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(TheSystematic Approach)
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12-LEAD ECG's - A "Web Brain" for EasyInterpretation
Starting Out:
Review of the Basics
The KEY to interpretation of any ECG is to utilize a systematic approach.The approach we suggest for interpreting each 12-lead ECG that youencounter entails a systematic assessment of each of the following:
R
ate
R
hythm
I
ntervals (PR/QRS/QT
)
A
xis
H
ypertrophy
I
nfarct (QRST changes)
We outline key elements to assess for each of the above parameters in the"Analyze an ECG"section of this ebook. Discussion is limited here to thefollowing points:
•
The purpose of having (and regularly using) a systematic approach issimple: It prevents you from overlooking potentially importantfindings.
•
Additional benefits include increased accuracy, improvedorganization, and increased speed in completing your interpretation.The process of 12-lead ECG interpretation should be thought of asconsisting of two major steps:
1.
Descriptive Analysis: Simply describe what is seen on the tracing (as per the"Analyze an ECG"section of this ebook). Ideally,
WRITEOUT
your findings
2.
The Clinical Impression: should only come after the first step has been completed. Those specific findings identified in descriptiveanalysis should now be interpreted in light of the clinical context (i.e.,as defined by the patient's age, presenting complaint, and additionalrelevant clinical history).
KEY Clinical Point:
The secret of successful ECG interpretation depends on keeping these2 steps separate in your mind.
Why 2 separate steps?
Consider the following: Symmetric T wave inversion is often seen in theanterior leads (V1, V2, and V3) of pediatric patients. In an otherwisehealthy child (with no heart murmur), this finding represents a completely benign normal variant that is commonly referred to as a Juvenile T WavePattern.
However, the same ECG (with identical T wave inversion) would have to beinterpreted very differently if the patient in question was an older adult withnew-onset chest pain (in whom this finding should strongly suggestischemia).Thus, descriptive analysis is the same in both cases (i.e., "symmetric T waveinversion in leads V1-3"), but the clinical impression is very different!
Tips for Applying the
Systematic Approach
•
Be sure to carefully survey all 12 leads on the ECG, except perhapsfor lead aVR, which can usually be ignored unless you suspectdextrocardia or lead misplacement (see below).
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Common Causes of QT Prolongation for 12- Lead ECG-A Web Brain for Easy Interpretation (2)
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