Basic ECG

Reading

Basic ECG Reading

1 April 2006

Basic ECG Reading

1 April 2006

ECG terminology

Normal ECG
Basic ECG Reading
1 April 2006

Basic ECG Reading

1 April 2006

Determining the Heart Rate

Approach to Interpretation of the ECG

Rate

The number of large squares between 2

consecutive R waves = X

Regularity
Axis

Heart Rate = 300 / X

PQRSTU

Basic ECG Reading

1 April 2006

Basic ECG Reading

1 April 2006

1 small square =
0.04 s

Is there any electrical activity?

1 large square =
0.2 s

If there is no activity,
Check - connections
QRS gain
In 2 other Leads, eg Lead I & II
5 large squares =1s
1 QRS per s
Heart rate = 60 per min

Count the number of large

squares between 2 RR
intervals and divide into 300

Basic ECG Reading

1 April 2006

If still no activity - ASYSTOLE

Basic ECG Reading
1 April 2006

Ventricular Fibrillation

Asystole
Complete absence of QRS
P waves may occur
If no organised QRS complex is seen and the patient has a pulse
then the ECG is improperly connected, turned off or improperly
calibrated

Totally disorganised pattern

No distinguishable QRS complexes
Continuous erratic movement of the baseline
Rate is very rapid and too disorganised to count

VF may masquerade as asystole; it is best always to check 2 leads

perpendicular to each other to make sure that asystole is not VF

Coarse VF vs Fine VF
Management : Immediate defibrillation
Basic ECG Reading
1 April 2006

Basic ECG Reading

1 April 2006

Pulseless Electrical Activity

Basic ECG Reading

1 April 2006

Pulseless electrical activity

Basic ECG Reading

1 April 2006

What is the rhythm?

Analyse P-QRS

Complete heart block

Assess:
P wave - present / absent
morphology
QRS morphology and width
Relation between P wave and QRS

Basic ECG Reading

1 April 2006

Basic ECG Reading

1 April 2006

Sinus tachycardia

What is the width of QRS?

Widened QRS Complex

(> 0.12s)

Basic ECG Reading

1 April 2006

Basic ECG Reading

1 April 2006

Irregular narrow complex

tachycardia

Basic ECG Reading

1 April 2006

Narrow QRS Complex

Narrow complex tachycardia

Basic ECG Reading

1 April 2006

Electrocardiogram of ACS

Wide complex tachycardia

May be normal when pain free
Subtle features
- Horizontality of the ST segment
- Squaring of the ST-T wave angle
Ideal to do ECG at time of symptoms

Basic ECG Reading

1 April 2006

Basic ECG Reading

1 April 2006

Ischaemia - ST depression

Acute Ischemia
Basic ECG Reading
1 April 2006

Basic ECG Reading

1 April 2006

Acute anteroseptal MI
Basic ECG Reading
1 April 2006

Evolved Anterior MI
Basic ECG Reading
1 April 2006

Acute inferior + RV Mi

Acute Anterior MI
Basic ECG Reading
1 April 2006

Basic ECG Reading

1 April 2006

69 years old female Hyperkalemia

Pericarditis
Basic ECG Reading
1 April 2006

Basic ECG Reading

1 April 2006

Acute pulmonary embolism

Basic ECG Reading

1 April 2006