Professional Documents
Culture Documents
Aims
• 10 ECG rules
• ECG signs of M.I.
• Evolution of changes in M.I.
• Classical Appearences
QRS waveform nomenclature
R r qR qRs Qrs QS
Qr Rs rS qs rSr’ rSR’
The 10 rules for a normal ECG
.2
Rule 1
1.0 R
PR
interval
0.5
T
PR interval should be 120 to
Millivolts
-0.5 S
Milliseconds
Rule 2
1.0 R
0.5
T
The width of the QRS complex
Millivolts
-0.5 S
QRS
Milliseconds
Rule 3
Q S
Rule 6
V6
V5
V4
V3
V2
V1
P
• At least 0.04 seconds in duration
T
• Depth of more than 25% of
Q
ensuing R wave
T wave changes
• Late change
R
• Occurs as ST elevation is
ST
P returning to normal
• Apparent in many leads
T
Q
Bundle branch block
Anterior wall MI Left bundle branch block
I II III aVR aVL aVF V1 V2 V3 V4 V5 V6 I II III aVR aVL aVF V1 V2 V3 V4 V5 V6
Sequence of changes in evolving AMI
R
R R
ST ST
T
P P P
T
Q S Q
Q
1 minute after onset 1 hour or so after onset A few hours after onset
ST T
P P ST
P
T T
Q Q Q
Left
coronary
artery
Inferior infarction
Inferior infarction
Right
coronary
artery
Lateral infarction
Lateral infarction
Left
circumflex
coronary
artery
Location of infarct combinations
I aVR V1 V4
ANT
LATERAL POST ANT
II aVL V2
SEPTAL
V5
ANT
V3 V6 LAT
III aVF
INFERIOR
Diagnostic criteria for AMI