ECG new

Mobin



ECG
Rhythm
Heart Rate
QRS axis, the T wave and QRS angle
Intervals: PR, QRS and QT
P wave amplitude and duration
QRS amplitude and R/S ratio
ST segment and T wave abnormalities

Rhythm
Sinus Rhythm
normal rhythm at any age and is
characterized by P waves preceding
each QRS complex
normal P axis is important in
discriminating sinus from nonsinus
rhythm.
P waves must be upright in leads I
and aVF or at least not inverted in
these leads
























Heart Rate
memorizing heart rates for selected R-R
intervals
When R-R intervals are 5, 10, 15, 20, and
25 mm, the respective heart rates are 300,
150, 100, 75, and 60 beats/minute.


Heart Rate
QRS Axis
Step I: Locate the quadrant using lead
I and AVF
Among the remaining 4 limb leads ,
determine the isoelectric QRS( in
which the height of R wave and depth
of S wave are equal)
The QRS Axis is perpendicular to the
lead with isoelectric QRS
QRS Axis
Left Axis Deviation
QRS axis is less than the normal for
patients age
Left ventricular hypertrophy
Left bundle branch block
Left anterior hemiblock



Right axis deviation
Right ventricular hypertrophy
Right bundle branch block



Superior axis deviation
When S wave is greater than R wave
in aVF.
Tricuspid atresia
Endocardial cushion defect
Pompe disease



T wave axis
Determined in the same way as QRS
axis
0-+90
Upright in lead I and aVF
Must not be inverted



QRS-T angle
Formed by QRS axis and T axis
>60 is abnormal
Ventricular hypertrophy with strain
Ventricular conduction disturbances
Myocardial dysfunction
Intervals
P-R interval
QRS interal
QT interval

Prolonged PR interval
Myocarditis
Rheumatic
Digitalis
Quinidine
Ebstien anomaly
ASD
Hyperkalemia


Short PR interval
Wolffe -Parkinson White
Long Gangong Leviene
Duchenne
Fredrichs


Prolonged QRS
Right bundle branch block
Left bundle branch block
Interventricular block
Preexcitation syndromes
Ventricular arrhythmias
Varies with age
QT interval
Varies with heart rate
Corrected QTc interval calculated by
Bazett formula
Normally between 0.40-0.44s in
children >6 m
0.45-0.47s in the first 6 months of life
Long QT interval
Romono Ward
Jervell-Lange-Nelson
Hypocalcemia
Myocarditis
Hypertrophic CM
Dilated CM
Head injury
Severe Malnutrition


Short QT
Digitalis
Hypercalcemia
Short QT syndrome

P wave amplitude and
duration
Used to diagnose atrial hypertrophy
Normally amplitude <3mm
Duration <0.09s in children and <0.07 in
infants
P wave > 3mm in duration indicates
Right atrial hypertrophy
Wide and notched P wave > >0.10s in
children and >0.08s in infants indicates
left atrial hypertrophy
In Biatrial hypertrophy a combination of
increased amplitude and duration is
present

















QRS amplitude,R/S ratio and
Abnormal Q waves
Useful in the diagnosis of ventricular
hypertrophy
R waves taller then S waves in right
precordial leads (V1,V II)
S waves deeper then R waves in left
precordial leads( V 5,V6)
R/S ratio larger in right precordial
leads
R/S ratio smaller in left precordial
leads
Abnormal Q wave
Average Q wave duration 0.02- 0.03s
Wide and deep
Deep Q waves in Ventricular
hypertrophy
Deep and wide in Myocardial
infarction
Presence in right precordial leads-
Abnormal
Absence in left precordial leads-
Abnormal



ST segment and T waves
Normal ST segment isoelectric
In the limb leads elevation/depression
>/< 1 mm normal
Judged in relation to PR segment
May be non-pathological or
pathological
Pathological ST segment
accompanied by T wave inversion
Either downward slant followed by
diphasic or inverted T wave
Horizontal elevation or depression
sustained for 0.08s
T wave
Tall T wave in ventricular hypertrophy,
hyperkalemia
Flat or low T wave in hypokalemia,
hypothyroidism, myocarditis,
Myocardial ischemia
T wave >3mm indicates Right atrial
Hypertrophy





Criteria for Right Ventricular
Hypertrophy
Right Axis deviation for the patients age
R waves in lead V1,V 2 and aVR greater then the upper
limit of normal for age
S waves in lead I and V6 greater then the upper limit of
normal for age
Normal QRS duration
R/S ratio in V1&V2 greater then upper limit of normal for
age
R/S ratio in V5&V6 > 1 after 1 month
Upright T wave in lead V1,V5and V6
Q wave in V1



















Criteria for Left Ventricular
Hypertrophy
Left axis deviation for the patients age
R waves in lead I,II,III,aVF,aVL,V5 and
V 6 greater then the upper limit of
normal for age
S wave in V1 and V2 greater then the
upper limit of normal for age
R/S ration in V1 and V2 less then the
normal for age
Q waves in V5 and V 6 >5mm and tall
symmetrical T waves in the same
leads











Left Bundle branch block
QRS complex is prolonged for age
Slurred portion of QRS is directed
leftward and posteriorly
Q wave absent in V6
Prominent QS pattern in V1 and tall R
wave in V6



Interventricular block
Prolongation throughout the duration
of QRS







Myocardial Infarction





Potassium