Baby Steps to ECG

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Baby Steps to ECG

• Dr Saqib Mahmud
• MRCP(UK), MRCPS(Glasg), MRCGP

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Electrical Conducting system
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ECG LEADS
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leads representing regions
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Anatomic region of heart associated coronary
artery

• Inferior MI----------------?RCA
• Antero-septal MI---------?LAD
• Antero-lateral MI---------?Circumflex
• Posterior MI--------------?RCA
• --------------------------------------------------
  ---------
• Inferior leads-------------?II, III, aVF
• Antero-septal leads------?V1,V2,V3V4
• Antero-lateral leads------?I,aVL,V2-V6

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Normal ECGPR interval?0.12s-0.2s(notgt1 large
sq)QRS duration?0.12s(notgt3 small
squares)P?QRS?TST segment?isoelectricT?
upright
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ECG reporting-systematic approach

• Rate
• Rhythm P waves
• Conduction intervals
• Axis
• QRS complexes-narrow, wide, bizarre
• ST segments-elevation or depression
• T waves-inverted, upright, peaked

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How to calculate heart rate

• Relationship b/w R-R interval (large squares)
  heart rate
• --------------------------------------------------
  ----------------
• R-R interval (large squares) heart rate
• 1 300
• 2 150
• 3 100
• 4 75
• 5 60
• 6 50

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QRS nomenclature
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Axis
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Cardiac axis

• Normal axis- double thumbs up(IIII)
• RAD--- I ve, III ve
• LAD--- I ve, III ve
• ---------------------------------------------
• RAD-(causes) normal in children, R vent
  hypertrophy, PE, ASD/ VSD, antero-lateral MI
• LAD-inferior MI, WpW, emphysema, conduction
  defects

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Bundle branch block

• RBBB
• Tall R wave V1
• QRSgt0.12sec
• RsR-V1
• LBBB
• QS-V1,V2
• QRSgt0.12

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LBBB
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RBBBLAD
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Atrial flutter fibrillation

• Atrial flutter
• Saw tooth appearance
• Rapid regular rhythm
• Atrial fibrillation
• No P waves or bizarre P waves
• Always irregular rhythm
• Can be slow or rate controlled

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ACS classification
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Heart block

• 1st degree HB-prolonged PRgt0.2sec
• Causes-increased vagal tone, IHD, Rh fever, dig
  toxicity, electrolyte imbalance,myocarditis
• 2nd degree HB-
• Mobitz type 1 or wenckebeck-progressively
  increased PR,non conducted beat,short PR
  (causes-inf MI, athelete, drugs-Ca beta
  blockers,digoxin)
• Mobitz type 2-(21) fixed PR, one P wave not
  folowed by QRS-(causes-degenerative disease of
  conducting system, anteroseptal MI-may herald CHB)

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CHB or 3rd degree HB

• Atrial contraction normal-no beats conducted to
  ventricles
• Ventricles excited by slow escape rhythm
• ECG-no relationship b/w P waves and Q waves
• Bizarre or wide QRS complexes
• Causes-degenerative fibrosis of bundle of his,
  MI, drugs eg betablockers, digoxin

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wpw
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hyperkalaemia
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P-pulmonale
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SI,QIII,TIII-RV strain
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Thank you

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• Peripheral vascular disease
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