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What types of pathology can we identify and study from EKGs?

What types of pathology can we identify and study from EKGs?. Arrhythmias Myocardial ischemia and infarction Pericarditis Chamber hypertrophy Electrolyte disturbances (i.e. hyperkalemia, hypokalemia) Drug toxicity (i.e. digoxin and drugs which prolong the QT interval). Anatomy.

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What types of pathology can we identify and study from EKGs?

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  1. What types of pathology can we identify and study from EKGs? • Arrhythmias • Myocardial ischemia and infarction • Pericarditis • Chamber hypertrophy • Electrolyte disturbances (i.e. hyperkalemia, hypokalemia) • Drug toxicity (i.e. digoxin and drugs which prolong the QT interval)

  2. Anatomy

  3. ECG Electrodes

  4. ECG Waveform

  5. The 12 lead ECG

  6. PR QRS AH HV How does the heart work

  7. AV node activated by Atrial depolarizationSends signal through His-purkinje bundleGet depolarization of SEPTUM Left and Right BUNDLES transmit signal to Left and Right VENTRICLESNet “Vector” towards the LVShould be narrow (<120msec) if bundles working properlyThen have REPOLARIZATION = TwaveThe appearance of this electrical activity depends on which lead you are using to look at it

  8. Review of waveforms

  9. How to Look at an ECG • Rate: Is the heart rate too fast or slow? • Rhythm: Sinus rhythm or not? • Axis: Where does the majority of electrical activity point? • P wave: How big are the atria? • PR interval: How healthy is the AV node? • QRS wave: Is there abnormal conduction or a ventricular source? • QT: Long is bad • Ischemia and hypertrophy

  10. ECG PaperCan Determine Heart Rate Rule: 300, 150, 100, 75, 60, 50 counting over for each big sqaure

  11. What is the heart rate? Answer = 75 per min

  12. Rhythm : Is there a p wave? = Sinus Is it followed by a QRS?

  13. Is the rhythm regular or irregular?

  14. Irregular pacemaker Multifocal atrial rhythm Atrial fibrillation Atrial fib/flutter Ectopic beats PVC PAC PJC Irregular conduction AV node block 1st degree: PR interval > 200 msec 2nd degree: Type 1: Wenkebach Type 2: dropped beat 3rd degree: p waves marching independent to QRS Reasons to have an irregular rhythm

  15. Examples of Rhythms Multifocal Atrial Rhythm AFIB Atrial Flutter AFIB V TACH

  16. Example of a PVC

  17. Telling the Axis from the leads

  18. EKG Leads 3 Standard Limb Leads 3 Augmented Limb Leads 6 Precordial Leads The standard EKG has 12 leads: The axis of a particular lead represents the viewpoint from which it looks at the heart.

  19. Standard Limb Leads

  20. Standard Limb Leads

  21. Augmented Limb Leads

  22. All Limb Leads

  23. The axis wheel

  24. The QRS QRS < 120 msec QRS > 120 msec Rabbit ears in V1 & V2 Wide S wave in V5 & V6 R axis deviation QRS > 120 msec Deep slurred S wave in V1 Wide R wave in V6, I & avL L axis deviation

  25. Ishcemia vs Acute Infarct

  26. Example of Ischemia

  27. Examples of Infarctions

  28. Review • Rate: Is the heart rate too fast or slow? • Rhythm: Sinus rhythm or not? • Axis: Where does the majority of electrical activity point? • P wave: How big are the atria? • PR interval: How healthy is the AV node? • QRS wave: Is there abnormal conduction or a ventricular source? • QT: Long is bad • Ischemia and hypertrophy

  29. Describe this ECG

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