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ECG Interpretation

ECG Interpretation. Chapter 22. ECG Interpretation. Axis Hypertrophy Blocks Infarct Ischemia. Rate Atrial rate: PP interval Ventricular rate: RR interval Rhythm P wave PR interval QRS voltage (height) width. Standardization. Standardization mark

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ECG Interpretation

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  1. ECG Interpretation Chapter 22

  2. ECG Interpretation Axis Hypertrophy Blocks Infarct Ischemia • Rate • Atrial rate: PP interval • Ventricular rate: RR interval • Rhythm • P wave • PR interval • QRS • voltage (height) • width

  3. Standardization • Standardization mark • 10 mm vertical deflection = 1 mVolt

  4. Rate • Ventricular rate (heart rate) • RR interval • Atrial rate • PP interval • 3rd degree AV block

  5. Heart Rate Calculation

  6. Rhythm • Sinus rhythm - consistent P waves • Atrial rhythm - irregular P waves • Junctional/Nodal rhythm - no P waves, late P waves, or inverted P waves • Ventricular rhythm - no P waves, wide QRS

  7. AV Junctional Rhythms • Retrograde P waves immediately preceding the QRS complexes in aVR and II. • Retrograde P waves immediately following the QRS complexes • Absent P waves

  8. ECG Waves • P wave • atrial depolarization • ≤ 2.5 mm in amplitude • < 0.12 sec in width • PR interval (0.12 - 0.20 sec.) • time of stimulus through atria and AV node • prolonged interval = first-degree heart block

  9. P wave • Tall = RAE • Wide = LAE

  10. PR Interval • Long PR interval = first degree AV block • Short PR interval = WPW • Short PR interval with inverted P waves = ectopic atrial or junctional pacemaker

  11. Classification of AV Heart Blocks

  12. Wolff-White-Parkinson • Wide QRS • due to early depolarization • not due to a delay in depolarization • Shortened PR interval • Upstroke QRS complex is slurred; delta wave

  13. ECG Waves • QRS • width 0.12 second or less

  14. Normal QRS V6? V6? V1? V1? Fig. 4-6

  15. Normal Q waves • Septal r wave • Septal q wave

  16. Q Waves • Abnormal if wider than 0.04 sec • Leads I, II, III, aVf or leads V3 - V6. • Greater than 25% of the R wave • Note: Not all Q waves are abnormal, Not all Q waves are the result of MI.

  17. QRS Width • Wide • RBBB or LBBB • Premature ventricular beats • WPW

  18. QRS Voltage • RVH • LVH

  19. Mean QRS Axis

  20. Axis Deviation

  21. R Wave Progression

  22. Transmural MI

  23. Overview

  24. ST Segments • J point: • end of QRS wave • beginning of ST segment • ST segment • beginning of ventricular repolarization • normally isoelectric (flat) • changes, elevation or depression, may indicate pathological condition

  25. Subendocardial Ischemia • ST segment depression criteria • 1 mm or more • horizontal or downward • lasts 0.08 seconds • depression of only the J point with rapid upward sloping are considered normal.

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