS precede
Pacemaker ? The QRS’s are wide because the
by large spike, QRS
stimulus originates in the ventricles
complexes broad
Links 728x15
Axis deviation
Lead I Lead II Axis
+ + Normal
+ - LAD
- Either RAD
aVR should always be negative!
If it is positive,it is called north-west axis. it could be due to incorrect limb lead placement,
dextrocardia, or artificial pacing, due to the pacemaker wire - this enters the heart at the apex.
Carotid sinus pressure
By applying pressure to the carotid sinus you can stimulate the AV and SA nodes via vagal stimulation. This
will reduce the frequency of discharge of the SA node, and increase the time of conduction across the AV
node.
Thus, by applying pressure to the carotid sinus you can:
• Reduce the rate of some arrhythmias
• Completely stop some arrhythmias
• It will have NO EFFECT ON VENTRICULAR TACHYCARDIAS – thus is can help you differentiate.
Applying the pressure basically reduces the frequency of QRS complexes, and allows the underlying
atrial arrhythmia to become more visible.
- See more at:
http://almostadoctor.co.uk/content/systems/-
cardiovascular-system/ecgs/summary-ecg-
abnormalities#sthash.5g6RCyVB.dpuf