Principles of ECG Interpretation
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Transcript of Principles of ECG Interpretation
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ECG ConferenceECG Conference
Henry Tran, MDHenry Tran, MDJanuary 13, 2016January 13, 2016
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Goals
Review basic principles of EKG RHYTHM: Identify sinus vs atrial arrhythmias
Recognize patterns of STEMI
Recognize patterns of ischemia
Distinguish Wide Complex Tachycardia: Ventricular Tachycardia vs. Aberrant Conduction
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Conduction System
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ECG
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Positioning Precordial Leads
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12 Lead ECG
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Axis
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ECG Interpretation Methodology #1 Rhythm: what rhythm governs the atria
Sinus or Not sinus AV Block Bundle Branch Conduction
#2 Axis: Look for LAFB or Right Axis
#3 Waveform Analysis
#4 The Big Picture
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Pt #1 Bruce Stage 2
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P Waves: ? Sinus or Ectopic
SINUS P WAVE IS UPRIGHT IN LEAD I and LEAD II
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Pt #1 Resting ECG prior to regular exercise stress test
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Pt #1 Bruce Stage 1, 2:45 min
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Pt 2
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Pt 3
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Typical Atrial Flutter
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ECG Interpretation Methodology #1 Rhythm: what rhythm governs the atria
Sinus or Not sinus AV Block Bundle Branch Conduction
#2 Axis: Look for LAFB or Right Axis
#3 Waveform Analysis
#4 The Big Picture
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Mobitz I Wenckebach
• Although it is possible to syncopize due to Mobitz I, it is generally considered benign and a normal variant
• If you see it at night during sleep, not an emergency
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Mobitz 2
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Where’s the block?
Mobitz I
Mobitz II
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Pt 3
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Don’t miss this…
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Conduction in AVRT
Orthodromic Antidromic
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Vi / Vt
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LAFP•Axis >45o
•qR in I, AVL
LPFP•Very rare• >100o
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V TACH!!!
Axis Deviation: Causes
NORMAL
Northwest LEFT
RIGHTLead
I
Lead aVF
•normal finding in children and tall thin adults•RVH•COPD•ASD/VSD•PE•Anterolateral MI•left posterior hemiblock (>125 degree)
•left anterior hemiblock (>-45o)•Q waves of inferior MI•WPW-Right Pathway
LVH DOES NOT CAUSE LEFT AXIS
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Pt 6
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WPW
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Pt 7
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Pt 8: 43 yo female complains of chest tightness
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55 yo male POD #1 s/p laminectomy, remains intubated
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Don’t Miss This…
Don’t Miss These…
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27 yo asian male complains of malignant syncope
NO TERMINAL S WAVE AS IN RBBB
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Brugada Syndrome• Channelopathy: Na+ SCN5A, L-Type calcium• Increase epicardial dispersion of repolarization in the RV
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44 yo male with schizophrenia and HCV complains of chest pain:
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83 yo male hx of afib on coumadin brought to ER due to poor PO intake:
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Accelerated junctional rhythms
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33 yo male with no PMHX complains of chest pain x 3 hrs. Do you give kayexalate?
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25 yo female complains of palpitations and dizziness. What imaging modality shouldbe ordered next?
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Digoxin Toxicity LBBBLVH
GUESS THE REPOLARIZATION ABNORMALITY!
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Summary
What’s the rhythm?????
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Thanks!