1. DATA INTERPRETATION-1 1. BASIC ECG 2. Lipid Profile

2. Objectives: Identify normal ECG pattern
Recognize abnormal finding in hypertensive patients.
Enumerate the lab investigation in patients diagnosed as Hypertension.
Differentiate between normal and abnormal values.

3. What is an ECG?
The electrocardiogram (ECG) is a representation of the electrical events of the cardiac cycle.
Each event has a distinctive waveform
the study of waveform can lead to greater insight into a patient’s cardiac pathophysiology.

4. WHAT WE CAN IDENTIFY By ECG
Arrhythmias
Myocardial ischemia and infarction
Pericarditis
Chamber hypertrophy
Electrolyte disturbances (i.e. hyperkalemia, hypokalemia)
Drug toxicity (digoxin and drugs which prolong the QT interval)

5. Impulse Conduction & the ECG
Sinoatrial node
AV node
Bundle of His
Bundle Branches
Purkinje fibers

6. NORMAL ECG

7. The “PQRST” P wave – Atrial depolarization
QRS – Ventricular depolarization
T wave – Ventricular repolarization

8. Atrial depolarization
The PR Interval
Atrial depolarization +
delay in AV junction
(AV node/Bundle of His)
(delay allows time for the atria to contract before the ventricles contract)

9. The ECG Paper Horizontally Vertically One small box - 0.04 s
One large box s
Vertically
One large box mV

10. ECG LEADS
which measure the difference in electrical potential between two points
1. Bipolar Leads: Two different points on the body
2. Unipolar Leads: One point on the body and a virtual reference point with zero electrical potential, located in the center of the heart

11. ECG LEADS The standard ECG has 12 leads: 3 Standard Limb Leads
3 Augmented Limb Leads
6 Precordial Leads

12. STANDARD LIMB LEADS

13. STANDARD LIMB LEADS

14. AUGMENTED LIMB LEADS

15. ALL LIMB LEADS

16. Precordial Leads

17. PRECORDIAL LEADS

18. QRS in LVH & RVH

19. LEFT VENTRICULAR HYPERTROPHY19

21. Findings: V1 and V6 more than 35 mm with strain pattern (LVH)
II, III, and avf T wave inversion (Inf. Ischemia)
Generalized Ischemia
Normal Axis ( ‘R’ in Lead I and avf are upright)

22. LEFT VENTRICULAR HYPERTROPHY
Compare these two 12-lead ECGs. What stands out as different with the second one?
The QRS complexes are very tall (increased voltage)
Normal
Left Ventricular Hypertrophy
Answer: 22

23. LEFT VENTRICULAR HYPERTROPHY
Criteria exists to diagnose LVH using a 12-lead ECG.
For example:
The R wave in V5 or V6 plus the S wave in V1 or V2 exceeds 35 mm.
However, for now, all you need to know is that the QRS voltage increases with LVH. 23

24. LEFT VENTRICULAR HYPERTROPHY
Take a look at this ECG. What do you notice about the axis and QRS complexes over the left ventricle (V5, V6) and right ventricle (V1, V2)?
The deep S waves seen in the leads over the right ventricle are created because the heart is depolarizing left, superior and posterior (away from leads V1, V2).
There is left axis deviation (positive in I, negative in II) and there are tall R waves in V5, V6 and deep S waves in V1, V2. 24

25. LEFT VENTRICULAR HYPERTROPHY
To diagnose LVH you can use the following criteria*:
R in V5 (or V6) + S in V1 (or V2) > 35 mm, or
avL R > 13 mm
S = 13 mm
* There are several other criteria for the diagnosis of LVH.
R = 25 mm
A common cause of LVH is hypertension. 25

26. Q3. A 58-year-old man is a known case of diabetes and hypertension came for routine follow up.
His ECG is shown.

27. Mention four abnormal findings in this ECG.

28. Left axis deviation
Prolonged PR interval or First degree heart block
Left ventricular hypertrophy
Left ventricular strain or Anterolateral ischaemia

29. CASE-1 Your interpretation??
A 47-years-old gentleman, recently diagnosed to have HTN, on treatment. His BMI is 30.2.
He was investigated the results as follow:
FBS: 103 mg /dl (5.7 mmol/l)
Lipid profiles:
Total cholesterol: 6.2 mmol/L
LDL cholesterol : 3.1 mmol/L
HDL cholesterol : 0.8 mmol/L
Triglyceride : 2.1 mmol/L
Your interpretation??

30. ABNORMAL VALUES Total cholesterol(TC): >5.18 mmol/L (>200mg/dL);
LDL-cholesterol
>2.59mmol/L (>100mg/dL);
Non-HDL-cholesterol:
<3.367 mmol/L(<130mg/dL);
HDL-cholesterol:
<1.04mmol/L (<40mg/dL) for men <1.29 mmol/L (<50mg/dL) for women;
Triglycerides
>1.7 mmol/L (>150mg/dL)

31. Clinical Classification of DLD
Isolated hypercholesteremia; mostly due to increased LDL
Mixed or combined dyslipidaemia: elevations in total or LDL-cholesterol, and in triglycerides
Isolated hypertriglyceridaemia: elevation in triglycerides only
Low HDL-cholesterol: either isolated or in association with hypercholesterolaemia or hypertriglyceridaemia

32. Risk Calculation:
THANK YOU