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ECG Basics: Interpretation and Analysis

The document discusses electrocardiography (ECG), which produces a graphical representation of the electrical activity of the heart over time. It describes how ECG can help detect various cardiac conditions and abnormalities. Key aspects of ECG covered include the conduction pathway, components of the waveform, 12-lead ECG configuration, parameters for evaluation, various rhythms including sinus, bradycardia and tachycardia, and cardiac arrhythmias. In summary, the document provides a comprehensive overview of ECG, its uses in cardiac evaluation, important waveform components, and classifications of normal and abnormal cardiac rhythms.

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18 views12 pages

ECG Basics: Interpretation and Analysis

The document discusses electrocardiography (ECG), which produces a graphical representation of the electrical activity of the heart over time. It describes how ECG can help detect various cardiac conditions and abnormalities. Key aspects of ECG covered include the conduction pathway, components of the waveform, 12-lead ECG configuration, parameters for evaluation, various rhythms including sinus, bradycardia and tachycardia, and cardiac arrhythmias. In summary, the document provides a comprehensive overview of ECG, its uses in cardiac evaluation, important waveform components, and classifications of normal and abnormal cardiac rhythms.

Uploaded by

maryam tariq
Copyright
© All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd

ECG

ECG is Graphical representation of the electrical activity of the myocardium over time.
ECG Helps In The Detection Of:
 Ischemic heart disease, acute or chronic.
 Dysrhythmias.
 Electrolyte disturbances.
 Conduction abnormalities.
 CAD (exercise stress test).
 Cardiac structural abnormalities.
 Cardiac manifestations of non-cardiac disease (PE, metabolic disorders, lung disease).

Conduction Pathway:
1. SA Nodes
2. AV Nodes
3. Bundle Branch
4. Purkinje Fibers

ECG Components:
 Waveform
o P wave (Atrial Depolarization/ Contraction)
o QRS complex (Ventricular Depolarization/ Contraction)
o T wave (Ventricular Repolarization/ Relaxation)
 Segments
o PR segment
o ST-segment

12 lead ECG:
Standard 12 lead ECG assesses this in various planes to give a roughly 3D view of the heart.
 3bipolar l, ll, lll
 9 unipolar lead aVR, aVL, aVF, V1, V6
 Can consider other unipolar lead placement
o V1-6R-look at RV
o V7-9- look at post LV wall

ECG evaluation:

 Rate (N/Tachy/Brady)
 Rhythm (Regular/ Irregular)
 P wave (Absent/Present)
 QRS complex (Narrow/ Wide)
 ST segment (Depression/ Elevation)
RATE:
Number of times the heart beats in a minute.
Normal: 50-100 BPM
Tachycardia: >100 BPM
Bradycardia: <50 BPM

Heart Rate Evaluation:


1. Big Box Method: (Good For Regular Rhythms)
Consider Two R Peaks and Count No. Of Big Boxes In-Between
1 2 3 4 5 6 7 8 9
300 150 100 75 60 50 43 38 33

2. 6 Second Strip Method: (Good For Irregular Rhythms)


1 Big Box: 0.20 Seconds
5 Big Boxes: 1 Second
30 Big Boxes: 6 Seconds
Take 6 second strip and count no. of R peaks in that time interval, multiple no. of R peaks with 10
to get the rate of an irregular rhythm.
No. Of R Peaks X 10 = HR
| 1 | 2 | 3 | 4 | 5 | 6 |

14 X 10 = 140 BPM

RHYTHM:
The pattern in which the heart beats is termed as heart rhythm. It can be regular or irregular.
Regular Rhythm: distance between every R peak is same.

Irregular Rhythm: distance between every R peak is not same.


P-WAVE:
Present: presence of P wave indicates that electrical activity is generated through SA node. So the
rhythm is termed as “sinus” rhythm.

Absent: Absence Of P Wave Indicate Arrhythmias.

QRS-COMPLEX:
The QRS width is useful in determining the origin of each QRS complex (e.g. sinus, atrial, or
ventricular).
Narrow complexes (QRS < 3 small boxes) are supraventricular (atrial) in origin.

Broad complexes (QRS > 3 small boxes) may be either ventricular in origin.
SINUS RHYTHMS

Normal Sinus Rhythm


 Rate: 60-100
 Rhythm: Regular
 QRS: Normal
 P Wave: Present

Sinus Bradycardia
 Rate: ≤ 50
 Rhythm: Regular
 QRS: Normal
 P Wave: Present

Sinus Tachycardia
 Rate: ≥ 150
 Rhythm: Regular
 QRS: Normal
 P Wave: Present
BRADYCARDIAS

First-Degree Heart Block


 Rate: ≤ 50
 Rhythm: Regular
 QRS: Normal
 PR Segment: Prolonged (> 0.20 Seconds)

Second-Degree Heart Block-Mobitz Type I (Wenckebach)


 Rate: ≤ 50
 Rhythm: Irregular
 QRS: Normal
 PR Segment: Progressive Prolongation (PPP)

Second-Degree Heart Block-Mobitz Type II


 Rate: ≤ 50
 Rhythm: Irregular
 QRS: Normal
 PR Segment: Fixed Prolonged

Third-Degree Heart Block


 Rate: ≤ 50
 Rhythm: Regular
 QRS: Normal
 P Wave: Present But Have No Relation With QRS (disassociation)
TACHYCARDIA’S
(Narrow complexes)

Supraventricular Tachycardia
 Rate: > 180
 Rhythm: Regular
 QRS: Narrow
 P Wave: Absent

Atrial Fibrillation
 Rate: > 150
 Rhythm: Irregular
 QRS: Narrow
 P Wave: Absent

Atrial Flutter “Saw-Toothed”


 Rate: 100-150
 Rhythm: Mostly Regular
 QRS: Narrow
 P Wave: Absent

Asystole
 Rate: Pulseless
 Rhythm: Irregular
 QRS: Absent
 P Wave: Absent
TACHYCARDIA’S
(Wide complexes)

Ventricular Fibrillation
 Rate: Pulseless
 Rhythm: Irregularly irregular
 QRS: Wide
 P Wave: Absent

Monomorphic Ventricular Tachycardia


 Rate: > 150
 Rhythm:Regular
 QRS: Wide
 P Wave: Absent

Polymorphic Ventricular Tachycardia


 Rate: Pulseless
 Rhythm: Regularly Irregular
 QRS: Wide
 P Wave: Absent
QUICK ASSESSMENT

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