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Attribution: Kim Eagle, M.D., 2012 License: Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution–Share.

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Presentation on theme: "Attribution: Kim Eagle, M.D., 2012 License: Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution–Share."— Presentation transcript:

1 Attribution: Kim Eagle, M.D., 2012 License: Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution–Share Alike 3.0 License: http://creativecommons.org/licenses/by-sa/3.0/ We have reviewed this material in accordance with U.S. Copyright Law and have tried to maximize your ability to use, share, and adapt it. The citation key on the following slide provides information about how you may share and adapt this material. Copyright holders of content included in this material should contact open.michigan@umich.edu with any questions, corrections, or clarification regarding the use of content. For more information about how to cite these materials visit http://open.umich.edu/education/about/terms-of-use. Any medical information in this material is intended to inform and educate and is not a tool for self-diagnosis or a replacement for medical evaluation, advice, diagnosis or treatment by a healthcare professional. Please speak to your physician if you have questions about your medical condition. Viewer discretion is advised: Some medical content is graphic and may not be suitable for all viewers.

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3 Kim A. Eagle, M.D. University of Michigan Health System ElectrocardiogramElectrocardiogram Cardiovascular Sequence Fall 2012

4 Kim A. Eagle, MD Director University of Michigan Cardiovascular Center Grants: NIH, Hewlett Foundation, Mardigian Foundation, Varbedian Fund, GORE Consultant: NIH NHLBI

5 Electrocardiogram Key Words: Depolarization, repolarization, EKG leads, electrical axis, ST segment shifts Objectives: 1.To learn the nomenclature and classification system for ECG interpretation. 2.To learn the major conduction abnormalities seen on ECG interpretation. 3.To diagnose ischemic heart disease patterns on ECG’s. 4.To become familiar with how structural heart conditions affect ECG findings.

6 Electrocardiogram The Normal EKG: Outline Electrical Measurement - Single Cell EKG Reference System - Technical Considerations - Sequence of Activation Interpretation - Calibration - Rhythm - Rate - Intervals - QRS Axis - P-waves - QRS - ST-T wave abnormalities

7 Electrical Measurement Single Cell Key Concepts - Resting state - polarized - Depolarization - Repolarization - Directionality

8 Lilly. Pathophysiology of Heart Disease, 4th Ed. Lippincott Williams, 2007. Page 81

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10 Lilly. Pathophysiology of Heart Disease, 4th Ed. Lippincott Williams, 2007. Page 82

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13 EKG Lead Reference System Unipolar Bipolar Chest Leads

14 Lilly. Pathophysiology of Heart Disease, 4th Ed. Lippincott Williams, 2007. Page 83

15 Lilly. Pathophysiology of Heart Disease, 4th Ed. Lippincott Williams, 2007. Page 84

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17 Lilly. Pathophysiology of Heart Disease, 4th Ed. Lippincott Williams, 2007. Page 86

18 Lilly. Pathophysiology of Heart Disease, 4th Ed. Lippincott Williams, 2007. Page 85

19 Magnitude and Direction of Electrical Activity Key Principles: –Electrical force directed at (+) pole of a lead generates upward EKG deflection –Forces directed away from (+) pole generate downward deflection –Magnitude of deflection reflects how parallel the electrical force to lead –Forces directed perpendicular to a lead generate no activity or flat line

20 Lilly. Pathophysiology of Heart Disease, 4th Ed. Lippincott Williams, 2007. Page 85

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24 Lilly. Pathophysiology of Heart Disease, 4th Ed. Lippincott Williams, 2007. Page 87

25 Sequence of Normal Cardiac Activation

26 Lilly. Pathophysiology of Heart Disease, 4th Ed. Lippincott Williams, 2007. Page 87

27 A Lilly. Pathophysiology of Heart Disease, 4th Ed. Lippincott Williams, 2007. Page 89

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29 DE Lilly. Pathophysiology of Heart Disease, 4th Ed. Lippincott Williams, 2007. Page 89 (Both Images)

