ECG ABC in SAAD A. SHETA MBChB, MA, MD Assoc. Prof. MDS Department KSU

How To Read ECG Rate? QRS Duration? Stability?

Anatomy of Heart and ECG signal Normal ECG signal Conducting System of Heart

Measurements Small square = 0.04 sec. Large square = 5 small square = 0.2 sec. One second = 5 large square One minute = 300 large square

3, 3, 3 and 5 Remember This P duration = 3 small sqs = 0.12 sec. P height = 3 small sqs = 0.12 sec. QRS duration = 3 small sq = 0.12 sec. P-R interval = 5 small sqs = 0.2 sec.

SAN: 60 - 100 AVN : 40 - 60 Bundle Branch: 20 - 40 Three Levels:

Rate: RATE may be: Normal 60 -100 Bradycardia < 60 If regular : Divide 300/ number of large squares between 2 Rs = HR If irregular: Count number of complexes in 6 sec. and multiply by 10 RATE may be: Normal 60 -100 Bradycardia < 60 Tachycardia > 100 P = Sinus No P = Non sinus

QRS Duration: Slim lady Obese lady

Stability: * Stable patient: think of drug therapy * Unstable patient: think of electric therapy

Supraventricular Rhythm Rate > 100. QRS: Narrow. Stable or unstable Rate < 60. QRS: Narrow. Stable or unstable Sinus bradycardia 1st degree HB 2nd degree HB Complete HB Sinus tachycardia Atrial flutter Atrial fibrillations PAT, PNT

Supraventricular Rhythm: Tachycardia Sinus Tachycardia

Supraventricular Rhythm: Tachycardia Atrial Flutter

Supraventricular Rhythm: Tachycardia Atrial Fibrillations

Supraventricular Rhythm: Tachycardia Paroxysmal SVT

Supraventricular Rhythm: Bradycardia Normal Sinus Rhythm Sinus Bradycardia

Supraventricular Rhythm: Bradycardia 1st Degree HB

Supraventricular Rhythm: Bradycardia 2nd Degree HB: Mobitz 1 Wenckebach. Progressive lengthening of the P-R interval with intermittent dropped beat

Supraventricular Rhythm: Bradycardia 2nd Degree HB: Mobitz 2 Sudden drop of QRS without prior P-R changes

Supraventricular Rhythm: Bradycardia 3rd Degree HB

Idioventricular Rhythm.

Accelerated Idioventricular Rhythm.

Ventricular Rhythm

Ventricular Rhythm

Ventricular Rhythm Pacer Rhythm

Treatment Supraventricular Rhythm: Stable = Drugs = Alii A denosine L anoxine I soptin I nderal Unstable = Electric DC with 25 joules, +++

Treatment Ventricular Rhythm: Stable = Drugs = AlP A miodarone. L idocaine. P rocainamide. Unstable = Electric DC with 200 joules, 300, 3600.

Myocardial Ischemia Due to lack of adequate blood flow to the myocardium Ischemia is reversible. Changes in ECG: T wave peaking Symmetric T wave inversion ST segment elevation

Different ECG Signals Normal Signal ST segment elevated signal ECG with T wave inversion ECG Signal with peak T waves

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