READING &INTERPRITING ECG continuation
QRS COMPLEX
NORMAL 0,06-0,10 s
ABNORMALITIES OF QRS 1- QRS WIDENING
BOUNDLE BRANH BLOCK(BBB):
*RBBB
-Normal varient
-Rt ventricle pathology
-Congenital heart disease (atrial septal defect)
-Coronary artery disease
*LBBB
-Coronary artery disease
-Hypertension.
-Aortic valve disease
-Cardiomyopathy
RBBB
-Wide QRS complex
-rSR Pattern or M shape in V1
-Slurred S in V5 V6
-Inverted T in V1
LBBB
-Wide QRS complex
-Small Q in V1
-M shape QRS in V6
2- INCREASE VOLTAGE
VENTRICULAR HYPERTROPHY:
*LVH
-Hypertension
-Hypertrophic cardiomyopathy
-Aortic stenosis
*RVH
-Pulmonary stenosis
-Pulmonary hypertension
*LVH
-Increase R in V5-6
- Increase S in V1-2
Sum. <35 s sq
-LV strain pattern (ST,T inversion in: I,aVL,V5-V6)
*RVH
-Increase R voltage in V1-V2
-Deep S in V5-6
-RV strain pattern (ST,T inversion in V1-2 )
3- ABNORMAL Q WAVE
Myocardial infarction
*Inferior MI: pathological Q wave in leads II, III ,aVF
*Anterior MI: pathological Q wave in leads I,AVL,V1-6
ST SEGMENT
Start from S wave till the beginning of T wave
ABNORMALITIES OF ST SEGMENT 1.ST ELEVATION
ST Elevation convex upward
*Acute MI
*Prinzmetal angina
*Ventricular Aneurysm
*Normal variant
ST Elevation concave upward
*Pericarditis
OTHER CAUSES (LBBB,hyperkalemia)
2. ST DEPRESSION
IHD
*Subendocardial ischemia
*Non q wave MI
*Reciprocal changes in acute MI
NON-ISCHEMIC CAUSES
*VH, BBB, digoxine,
hypokalemia, MVP, CNS diseases
T WAVE
Most labile wave in ecg
Amplitude >5mm
ABNORMALITIES OF T WAVE
T INVERSION
*MI
*Ischemia
*Pericarditis
*Myocarditis
*CNS dis
*VH (strain pat.)
*Digoxine
*MVP
PEAKED T WAVE
*Anxiety
*Hyperkalemia
U WAVE
Represent afterdepolarisation of ventricles.
Normal U has same polrity of T, amplitude 1/3 of T
ABNORM. OF U WAVE
PROMINENT UPRIGHT U
*Bradycardia
*hypokalemia
*Quinidine
*MVP
*CNS diseases
INVERTED U WAVE
*IHD
*Non- ischemic (LVH)
AXIS OF THE HEART
NORMAL :(-30 )TO (+110)
*>-30 :left axis deviation
*<+110:right axis deviation
LAD : LI UP
L II,LIII DOWN
RAD : L II DOWN
LII,III UP
