Abnoramal ECG

Dinesh k. lamsal M.D

Rate ;
Rytham
Axis
Pr interval
Qrs complex
Aetiological factors
 Contd……
 Rate- <60bmn or >100bmn?
 Rhythm-sinus ?
 P,q,r,s,t,u waves ?normal size
 Axis –nad ,rad,lad?
 Pr-interval –normal duration?
 St segment _isoelectric ?
 Qrs complex_?
 Aetiology –individual disease/abnormality?
 Ventricular abnormality
 (L) ventricular hypertrophy
 ® ventricular hypertrophy
 Ventricular tachycardia
 Ventricular fibrillation
 Ventricular ectopics
 Abnormal findings
 Pericardial disease :
 Pericardial effusion
 Pericarditis
 Acute MI:( myocarditis)
 NON Q ,Trans mural,
 Inferior,anterio-septal,
 Endocarditis/cardiomayopathy
 Electrolytes abnormalities
 Hyperkalemia
 Hypokalemia
 Hypercalcemia
 hypocalcemia
 Electrolytes abnormality
 Hyperkalemia:
 Increased t wave amplitude,decreased p wave
amplitude
 Increased pr interval,increased Qrs duration.
 Hypokalemia
 Decreased t wave amplitude.
 Increased u wave amplitude
 Arrythmia
 1stdegree av block;
 Rate –(n)
 Rhythm-regular
 Pr interval-0.20sec
 Qrs –(n)
 Long pr with all beats conducted,an adequet r-p
interval.
 2nd degree av block –type 1(mobitz)

 Rate- (n)
 Rhythm-irregular
 Pr inter-0.20sec,lengthening,then shortening but
at the end beat dropped,qrs—(N)
 Type 11(wenckebach)
 Rate-(n)
 Rhythm-irregular
 Pr inter-(n)/some p waves not conducted
 Qrs broad,fixed normal pr 7 dropped beats
 3rd degree av block(complete)

 Ecg—
 Rate-58 bmn
 Rhythm regular
 Pr inter-na
 Qrs-narrow /broad
 Regular p waves@ ,130bmn,regular qrs
@58bmn & av dissociation.
 Rbbb-
 Rate –(n)
 Rhythm-(n)
 Pr inter-(n)
 Qrs-0.12 sec or > ,classical pattern v1 is rSR
 Broad qrs mainly positive in v1
 In 1,avl,& v6-broad s wave
 lbbb

 Rate –(n)
 Rhythm-(n)
 Pr inter- (n)
 Qrs-0.12 or >
 Broad qrs ,mainly negative in v1,1,avl &v6,tere
is an r wave no q & s wave.sometimes t wave
may change
 External factors
 Hypothermia
 Digoxin toxicity
 Pulmonary embolism
 Heart failure
 Dextrocardia
 Specific syndrome
 Wpw
 Lgl (lown-ganong-levine)
 Technical errors
 Lead misplacement
 Incorrect paper speed
 Incorrect voltage calibration
 Systemic disease
 Hypertension
 Valvular disease(aortic,mitral)
 Pulmonary htn
 Ischemia
 Infraction
 Pul. Embolism
 Heart failure
 Copd
 Asthma etc.
 (l) Ventricular hypertrophy
 Ecg characterstics:
 Rate ;(N)
 Rhythm :(n)
 Pr interval (n)
 Qrs complex: increased amplitude(tall r wave in
v5 –v6 ,1 ,avl,& deep s wave in v1-v6)
 (L) axis deviation
 Convex upward st segment &inverted t wave in
1,avl,v1-v4
 ® ventricular hypertrophy

 Ecg charactarstics:
 Rate-(N)
 Rythm-(n)
 Pr interval-(N)
 Qrs complex-9n0 ,may devloped q wave in
11,111,avf
 ® axis deviation,incomplete Rbbb pattern –
V1(rSr)
 Tall p wave in 11,111,& avf,v1
 Ventricular tachycardia
 Ecg characteristics
 Rate-100-170bmn
 Rhythm-regular,sinus
 Pr interval-na
 Qrs-0.12sec
 Broad qrs complex,lad,
 Ventricular fibrillation
 Ecg characteristics:
 Rate-150-300bmn
 Rhythm –regular or irregular
 Pr interval- na
 Qrs- broad/poorly defined
 Zig-zag/sine wave configuration(not clear qrs)
 Ventricular ectopics(pvcs)
 Rate-underlying rhythm
 Rhythm-irregular(due to pvc)
 Pr interval-no p wave associated with pvc
 Qrs-wider due to pvc
 No related p wave,broad qrs complex,t wave of
opposite polarity.
 Pericardial effusion

 Low voltage
 St segment elevation
 Total alternans of p & qrs –is patognomonic
 Pericarditis;(ACUTE)
 Elevation of ST with upward concavity in allstandard
leads,depressed pr segment in limb leads & v2-v6(st
stage).
 Widespread t wave inversion, returned of st in isoelect
.(t-stage)