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BulgariaStudentSupportNetwork(BSSN)presents: ECG Interpretation DeliveredbyDrJamesMoore GraduateMedicalAdvisorLeadatBSSN Insta: @Bg.StudentSupportNetworkA FEW IMPORTANT THINGS.. We are not cardiologists! The purpose of this webinar is to learn how to follow a system when interpreting ECGs The system was created by Dale Dubin in his book “Rapid Interpretation of EKGs” 󰎲 Amazon Link 󰏅 Amazon LinkPrinciples of 01 Rate 02 Rhythm ECG 03 Axis 04 Hypertrophy 05 Infarction DetermineRate 1 RA TE | byObservation DetermineRate 1 RA TE | byObservation **Bradycardia(slowrates) ● Cycles/10secondstripX6=Rate1 RA TE | Clinical Significance Bradycardias Tachycardia Syncope Syncope palpitations chest painExample Determining 2 RHYTHM | Byscanningthetracing Sinus Rhythm: origin is the SA Node ("Sinus Node"), normal sinus rate is 60 to 100/minute. ● Rate more than 100/min. = Sinus Tachycardia ● Rate less than 60/min. = Sinus Bradycardia Determine any co-existing, independent (atrial/ventricular) rates: A Sinus Rhythm (or atrial rhythms) may coexist with an independent rhythm from an automaticity focus of a lower level. Determine rate of each. Irregular Rhythms: With Irregular Rhythms (such as Atrial Fibrillation) always note the general (average) ventricular rate (QRS's per 10-sec. strip X or take the patient's pulse. Determining 2 RHYTHM | Byscanningthetracing Identify basic rhythm... ….then scan entire tracing for pauses, premature beats, irregularity, and abnormal waves. Always: Check for: ✓ P before each QRS. ✓ QRS after each P. Check: ✓PR intervals (for AV Blocks). ✓QRS interval (for BBB). ✓ Has QRS vector shifted outside normal range? (to rule out Hemiblock).2 RHYTHM | Regularv. IrregularRhythms2 RHYTHM | Narrowv.Broad QRS2 RHYTHM | BlockstouchingonExampleExample3 AXIS | ElectricAxisminationofExample4 INF ARCTION | TWaves Inversion T wave inversion = Ischemia ● and right half are mirror images). Normally T wave islf upright when QRS is upright, and vice versa. ● Usually in the same leads that demonstrate signs of acute infarction (Q waves and ST elevation). ● Isolated (non-infarction) ischemia may also be located; note those leads where T wave inversion occurs, then identify which coronary vessel is narrowed. STSegment 4 INF ARCTION | ElevationorDepression ST(segment)elevation=(acute)Injury(alsodepression) ● Signifies an acute process, ST segment returns to baseline with time. ● ST elevation associated with significant Q waves indicates an acute (or recent) infarct. ● An ST elevation is considered significant if the vertical distance inside the ECG trace and the baseline at a point 0.04 seconds after the J-point is at least 0.1 mV (1 small square) in a limb lead or 0.2 mV (2 small squares) in a precordial lead ● Mimics- BER and pericarditis4 INF ARCTION | QWaves Qwave=Necrosis(significantQ'sonly) ● Significant Q wave is one millimeter (one small square) wide, which is .04 sec. in duration… or is a Q wave 1/3 the amplitude (or more) of the QRS complex. ● present.se leads (omit AVR) where significant Q's are ● Old infarcts: significant Q waves (like infarct damage) remain for a lifetime.4 INF ARCTION | ArteryAnatomyExampleExample Atrial 5 HYPERTROPHY | Hypertrophy RightAtrialHypertrophy large,diphasicPwavewithtallinitial component LeftAtrialHypertrophy large,diphasicPwavewithwide terminalcomponent Ventricular 5 HYPERTROPHY | Hypertrophy Right Ventricular Hypertrophy ● R wave greater than S i1 V but R wave gets progressively smaller from V1- 6 ● S wave persists in V and V 1 6 ● R.A.D. with slightly widened QRS. ● Rightward rotation in the horizontal plane. Left Ventricular Hypertrophy S wave in 1 (in mm.) + R wave in 5 (in mm.) ____________________________________ Sum in mm. Is more than 35 mm with LVH ● L.A.D. with slightly widened QRS. ● Leftward rotation in the horizontal plane.ExampleExample6 MISCELLANEOUS 350–450 ms in males and 360–460 ms in femalesQUIZ TIME!