ECG INTERPRETATIONS

Dr Christy Louis MD
Professor and head
Anna Medical college
Mauritius
SINO ATRIAL RHYTHMS
Sinus Rhythm
Sinus Bradycardia
Sinus Tachycardia
 SINUS Arrhythmia

During respiration, the intermittent vagus nerve activation occurs, which results in beat to beat variations in the
resting heart rate. (CARDIOTACHOMETER)
During inspiration vagal tone is slowed down and the heart rate goes up (being maximal at the peak of inspiration),
While during expiration vagal tone is increased and heart rate decreases, being slowest at end-inspiration.
It is more commonly seen in young healthy people, especially those with enhanced vagal tone or slower heart
rates.
SICK SINUS SYNDROME-sinus pause /sinus
arrest
Premature Depolarization
Premature Atrial contaction

➢Originate in atria
➢Pwave morphology is altered
➢Normal QRS complex and T wave
➢PR interval is not prolonged
Premature Ventricular contractions

➢ Ectopic foci in ventricles

➢ Bizarre QRS complexes
Atrioventricular Conduction
Blocks
Stroke adam Syndrome -ECG

➢ A classic Stokes-
Adams attack is a
collapse without
warning, associated
with loss of
consciousness for a
few seconds.
➢ complete (third-
degree) heart block is
seen on the ECG
during an attack
Ectopic Tachycardias
• Also known Paroxysmal Tachycardias (Begin or Malignant)

• Originate from an ectopic Focus -Supra ventricular or Ventricular

• Due to 1. Rapid firing of an ectopic pacemaker

2. Impulse that circles a reentry loop repetitively
Supraventicular Tachycardia
Classification of Supra ventricular tachycardias by
site of origin and regularity
Regular Atrial Irregular Atrial
Sinus tachycardia Atrial fibrillation
Atrial tachycardia Atrial flutter (variable block)
Inappropriate sinus tachycardia Multifocal atrial tachycardia
Sinus node re-entrant tachycardia

Regular Atrioventricular
AVRT
AVNRT
Automatic junctional tachycardia
SVT-Regular Atrial or Nodal
Atrial Flutter
Atrial Fibrillation
WPW Syndrome
➢ Wolff-Parkinson-White
(WPW) syndrome is a
conduction disorder
➢ Patients get tested for WPW
syndrome if you have atrial
fibrillation

(1) PR interval less than 0.12 seconds

(2) with a slurring of the initial segment of the QRS

complex, known as a delta wave,

(3) a QRS complex widening with a total duration

greater than 0.12 seconds
Ventricular Tachycardia
Ventricular Tachycardia

➢ ventricular beats with

rate 100–250 beats
per minute (in most
cases >120 beats per
minute).

➢ Wide QRS
complexes (QRS
duration ≥0,12 s).
Ventricular flutter ➢ ECG pattern of
ventricular flutter
shows regular,
continuous waves,
usually of large
amplitude
➢ The tracing often
resembles a continuous
sine wave, with no
distinction among the
QRS complex, ST
segment, and T wave.
Effect of K+ and Ca+
HYPERKALEMIA
Hypokalemia
Hyperkalemia
Ca+
Surface & Intracardiac ECG
Questions
Q:A 65 year old man had the above electrocardiogram recorded during his annual
physical examination.Which of the following is the most likely diagnosis
A)Atrial paroxysmal tachycardia
B)Second degree A-V block
C)First degree A-V block
D)Third degree A-Vblock
E)Atrial Flutter
Q: A 75 yearold man comes into the emergency department and
faints.Five minutes later,he is alert.An electrocardiogram shows 75 P
waves per minute and 35 QRS waves per minute ,with a normal QRS
width.Which of the following is the most likely diagnosis?
A)First degree atrioventricular block
B)Stokes-Adams Syndrome
C)Atrial paroxysmal tachycardia
D)Electrical alterans
E)Atrial premature contractions