TUTORIAL
باطنيةد. جاسم محمد طيب
عدد الاوراق (5)
30-4-2013Reading 12-Lead ECGs
The best way to read 12-lead ECGs is to develop a step-by-step approach (just as we did for analyzing a rhythm strip). In these modules we present a 6-step approach:Calculate RATE
Determine RHYTHM
Determine QRS AXIS
Calculate INTERVALS
Assess for HYPERTROPHY
Look for evidence of INFARCTION
SINUS ARRHYTHMIA
Normal phenomenon
Heart rate increases during inspiration & decreases during expiration
Constant PR interval
Every P is followed by a QRS
Only finding is varying R-R interval
Wolf Parkinson White WPW
Aceesory pathwayShort PR interval (<0.12), a delta wave and prolonged QRS (>0.12)
SVT ,AF
Treatment of SVT same as AVNRT
In case of AF drugs that prolonge the refractory peroid of accessory pathway required like amiodarone.
R-on-T Phenomenon: May cause a run of PVCs or Vfib
Ventricular Tachycardia
Impulse is initiated from the ventricle itself
Wide QRS, Rate is 140-250If unstable DC cardiovert
If not, IV Amiodarone and/or DCCV
Consider procainamide
Nonsustained ventricular tachycardia needs no treatment
This is coarse vfib
Most common in acute MI, also drug overdose, anesthesia, hypothermia & electric shock can precipitate
Absence of ventricular complexes
Usually terminal event
Use Amiodarone if refractory to DCCV.
This is fine vfib
AsystoleNo ventricular activity seen
P wave seen occasionally, R wave absent
Classically presents as a FLAT LINE
ST elevation
Occurs in the early stagesOccurs in the leads facing the infarction
Slight ST elevation may be normal in V1 or V2
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