2. What types of pathology can we identify and study from EKGs?
Arrhythmias
Myocardial ischemia and infarction
Pericarditis
Chamber hypertrophy
Electrolyte disturbances (i.e. hyperkalemia, hypokalemia)
Drug toxicity (i.e. digoxin and drugs which prolong the QT interval)

3. Anatomy

4. ECG Electrodes

5. ECG Waveform

6. The 12 lead ECG

7. How does the heart work PR
QRS AH HV

8. AV node activated by Atrial depolarization Sends signal through His-purkinje bundle Get depolarization of SEPTUM Left and Right BUNDLES transmit signal to Left and Right VENTRICLES Net “Vector” towards the LV Should be narrow (<120msec) if bundles working properly Then have REPOLARIZATION = Twave The appearance of this electrical activity depends on which lead you are using to look at it

9. Review of waveforms

10. How to Look at an ECG Rate: Is the heart rate too fast or slow?
Rhythm: Sinus rhythm or not?
Axis: Where does the majority of electrical activity point?
P wave: How big are the atria?
PR interval: How healthy is the AV node?
QRS wave: Is there abnormal conduction or a ventricular source?
QT: Long is bad
Ischemia and hypertrophy

11. ECG Paper Can Determine Heart Rate
Rule: 300, 150, 100, 75, 60, 50 counting over for each big sqaure

12. What is the heart rate?
Answer = 75 per min

13. Rhythm :
Is there a p wave? = Sinus
Is it followed by a QRS?

14. Is the rhythm regular or irregular?

15. Reasons to have an irregular rhythm
Irregular pacemaker
Multifocal atrial rhythm
Atrial fibrillation
Atrial fib/flutter
Ectopic beats
PVC
PAC
PJC
Irregular conduction
AV node block
1st degree:
PR interval > 200 msec
2nd degree:
Type 1: Wenkebach
Type 2: dropped beat
3rd degree:
p waves marching independent to QRS

16. Examples of Rhythms Multifocal Atrial Rhythm AFIB Atrial Flutter AFIB
V TACH

17. Example of a PVC

18. Telling the Axis from the leads

19. EKG Leads The standard EKG has 12 leads: 3 Standard Limb Leads
3 Augmented Limb Leads
6 Precordial Leads
The axis of a particular lead represents the viewpoint from which it looks at the heart.

20. Standard Limb Leads

21. Standard Limb Leads

22. Augmented Limb Leads

23. All Limb Leads

24. The axis wheel

25. The QRS QRS < 120 msec QRS > 120 msec QRS > 120 msec
Rabbit ears in V1 & V2
Wide S wave in V5 & V6
R axis deviation
QRS > 120 msec
Deep slurred S wave in V1
Wide R wave in V6, I & avL
L axis deviation

26. Ishcemia vs Acute Infarct

27. Example of Ischemia

28. Examples of Infarctions

30. Review Rate: Is the heart rate too fast or slow?
Rhythm: Sinus rhythm or not?
Axis: Where does the majority of electrical activity point?
P wave: How big are the atria?
PR interval: How healthy is the AV node?
QRS wave: Is there abnormal conduction or a ventricular source?
QT: Long is bad
Ischemia and hypertrophy

32. Describe this ECG