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 -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 *RVH -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-ISCHEMIC CAUSES *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