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Interpretation of Normal ECG Marriot

Interpretation of Normal ECG Marriot

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Published by Mended_Heart
THis chapter in Marriot's textbook, Describes how to interpret a normal ECG and find its abnormalities.
Hope You like it.
Enjoy reading.
THis chapter in Marriot's textbook, Describes how to interpret a normal ECG and find its abnormalities.
Hope You like it.
Enjoy reading.

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Published by: Mended_Heart on Jul 11, 2009
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01/10/2013

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Authors:Wagner, Galen S.Title:
Marriott's Practical Electrocardiography, 11th Edition 
Copyright
ﺁ
©
٢٠٠٨
Lippincott Williams & Wilkins
> Table of Contents > Section I - Basic Concepts > 3 - Interpretation of the Normal Electrocardiogram
3
Interpretation of the Normal Electrocardiogram
Galen S. WagnerTobin H. Lim
ELECTROCARDIOGRAPHIC FEATURES
Every electrocardiogram (ECG) has nine features that should be examined systematically:P.44
Figure 3.1.
Grid lines on standard ECG paper.1. Rate and regularity;2. P-wave morphology;3. PR interval;4. QRS-complex morphology;
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Rate, regularity, and
rhythm
are commonly grouped together. However, to accurately assess rhythm, it isnecessary to consider not only rate and regularity, but also the various waveforms and intervals.Determination of the ECG features requires understanding of the grid markings provided on the ECG paper(Fig. 3.1). The paper shows thin lines every 1 mm and thick lines every 5 mm. The thin lines therefore formsmall (1 mm) squares and the thick lines form large (5 mm) squares. The horizontal lines facilitatemeasurements of the various intervals and determination of heart rate. At the standard paper speed of 25mm/s, the thin lines occur at 0.04-s (40-msec) intervals and thick lines occur at 0.20-s (200-msec) intervals.The vertical lines facilitate measurements of waveform amplitudes. At the standard calibration of10mm/mV, the thin lines are at 0.1-mV increments and the thick lines are at 0.5-mV increments.Therefore, each small square is 0.04s
أ
٠
,
١
mV, and each large square is 0.20s
أ
٠
,
٥
mV.Much of the information provided by the ECG is contained in the morphologies of three principalwaveforms: (i) the P wave, (ii) the QRS complex, and (iii) the T wave. It is helpful to develop a systematicapproach to the analysis of these waveforms by considering their:The guidelines for measuring and estimating these four parameters for each of the three principal ECGwaveforms are presented in this chapter. The definitions of the various waveforms and intervals werepresented in Chapter 1 in the context of describing ECG recordings of base-to-apex and left- versus right-sided cardiac activity.
RATE AND REGULARITY
5. ST-segment morphology;6. T-wave morphology;7. U-wave morphology;8. QTc interval; and9. Rhythm.P.451. General
contour
s,2.
Durations
,3. Positive and negative
amplitude
s, and4.
Axes
in the frontal and transverse planes.P.46
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The cardiac rhythm is rarely precisely regular. Even when electrical activity is initiated normally in thesinus node, the rate is affected by the autonomic nervous system. When an individual is at rest, minorvariations in autonomic balance are produced by the phases of the respiratory cycle. A glance at thesequence of cardiac cycles is enough to determine whether the cardiac rate is essentially regular orirregular. Normally, there are equal numbers of P waves and QRS complexes. Either of these may be used todetermine cardiac rate and regularity. When, in the presence of certain abnormal cardiac rhythms, thenumbers of P waves and QRS complexes are not the same. Atrial and ventricular rates and regularities mustbe determined separately.If there is essential regularity in the cardiac rhythm, cardiac rate can easily be determined by counting thenumber of large squares between cycles. Because each square indicates one fifth of a second and there are300 fifths of a second in a minute (5
أ
٦٠
), it is necessary only to determine the number of large squaresbetween consecutive cycles and divide this number by 300. It is most convenient to select the peak of aprominent ECG waveform that occurs on a thick line and then count the number of large squares until thesame waveform recurs in the following cycle. When this interval is only one fifth of a second (0.2 s), thecardiac rate is 300 beats/min; if the interval is two fifths of a second (0.4 s), the cardiac rate is 150beats/min; if the interval is three fifths of a second (0.6 s), the cardiac rate is 100 beats/min, and so forth.Lead II is displayed in Figure 3.2 with the second QRS complex following the onset of the initial QRScomplex after four large squares (heart rate = 75 bpm).
Figure 3.2.
Lead II. bpm, beats per minute.P.47
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