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Transcript of Ecg
![Page 1: Ecg](https://reader034.fdocuments.in/reader034/viewer/2022051213/55a5ba941a28abd9368b457e/html5/thumbnails/1.jpg)
ELECTROCARDIOGRAPHY
Medical Unit-I
Holy Family Hospital
Rawalpindi
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A 26yrs old lady who has complained of palpitations in past, is admitted in ER with palpitations. HER ECG shows:
• Narrow complex tachycardia• Rate about 200/min• NO P waves• Normal axis• Regular QRS complexes• Normal ST segments & T waves
Diagnosis: Supraventricular tachycardia (SVT)
Narrow QRS complex Rate about 200/min
No P waves
No P waves
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A 55yr old man presented with h/o chest pain at rest for 6 Hrs. There are no abnormal physical findings. His ECG tracing shows:
• Sinus rhythm• Normal axis• Normal QRS complexes• ST segment depressions, Horizontal in V3-V4• ST segment depressions, Downward sloping in lead 1, aVL, V5-V6
Diagnosis: Anterolateral Ischemia(unstable angina)
ST segment depression, Horizontal
ST segment depression, downward sloping
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These 3 rhythm strips (all lead II) came from the ECGs of three different patients. They were all in their eighties & C/O breathlessness. What
diagnosis would you consider?
A. No P waves Irregular baselines QRS complexes are broad, regular & slow Diagnosis: Atrial fibrillation with complete block
B. Constant PR interval 2:1 conduction defectDiagnosis: Sinus rhythm with 2nd degree block
C. No correlation between P waves & QRS complexes Diagnosis: Complete (3rd degree) heart block
a. No P waves Broad, regular, slow QRS
b.Constant PR interval 2:1 conduction defect
No correlation b/w P waves & QRS complexc.
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This ECG was recorded from a 60 yrs old man being treated as an out patient for severe CCF. What might be diagnosis of underlying heart conduction?
• Atrial fibrillation• Ventricular rate of 75-200/min• Normal axis• Normal QRS complexes• Downward sloping ST segment depression esp, V5-V6
Diagnosis: AF with uncontrolled Ventricular rate & digoxin effect (ST segmrnt depressions)
No P waves. Irregular HR. (AF)
ST depression
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A 15yr old boy was referred to the outpatient for heart murmur. He had no symptoms. What does this ECG shows?
• Sinus rhythm• Normal axis• Broad QRS complexes• RSR pattern in lead I• Wide & slurred S waves in V5• Normal ST segments & T waves
Diagnosis: Right bundle branch block (RBBB)
Broad QRS complexRSR pattern
Wide & slurred S waves
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This ECG was recorded from a 25yr old pregnant women. She complaints of an irregular heart beat. Auscultation revealed a soft systolic
murmur but her heart was otherwise normal
• Sinus rhythm• Normal axis• Normal QRS complexes & T waves• Ventricular extra systoles
Diagnosis: Sinus rhythm with ventricular extra systoles
Ventricular Extra systole
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A 50yr old man is seen in A & E department with severe central chest pain which has been present for 18hrs. What does this ECG shows?
• Sinus rhythm• Normal axis• Q waves in V2-V4
• Raised ST segments in V2-V4
• Inverted T waves in lead I ,aVL , V2-V6
Diagnosis: Acute anterior Myocardial infarction
ST elevation
Inverted T waves Inverted T waves
Q waves
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This ECG was recorded from 60yr old women with rheumatic heart disease. She had been in heart failure but this had been treated & she was
no longer breathless. What does this ECG shows?
• AF with ventricular rate of 60-65/min• Normal axis• Normal QRS complexes• Prominent U waves in V2 (Suggest Hypokalemia)
• Downward sloping ST segments in V5-V6 (Suggest Digoxin effect)
U waves Downward sloping ST segments
No P waves (AF)
Diagnosis: AF with Digoxin effect
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This ECG was recorded from 65yrs old women admitted in A&E department with sever chest pain for 1 hr. What does this ECG shows?
• Sinus rhythm• Normal axis• Probably normal QRS complexes• Grossly ST segment elevation in anterior & lateral leads• Depressed ST segments in inferior leads, lead III, aVF
ST elevation
ST elevation
Depressed ST segments
Depressed ST segments
Diagnosis: Acute anterolateral MI
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This ECG was recorded from 60yr old man seen in clinic because of severe breathlessness which had developed over several years. His JVP is
raised. What does his ECG shows?
• Sinus rhythm, rate 140/min• One ventricular Extra systole• Peaked P waves (best in lead II, III, aVF)• Normal PR interval• Right axis• Dominant R waves in V1
• Deep S waves In V6
• Normal ST segments & T waves
Extra systole
Peaked P waves
Right axis Dominant R waves
Deep S waves
Diagnosis: Sinus tachycardia with 1 ventricular extra systole, Right atrial & right ventricular hypertrophy & clockwise rotation suggests COPD
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ECG QuizzesECG Quizzes
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• What is the PR interval in this ECG?
• A. 0.12 seB. 0.16 sec C. 0.20 sec D. 0.28 sec E. 0.50 sec
Q. 01
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Q. 02
What is the QRS duration seen here?
A. 0.04 sec B. 0.06 sec C. 0.10 sec D. 0.12 sec E. 0.14
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Q. 3
What is the approximate heart rate? A. 50 bpm B. 65 bpm C. 75 bpm D. 90 bpm E. 100 bpm
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Q. 04
What type of arrhythmia is pointed out by the two arrows? A. PACs (Premature Atrial Complexes) B. PVCs (Premature Ventricular Complexes) C. 1 is a PAC, and 2 is a PVC D. PSVT (Paroxysmal Supraventricular Tachycardia)
E. Left Bundle Branch Block
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Q. 05
Choose from the following responses to interpret this ECG. A. PJC (Premature junctional complex) B. Atrial flutter C. Atrial fibrillation D. AV nodal reentrant tachycardia E. Accelerated junctional rhythm