craig ernst, mhs, pa-c. rate rhythm axis hypertrophy infarct st-t changes (injury/ischemia) ...
TRANSCRIPT
The ECGCraig Ernst, MHS, PA-C
Rate Rhythm Axis Hypertrophy Infarct ST-T Changes (injury/ischemia) Intervals
◦ PR◦ QRS◦ QT
A Systematic Approach
Quick Estimate◦“300, 150, 100, 75, 60, 50”
Alternative Methods◦6 second strip and multiply by 10
Or
◦1500/# mm between R-R
Rate
What is the rate?
What is the rate?
P before each QRS?QRS follows each P?Regular or Irregular?
Rhythm
What is the Rhythm?
What is the Rhythm?
What is the Rhythm?
Leads I and AVF◦Upright in both = normal axis◦Up in I and down in AVF = LAD◦Down in I and up in AVF = RAD◦Down in both = Extreme RAD
Axis
What is the Axis?
What is the Axis?
What is the Axis?
S in V1 + R in V5 = greater than or equal to 35 mm
R in AVL greater than 11 mm
Hypertrophy (LVH)
Q wave of greater than .04 sec (one small block)
Q wave 1/3 the amplitude or more of the QRS complex
Infarct
Old Infarct? Where?
Location of Infarct
Injury◦ST elevation
Ischemia◦ST depression or T wave inversions
Location◦Same as for MI
ST-T Changes
What is going on?
PR duration: less than 0.12 or greater than 0.20
QRS duration: greater than 0.12QT duration: greater than 0.44
◦Should not be greater than half the R-R interval
Intervals
RhythmsBlocks◦1st degree◦2nd degreeMobitz IMobitz II
◦3rd degree
Name that Block
Name that Block
Name that block
Ectopy◦PVC
◦PAC
Rhythms
Rhythms
Tachycardias◦Sinus◦MAT◦PSVT◦A-fib◦A-flutter◦VT
What is the Tachycardia?
What is the Tachycardia?
What is the Tachycardia?
What is the Tachycardia?
What is the Tachycardia?
What is the Tachycardia?
What is the Tachycardia?
What is the Tachycardia?
Potassium Calcium Drugs
◦ B-blockers◦ Calcium channel blockers◦ Digitalis
Effects of Drugs and Electrolytes
Case