ECG 01/04/2014

MEASUREMENTS

QRS on horizontal
- bigger than 120 msec MAJOR BBB
- V1, V2 positive  RBBB
- V1 negative  LBBB
- Between 110-120 msec  minor BBB

P wave vertical
- more than 2-2.5 mm  pulmonary P
o hypertrophy of Right Atrium

P prolonged on horizontal and negative component  Left Ventricular Hypertrophy

SOKOLOV
- R in V5, V6 + S in V1,V2 > 35 mm (1 big square = 5mm vertical)
o LVH
- RVH  Sum of R (V1,V2) and S (V5,V6) > 15 mm

BRADYCARDIA < 60 electrical impulses

Tachycardia > 100

Sinusal Tachycardia 100-150

Atrial Frequency
- count P waves or small f(fibrillation) waves or big F(Flutter) waves
- Atrial Tachycardia
o 150-250 electrical impulses
- atrial Flutter
o 250-350
o presence of F waves
o always put transmission  count Flutter waves , e.g. after 4 Flutter waves
comes an QRS complex  4:1 conduction
o 90% of Flutter  regulated rhythm
o 10%  with irregular AV transmission (some 4:1, some 3:1, etc)
 rare !!
- Atrial Fibrillation
o 350/400 – 600
o no p waves
o different R-R

Paroxystic
- begins and ends very quick
- can happen without specific cause
- paroxystic arrhythmias  most dangerous
summation complex
- when P and T in one compartment (cannot differentiate them separately )

Ventricular Arrhythmias
- no P or T
- only QRS
- Ventricular Tachycardia
o 150-200 electrical impulses
- Ventricular Flutter
o 200-250
- Ventricular Fibrillation
o 250-400
o no ventricular contractions
- when the frequency is getting higher, the waves become smaller / narrower

Definition of Q wave
- > 25 % of R wave
- appear in 2 contiguous leads
- check for tiny R’s
- R  means something positive
- Q  means something negative
- V2, V3  Q wave only 0,03 sec possible

Depression and elevation

- 1mm  ischemia or something else

SUSTAINED (Ventricular Arrhythmias ) NON-SUSTAINED (Ventricular

Arrhythmias)
> 30 seconds < 30 seconds

WPW
- PR < 0,12 sec
- Delta wave (an inflection on QRS)
o Almost in all leads

CALCULATION RULE
- Atrial Frequency = 1500/ number of small boxes between 2 Flutter waves
- Ventricular Frequency = 1500 / number of small boxes between R-R
- How to find Atrio-ventricular conduction
o = Atrial Frequency / Ventricular Frequency
STEPS

1) Extrasystoles

2) Tachycardia ( more then 3 extrasystoles)

3) Flutter

4) Fibrillation

5) No pulse

6) Death

AV BLOCK GRADE I
- PR  Prolonged , more than 0,2 sec
- PR  constant = everywhere the same duration

AV BLOCK GRADE II- Type I (Mobits I)

- PR getting prolonged progressively till one QRS is missing

AV BLOCK GRADE II – TYPE II (Mobits II)

- PR normal or prolonged
- QRS missing in an algorithmic way (2:1, 3:1,…)