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Working with ECGs Dr Cynthia Lim Dr Dean Pritchard FACEMs, Emergency Department The Northern Hospital.

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Presentation on theme: "Working with ECGs Dr Cynthia Lim Dr Dean Pritchard FACEMs, Emergency Department The Northern Hospital."— Presentation transcript:

1 Working with ECGs Dr Cynthia Lim Dr Dean Pritchard FACEMs, Emergency Department The Northern Hospital

2 ECG 123s – Measurement of electrical flow across the heart using electrodes placed on the chest and limbs – Deviation of electrical flow from normal pathways indicates cardiac anomaly or cardiac disease

3 The Leads Limb Leads – aVR – Right arm – aVL – Left arm – aVF – Left leg Vectors – Flow of +ve current – I – R arm  L arm – II – R arm  L leg – III – L arm  L leg

4 The Leads Chest leads – V1 – V2 – V3 – V4 – V5 – V6

5 Look at leads I and avF If in left quadrant then look at lead II Axis

6 Successive approximation method

7 ECG Morphology

8 Pick the Problem… NORMAL ECG

9 ECG of 2 year old – normal or abnormal? Higher rate, Partial RBBB pattern, Dominant R V1, R axis deviation

10 Chest Pain

11 The Barn Door… Acute anterior ST elevation myocardial infarction

12 The Barn door Acute inferior ST elevation myocardial infarction

13 What about this? Septolateral Non-ST Elevation Myocardial Infarction

14 And this? Acute Pericarditis

15 ACS – STEMI Any ST dep except V1 or aVR (allowed in acute pericarditis) ST elevation III > II Horizontal or convex up ST elevation New Q waves

16 ACS – acute pericarditis PR dep multiple leads – Only reliably seen viral – transient Low voltage and tachycardia = large pericardial effusion Friction rub Use T-P as baseline (not P-P interval) If in doubt serial ECGs

17 T-wave Changes T-wave inversions – STEMI – After the appearance of ST changes – NSTEMI – After a period of hyperacute T-wave changes May persist for months or permanently


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