2. Right Bundle Branch Block

3. Right Bundle Branch Block

5. Left Bundle Branch Block

6. Left Bundle Branch Block

7. QRS Widening

8. RBBB

9. IVCD Lead 1 looks like LBBB, Lead V1 looks like RBBB

10. LBBB

11. Systematic Approach

12. Axis
Really -30 to -90 is Pathological. 0 to -30 is normal

13. 2 Lead and Quadrant Approach to Axis Determination

14. 2 Lead and Quadrant Approach to Axis Determination

15. Axis ?

16. Axis

17. Axis ?

18. Axis

19. Axis ?

20. Axis

21. Axis ?

22. Axis

23. Left Axis Deviation (LAD)

28. Systematic Approach

29. Atrial Enlargement

32. LVH

34. Left Ventricular Hypertrophy (LVH)

35. Strain / Strain Equivalent

37. Right Ventricular Hypertrophy

38. Systematic Approach

46. But, 50% of acute MIs and past MIs show normal ECGs  ECG not 100% predictive

47. Summary Reviewed basic principles of electrocardiography.
Described a systematic approach to ECG interpretation.
Reviewed common ECG abnormalities and discussed their significance.
We will now describe and interpret practice tracings.

48. Rate: 80
Rhythm: Sinus
Intervals: QRS normal, PR interval: 0.2, QT interval: prolonged
Axis: No-man’s land, up-right quadrant  indeterminant

49. Rate: 60-75bpm
Rhythm: Sinus
Intervals: QRS normal, QTI <1/2 S-S’, PRI normal
Axis: Pathological left deviation (<-30 degrees)
Find infarct:
Q: II, aVF, V2-V4 R: S:
ST: V2-V4 elevated
 Prior inferior MI b/c deep QS changes
Poor R wave progression