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Normal ECG: Rate and RhythmRead chapters 4 and 22
ECG Interpretation* *See Chapter 22 Standardization Rate RR intervalHeart rate Rhythm PP interval P wave width, height, shape, etc. PR interval QRS width (and height) axis R wave progression abnormal Q waves ST segment T waves QT interval U waves *See Chapter 22
ECG Interpretation Univ. of Wisconsin Medical School
The Normal ECG Normal = normal sinus rhythm
Rate R-R interval Is it regular? What is the heart rate?300, 150, 100, 75, 60, 50 300 / (# of large boxes) 1500 / (# of small boxes) Count the number of cardiac cycles in 10 seconds and multiple by 6.
Rate Bradycardia less than 60 bpm Tachycardia greater than 100 bpm
Rate P-P interval
Rhythm P wave PR interval QRS
4. P Wave Lead II and aVR Positive in II Negative in aVR< 2.5 mm in amplitude < 0.12 sec. in width
Normal P Wave aVR? II? Figures 4-2 and 4-3Normal direction of atrial depolarization aVR? II? Figures 4-2 and 4-3
Abnormal P Wave Direction of atrial depolarization with junction rhythm aVR? II? This is an example of a retrograde conduction
P wave The same direction as QRS Only one P wave in front of QRSDo all the P waves look alike?
5. PR interval seconds
6. QRS Complex What is the width? (less than 0.10 seconds)Do all the QRS waves in the same lead look alike? R wave progression Axis Abnormal Q waves (infarction)
QRS Complex Q waves
Normal QRS Two phases brief phase; depolarization of ventricular septum longer phase; depolarization of both ventricles but the left is larger
First Phase Depolarization of ventricular septum
Second Phase Depolarization of both ventricles but the left is larger
Precordial Leads V6 V1
Normal QRS V6? V6? V1? V1? Fig. 4-6
Normal QRS V1 V6
Normal QRS Septal r wave Septal q wave
6. QRS Complex R wave progression
Normal R Wave ProgressionTransition Zone?
R Wave Progression Transition Zone?
Transition Zone Figure 4-7
Early & Delayed TransitionV V V V V V6 Figure 4-7
6. QRS Complex What is the electrical axis? normal left axis deviationright axis deviation extreme axis deviation
7. St Segment ST segment elevation or depression (see chapters 8 & 9)
8. T Wave Normally positive where QRS wave is positiveV3- V6 and II, but negative in aVR Abnormally tall T waves
Practice ECG Library http://www.ecglibrary.com/ecghome.htmlECG: The Art of Interpretation
Not normal PR interval -Mobitz Type II block
Not normal LAD, R wave progression RBB w/inferior MI
Not normal - First degree block, left atrial enlargement, left bundle branch block, & inferior MI
Not normal Atrial fibrillation
Not normal Junctional rhythm
LAD, late R wave progressionNot normal LAD, late R wave progression Acute MI
Premature ventricular contractionsNot normal Premature ventricular contractions
Ventricular tachycardia: note fast rate and wide bizarre QRS.Not normal Ventricular tachycardia: note fast rate and wide bizarre QRS.
Second degree AV block - type IINot normal Second degree AV block - type II
Not normal RAD, R wave progression
Not normal Third degree AV block
Right bundle branch block. Note the wide QRS wavesNot normal Right bundle branch block. Note the wide QRS waves
Left bundle branch block. Note the wide QRS wavesNot normal Left bundle branch block. Note the wide QRS waves
a. yes b. vertical c. V3 d. yes e. yes f. yes
2. No. Although there are P waves, they are negative2. No. Although there are P waves, they are negative. negative P waves indicate a retrograde conduction likely coming from the AV junction.
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