THE HEART INSTITUTE

"
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THE HEART INSTITUTE



Two chamber concept
Poor progression of R waves
Clockwise rotation
 :
0 ,+90 0 30-
 Quick Axis Determination
AXIS L1 aVF

Normal + +
Left * + _
Right - +
Extreme - -
(northwest)
Borderline LAD (0 to -30 ) L2 positive
Definite LAD (-30 to -90 ) L2 negative
Axis determination
Axis determination
 ?
 ?
 ?
<(.. 0
) 30

)(LAH = left anterior hemiblock


LBBB
Ostium primum ASD
- ))WPW
 >(.. 0
) 90

)(LPH = left posterior hemiblock
"

RBBB

( )
- ))WPW
 /+150 to -( :
)90

()
VT
 T 60
QRS
Wide angle between QRS and T
frontal axes
 Systematic Evaluation of ECG
1. Rate and rhythm .
2. Intervals: PR , QRS, QT
3. Axis
4. P-wave morphology.
5. QRS-complex morphology.
6. ST-segment morphology.
7. T-wave morphology.
8. U-wave morphology.
 .. :
R
60,000
- R

Rate cycle length conversion
Rate Cycle Length
(bpm) (60000/rate)
msec "25
37 1620 8
43 1395 7
50 1200 6
60 1000 5
75 800 4
100 600 3
150 400 2
300 200 1
 ?
 PR : 120 200-
)(0.12-0.2 sec
PR:
-
SVT



(,

)
PR = 0.16
 PR : 120 200-
)(0.12-0.2 sec

PRIst degree AV block :

-
AV node

bundle branches

 QRS : 60-100-
()sec 0.06-0.1
QRS ):(0.1-0.12

)(ICRBBB, ICLBBB
-
QRS ):)> 0.12
CLBBB
CRBBB
IVCD
,VT, PVCS :- ,

QRS = 100
QT interval
Normal QT response to increased
heart rate
Rate QT QTc

50 440 400

60 400 400

75 360 400

100 310 400

120 282 400

 QTc : :
380 440- (0.38-0.44
)sec

:QTc QT
QT :Bazzet
RR . 400 =
0.4
 QT vs QTc
QT Rate QTc

400 60 400

400 75 447

400 100 516

400 150 632

 QTc : 380 440-
)(0.38-0.44 sec
QTc:
Congenital long QT syndrome
:- ,class IA, III :-
,
: ,,

:CNS - ,CVA ,

:
 QTc : 380 440-
)(0.38-0.44 sec
QTc:
:,
,
:
( Short QT syndrome )0.32
Normal P

L2

V1
 QRS Morphology
Contours, normal and abnormal waves
(Q, q, R, r, S ,s)
QRS duration
QRS axis
Normal QRS (QRS<100 ms)
Normal QRS Progression
ST segment
ST segment - II
 T/U wave
Size (amplitude)
Morphology
Horizontal and frontal axis
U wave