MAKING ECG’S EASY EVALUATING THE ECG Dr Nick Robinson 01206 504320 nickrobinson129@gmail.com

Don’t PANIC BASICS RELAX MAJOR POINTS ONLY PATTERN RECOGNITION

You will be able to: Perform ECG correctly Describe ECG Understand main features Identify basic normal ECG Distinguish between ECG arrhythmia and artefact

LATERAL LATERAL

INFERIOR INFERIOR INFERIOR

RIGHT SIDE

Antero-Septal ANT & RV Lateral ANT & RV Lateral Antero-Septal MAKING ECGS EASY - CDOCKX Antero-Septal ANT & RV Lateral ANT & RV Lateral Antero-Septal

RELATIONSHIP MAKING ECGS EASY - CDOCKX Lets look at how the conduction system related to what we record on the ECG. P wave: the sequential activation (depolarization) of the right and left atria QRS complex: right and left ventricular depolarization (normally the ventricles are activated simultaneously) ST-T wave ventricular repolarization U wave: origin for this wave is not clear - but probably represents "afterdepolarizations" in the ventricles   PR interval: time interval from onset of atrial depolarization (P wave) to onset of ventricular depolarization (QRS complex) QRS duration: duration of ventricular muscle depolarization QT interval: duration of ventricular depolarization and repolarization RR interval: duration of ventricular cardiac cycle (an indicator of ventricular rate) PP interval: duration of atrial cycle (an indicator of atrial rate)

INFORMATION ON THE 12-LEAD ECG

WHAT YOU NEED TO LOOK FOR Are the limb leads set up correctly? Are the chest leads set up correctly? Is the ECG free of artifact.

IS the ECG SET UP CORRECTLY? LIMB LEADS AVR – always negative Lead I – always positive CHEST LEADS R wave progression Small to Tall

MAKING ECGS EASY - CDOCKX Is this ECG hooked up correctly for the limb leads? Is it for the chest leads?

OTHER PROBLEMS WITH THE ECG Artifact Electrical interference Muscle tremor Wandering baseline

FIND THE ARTEFACT

MUSCLE TREMOR

ELECTRICAL INTERFERANCE

BASIC OBSERVATIONS Heart Rate Rhythm: regular? sinus? Intervals: PR, QRS ST segment

BOX METHOD MAKING ECGS EASY - CDOCKX Look at the number of large boxes before two R waves and then using this method find the HR . I just remember that 2 ½ large boxes or less is critical value for tachycardia 7 or more large boxes is critical for bradycardia

MAKING ECGS EASY - CDOCKX Look at the rhythm strip is it regular or irregular. How many large boxes are between two R waves = 5 = 60bpm

ECTOPIC BEATS

40 y/o with chest pain & palpitations short PR/delta wave (WPW)

Atrial Flutter Saw tooth baseline Atrial rate 300 bpm

Rhythm Sinus Not sinus Morphology Supraventricular Ventricular

The Normal ECG

Sinus rhythm (P before QRS) The Normal ECG Sinus rhythm (P before QRS) Rate 50 – 100 bpm Axis +90o to –30o Intervals: PR .12-.20 sec QRS <.12 sec

SUMMARY Correct electrode placement ? Regular ? Sinus/ ’p’ wave Rate Recognize basic values

Dr Nick Robinson 07973 437009