30 Lilly. Pathophysiology of Heart Disease, 4th Ed. Lippincott Williams, 2007. Page 90 (Both Images)

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32 Lilly. Pathophysiology of Heart Disease, 4th Ed. Lippincott Williams, 2007. Page 90

33 EKG Interpretation: 8 Steps 1.Check voltage calibration 2.Heart rhythm 3.Heart rate 4.Intervals (PR, QRS, ST) 5.Mean QRS axis 6.Abnormalities of P-waves 7.Abnormalities of QRS (hypertrophy, bundle branch block, infarction) 8.ST and T wave abnormalities

34 Lilly. Pathophysiology of Heart Disease, 4th Ed. Lippincott Williams, 2007. Page 91

35 Heart Rhythm Sinus Rhythm Rate > 60 BPM < 100 BPM

36 Lilly. Pathophysiology of Heart Disease, 4th Ed. Lippincott Williams, 2007. Page 93

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38 Lilly. Pathophysiology of Heart Disease, 4th Ed. Lippincott Williams, 2007. Page 94

39 Electrocardiographic Intervals IntervalNormal Decreased in Increased in PR 0.12-0.20 sec Pre excitation syndrome First-degree AV block (3-5 small boxes) Junctional rhythm QRS < 0.10 sec Bundle branch blocks (< 2.5 small boxes) Ventricular ectopic beat Toxic drug effect (e.g., quinidine) Toxic drug effect (e.g., quinidine) Severe hyperkalemia Severe hyperkalemia QT Corrected Qt a < 0.44 sec Hypercalcemia Hypocalcemia Tachycardia Hypokalemia ( QU interval due Tachycardia Hypokalemia ( QU interval due to U wave) to U wave) Hypomagnesemia Hypomagnesemia Myocardial ischemia Myocardial ischemia Congenital prolongation of QT Congenital prolongation of QT Toxic drug-effect (e.g., quinidine) Toxic drug-effect (e.g., quinidine)

40 Lilly. Pathophysiology of Heart Disease, 4th Ed. Lippincott Williams, 2007. Page 95

41 Atrial Abnormalities Lilly. Pathophysiology of Heart Disease, 4th Ed. Lippincott Williams, 2007. Page 97

42 Ventricular Hypertrophy Lilly. Pathophysiology of Heart Disease, 4th Ed. Lippincott Williams, 2007. Page 98

43 Ventricular Hypertrophy Lilly. Pathophysiology of Heart Disease, 4th Ed. Lippincott Williams, 2007. Page 98

44 Bundle Branch Blocks RBBB Lilly. Pathophysiology of Heart Disease, 4th Ed. Lippincott Williams, 2007. Page 99

45 Bundle Branch Blocks LBBB Lilly. Pathophysiology of Heart Disease, 4th Ed. Lippincott Williams, 2007. Page 99

46 The EKG of Myocardial Infarction Concept of ST elevation vs. Non STE Localization of MI Evolution of EKG changes in MI Concept of Q waves

47 Scan page 88 LILLY (4.25 transmural) Lilly. Pathophysiology of Heart Disease, 4th Ed. Lippincott Williams, 2007. Page 106

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49 Localization of MI Lilly. Pathophysiology of Heart Disease, 4th Ed. Lippincott Williams, 2007. Page 104

50 Localization of MI Anatomic SitesEKG LeadsCoronary Anatomy InferiorII, III, AVFRCA SeptalV 1, V 2 LAD AnteriorV 3, V 4 LAD (distal) AnterolateralI, AVLLCX AnteroapicalV 5, V 6 Any of 3

51 Lilly. Pathophysiology of Heart Disease, 4th Ed. Lippincott Williams, 2007. Page 105

52 Lilly. Pathophysiology of Heart Disease, 4th Ed. Lippincott Williams, 2007. Page 103

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