1. ECG interpretation Dr. Shamim Nassrally BSc (Hons) MB ChB MRCP(UK) Clinical Teaching Fellow

2. Objectives By the end of this session you should be able to:  Interpret ECGs using a systematic approach  Recognise important ECG abnormalities:  acute coronary syndrome  acute myocardial infarction  common arrhythmias.

3. Framework Basic information/Demographics Rate Rhythm Axis P wave and PR interval QRS complex ST segment

4. Basic information Identifying information: name/unit number Date/time Voltage (10mm/mV) Speed (25mm/s)

5. Rate 300/number large squares Normal: 60-100bpm <60 = bradycardia >100 = tachycardia

7. Rhythm Are there P-waves? Is each P followed by a QRS? Is each QRS preceded by a P wave? AF/atrial flutter Supraventricular tachycardias Heart block: 1 st degree 2 nd degree (Mobitz type 1 and type 2) 3 rd degree (complete heart block)

8. P wave and PR interval Normal P wave <2.5mm high, <0.11s Normal PR interval 0.12-0.2s (3-5 small squares)

14. Axis I and II positive = normal axis I positive + III negative = left axis deviation I negative + III positive = right axis deviation

16. QRS complex Normal QRS <0.12s (3 small squares) LVH criteria Wide QRS Left bundle branch block Right bundle branch block

19. ST segment ST elevation: MI, left bundle branch block ST depression: ischaemia, posterior MI, digoxin T-wave: Tall – hyperkalaemia, left bundle branch block Flat – ischaemia, hypokalaemia

22. Quiz Rate Rhythm P wave, PR interval Axis QRS complex ST segment T waves