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SAAD A. SHETASAAD A. SHETAMBChB, MA, MDMBChB, MA, MD

Assoc. Prof.Assoc. Prof.

MDS DepartmentMDS Department

KSUKSU

ECG

How To Read How To Read ECGECG

Rate?Rate?

QRS QRS Duration?Duration?

Stability?Stability?

Anatomy of Heart and ECG signalAnatomy of Heart and ECG signal

Normal ECG signalNormal ECG signalConducting System of Heart

MeasurementsMeasurements

Small square = 0.04 sec.Small square = 0.04 sec.

Large square = 5 small square = 0.2 sec.Large square = 5 small square = 0.2 sec.

One second = 5 large squareOne second = 5 large square

One minute = 300 large squareOne minute = 300 large square

P duration = P duration = 3 small sqs 3 small sqs = = 0.12 sec.0.12 sec.

P height = P height = 3 small sqs 3 small sqs = = 0.12 sec.0.12 sec.

QRS duration = QRS duration = 3 small sq 3 small sq = 0.12 sec.= 0.12 sec.

P-R interval = P-R interval = 5 small sqs 5 small sqs = 0.2 sec= 0.2 sec. .

Remember Remember ThisThis

3, 3, 3 and 53, 3, 3 and 5

Three Three Levels:Levels:

SAN:SAN: 60 - 60 - 100100

AVN :AVN : 40 - 6040 - 60

Bundle Branch:Bundle Branch: 20 - 20 - 4040

If regular : Divide 300/ number of large squares If regular : Divide 300/ number of large squares between 2 Rs = HRbetween 2 Rs = HR

If irregular: Count number of complexes in 6 sec. and If irregular: Count number of complexes in 6 sec. and multiply by 10multiply by 10

RATE may be:RATE may be:

Normal 60 -100Normal 60 -100

Bradycardia < 60 Bradycardia < 60

Tachycardia > Tachycardia > 100100

P P = Sinus= Sinus

No P = Non sinusNo P = Non sinus

Rate:Rate:

QRS DurationQRS Duration::

Slim lady

Obese lady

Stability:Stability:

* Stable patient: think of drug therapyStable patient: think of drug therapy * Unstable patient: think of electric * Unstable patient: think of electric

therapytherapy

Rate > 100.Rate > 100.

QRS: Narrow.QRS: Narrow.

Stable or Stable or unstableunstable

Rate < 60.Rate < 60.

QRS: Narrow.QRS: Narrow.

Stable or Stable or unstableunstable

Sinus tachycardiaSinus tachycardia

Atrial flutterAtrial flutter

Atrial Atrial fibrillationsfibrillations

PAT, PNTPAT, PNT

Sinus bradycardiaSinus bradycardia

11stst degree HB degree HB

22ndnd degree HB degree HB

Complete HBComplete HB

Supraventricular RhythmSupraventricular Rhythm

Supraventricular Rhythm: Supraventricular Rhythm: TachycardiaTachycardia

Sinus Tachycardia

Supraventricular Rhythm: Supraventricular Rhythm: TachycardiaTachycardia

Atrial FlutterAtrial Flutter

Atrial Atrial FibrillationsFibrillations

Supraventricular Rhythm: Supraventricular Rhythm: TachycardiaTachycardia

Paroxysmal Paroxysmal SVTSVT

Supraventricular Rhythm: Supraventricular Rhythm: TachycardiaTachycardia

Supraventricular Rhythm: Supraventricular Rhythm: BradycardiaBradycardia

Sinus BradycardiaSinus Bradycardia

Normal Sinus Normal Sinus RhythmRhythm

Supraventricular Rhythm: Supraventricular Rhythm: BradycardiaBradycardia

11stst Degree Degree HBHB

Supraventricular Rhythm: Supraventricular Rhythm: BradycardiaBradycardia

22ndnd Degree HB: Mobitz 1 Degree HB: Mobitz 1 Wenckebach.Wenckebach.

Progressive lengthening of the P-R interval with Progressive lengthening of the P-R interval with intermittent dropped beatintermittent dropped beat

Supraventricular Rhythm: Supraventricular Rhythm: BradycardiaBradycardia

22ndnd Degree HB: Degree HB: Mobitz 2Mobitz 2

Sudden drop of QRS without prior P-R changesSudden drop of QRS without prior P-R changes

Supraventricular Rhythm: BradycardiaSupraventricular Rhythm: Bradycardia

33rdrd Degree Degree HBHB

Ventricular RhythmVentricular Rhythm

Idioventricular Idioventricular Rhythm.Rhythm.

Ventricular RhythmVentricular Rhythm

Accelerated Idioventricular Accelerated Idioventricular RhythmRhythm.

Ventricular RhythmVentricular Rhythm

Ventricular RhythmVentricular Rhythm

Pacer Pacer RhythmRhythm

Ventricular RhythmVentricular Rhythm

TreatmentTreatment

Supraventricular Supraventricular Rhythm:Rhythm:

StableStable = = DrugsDrugs = =

AliiAliiA A denosinedenosine

L L anoxineanoxine

I I soptinsoptin

I I nderalnderal

Unstable = Unstable = ElectricElectric

DC with 25 joules, ++DC with 25 joules, ++++

TreatmentTreatment

Ventricular Rhythm:Ventricular Rhythm:

Stable Stable == Drugs Drugs = =

AlPAlPA A miodarone.miodarone.

L L idocaine.idocaine.

P P rocainamide.rocainamide.

Unstable = ElectricUnstable = Electric

DC with 200 joules, 300, DC with 200 joules, 300, 3600.3600.

Myocardial IschemiaMyocardial Ischemia

Due to lack of adequate blood flow to the myocardium

Ischemia is reversible. Changes in ECG:

T wave peakingSymmetric T wave

inversionST segment elevation

Different ECG SignalsDifferent ECG Signals

Normal SignalNormal Signal ST segment elevated signalST segment elevated signal

ECG with T wave inversionECG with T wave inversion ECG Signal with peak T wavesECG Signal with peak T waves

THANK YOUTHANK YOU