BASICS OF ELECTROCARDIOLOGY NINI VARGHESE MADRAS MEDICAL MISSION, CHENNAI - PowerPoint PPT Presentation

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BASICS OF ELECTROCARDIOLOGY NINI VARGHESE MADRAS MEDICAL MISSION, CHENNAI

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www.anaesthesia.co.in anaesthesia.co.in_at_gmail.com Normal 12 lead ECG ... Branch is blocked completely and other blocks ... BLOCKS First Degree A-V Block 2 ... – PowerPoint PPT presentation

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Title: BASICS OF ELECTROCARDIOLOGY NINI VARGHESE MADRAS MEDICAL MISSION, CHENNAI


1
BASICS OF ELECTROCARDIOLOGY NINI
VARGHESEMADRAS MEDICAL MISSION, CHENNAI
www.anaesthesia.co.in anaesthesia.co.in_at_gmail.co
m
2
Normal 12 lead ECG
3
Components of ECG
4
P wave
  • Indicates atrial depolarization or
    contraction of the atrium.
  • Normal duration is not more than
  • 0.11 seconds.
  • Amplitude is not more than 3 mm
  • No notching or peaking

5
QRS complex
  • Indicates ventricular depolarization
  • or contraction of the ventricles.
  • Normally not more than .10 seconds
  • in duration
  • R waves are deflected positively and the Q and S
    waves are negative

6
T wave
  • Indicates ventricular repolarization
  • Not more that 5 mm in amplitude in standard leads
    and 10 mm in
  • precordial leads
  • Rounded and asymmetrical

7
ST segment
  • Indicates early ventricular repolarization
  • Normally not depressed more than 0.5 mm
  • May be elevated slightly in some leads (no
    more than 1 mm)

8
PR interval
  • Indicates AV conduction time
  • Beginning of P- wave to the beginning
  • of QRS complex .
  • Duration time is 0.12 to 0.20 seconds

9
QT interval
  • Measured from the onset of QRS to
  • the end of the T wave
  • Represents ventricular depolarization and
    repolarization

10
How to calculate HR in ECG
  • HR 1500 / No.of small squares

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Conduction system
  • SA node- natural pacemaker - it initiates
    electrical impulses spontaneously ( High RA -
    junction of SVC- RA)
  • AV node - impulse from SA node pass through AV
    node before it reaches ventricle ( Above the
    insertion of tricuspid valve)

13
Cont..
  • Bundle of HIS - It transmit impulses from AV node
    to the remainder of conduction system beyond.
    (Left and Right bundle branches)
  • Purkinje fibers - located on the endocardial
    surface of ventricles

14
Natural Conduction system
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AV BLOCKS
  • 1 Heart Block - prolongation of PR interval
    does not change from beats to beats ( gt 0.21
    sec)

18
First Degree A-V Block
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2 Heart Block
  • 2 Heart Block- it exists when one or more atrial
    impulses fails to activate the ventricles
  • Type 1 - Wenckebach or Mobitz 1
  • progressive slowing and intermitent failure
    of AV
    conduction

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AV BLOCK Cont.
  • Type 2 - Wenckebach or Mobitz II
  • involves blocking of both bundle branches
  • One Bundle Branch is blocked completely and other
    blocks intermittently

22
Second Degree A-V Block
23
Complete Heart Block (CHB)
  • Total absence of AV conduction.
  • P wave no constant relation to QRS
  • complex.

24
Third Degree A-V Block
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Ventricular Tachycardia (VT)
  • Common and significant rhythm disturbances, may
    be life threatening
  • Three or more sequential ventricular ectopic
    complexes, mostly regular and occurring at rate
    more than 100 / min.

26
VT types
  • Sustained VT - Duration gt 30 sec
  • Non-sustained VT - self terminating lt
    30 sec
  • Incessant VT - long period of Tachycardia
    interrupted by NSR.
  • Recurrent VT - occuring periodically but
    occurances are separated by NSR longer than
    period of Tachycardia

27
Monomorphic VT
  • Originated from single focus.
  • Complexes looks similar and coupling intervals
    are equal
  • May be Sustained or Non-sustained

28
Polymorphic VT
  • originates from multiple foci. Complexes appears
    different from one another. coupling intervals
    are unequal.
  • If with long QT Torsades De Pointes

29
SUPRAVENTRICULAR TACHYCARDIA
  • Tachycardia which originates above the
    ventricles.
  • Types
  • Sinus Tachycardia - sinus rhythm with rate above
    100 bpm
  • Sinus Bradycardia - sinus rhythm with rate below
    60 bpm

30
Sinus Tachycardia
31
Sinus Bradycardia
32
Atrial Fibrillation (AF)
  • Rhythm irregular (Atrial Ventricular)
  • Rate Atrial (too rapid to determine)

    ventricular (variable)
  • P-wave absent
  • PR interval not measurable
  • QRS normal unless IVCD present

33
Atrial Fibrillation
34
Atrial Flutter (AFI)
  • Rate 250 - 450 bpm (atrial)
  • 150 bpm or below (ventricular)
  • Rhythm regular (atrial)
  • regular or irregular
    (ventricular)
  • P-wave flutter waves - saw tooth appearance
  • PR interval - not measurable
  • QRS normal unless IVCD present

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CONCLUSION
  • An electrocardiogram may show
  • Evidence of heart enlargement
  • Signs of insufficient blood flow to the heart
    (ischemia)
  • Signs of a previous injury to the heart
  • Heart rhythm problems (arrhythmias)

37
Cont..
  • Changes in the electrical activity of theheart
    caused by an electrolyte imbalance in the body.
  • Signs of inflammation of the sac surrounding the
    heart (pericarditis).

38
An electrocardiogram cannot predict whether you
will have a heart attack ?
39
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