1. ECG Interpretation Hina Shaikh

2. What is ECG? Graphical records of electrical current, that is generated by heart Basic equipment: electrodes, wires, amplifier, and strip chart recorder Evaluates cardiac status

3. A Typical ECG Wave

4. ECG Recording Recorded on ECG paper Standard speed: 25 mm/second Small box= 1 mm x 1 mm= 1 mm² * Time: 0.04 seconds * Voltage: 0.1 mV (10 boxes=1 mV) Large box= 5 small boxes= 5 mm² * Time: 0.2 seconds * Voltage: 0.5 mV ( 2 boxes= 1mV)

5. ECG Recording contd.

6. ECG Leads Standard 12 Lead - 6 limb leads - 6 chest leads -Allows to assess heart rate, heart rhythm, hypertrophy, and infarction Single lead ECG tracing - “Rhythm strip” - Assess heart rate, rhythm, and presence of arrythmias - Need a 12-lead to make a definitive diagnosis for hypertorphy, ischemia, or infarction

7. Electrical Activation of Heart: First ½ of P Wave Sinus impulse initiates in sinoatrial (SA) and activates right atrium Propagation in right atrium through intra- atrial pathways

8. P Wave Impulse activates left atrium and atrioventricular (AV) node Electrically: atrial depolarization Mechanically: atrial contraction Duration: Not over 0.11 seconds

9. PR Segment Start of P wave to beginning of Q Isoelectric line due to delay at AV node; Purpose of delay? The His-Purkinje system is activated but not seen on ECG Duration: 0.12-0.20 seconds

10. Q Wave Small narrow negative deflection Activation of interventricular (IV) septum from left to right Duration: Normal is less than 40ms (1 small box)

11. QRS Complex Ventricular depolarization, followed by ventricular contraction Activation of walls of heart Duration: Adult 0.05-0.10 sec; Nb 0.04-0.05 sec

12. J Point and ST Segment J Point : junction between the end of QRS and beginning of ST segment; important predictive value ST Segment : end of QRS complex (after J point) to beginning of T wave; slight pause= isoelectric line; represents early stage of ventricular repolarization

13. T wave Assymetrical curve Ventricular repolarization Since no mechanical contraction occuring, it is strictly an electrical phenomenon Amplitude: Not > than 10 mm in precordial leads

14. TP Segment Isoelectric line after T wave and beginning of another P wave Purpose: serves as reference point ST segment elevation can be identified

15. U Wave Rarely seen but just be aware of it Occurs as a positive or negative wave after T wave Mechanism: Unknown Amplitude: Low voltage Clinical significance: hypokalemia, myocardial ischemia, heart disease, hypertension, or acute myocardial ischemia

16. Reading an ECG Rate Rhythm Waveforms (PR, P, QRS, ST, T) Everything needs to be evaluated in terms of context. Need to ask if it has changed from normal.

17. Determining Heart Rate from ECG 6 second tracing: - Obtain ECG recording that is 6 seconds in length - Count the number of QRS complexes in six seconds - Multiply the number of QRS complexes by 10 to determine the heart rate per minute (HR/min) Heart rate: 100 tachycardia

18. Determing Rhythm Use calipers or small ruler to measure the R-R intervals Remember to place the calipers/ruler on the same point of QRS complex If R-R intervals remain consistent, the ventricular rhythm is regular

19. Determing Waveforms P wave 1. Is there a P-wave? 2. Has the duration changed? PR interval 1. Is the PR interval equal througout? QRS 1. Duration? 2. Height?

20. Determing Waveforms contd. ST Segment 1. Is it there? 2. Is it elevated or depressed? T Wave 1. What is its height? 2. Does it have a abnormal deflection?

21. Conclusion Evaluate case in terms of overall context Compare ECG to normal, if available Check the wires Error on side of caution based on overall case matter Remember to treat the patient, not just the monitor!