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Attribution: Kim Eagle, M.D., 2009 License: Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution–Share.

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Presentation on theme: "Attribution: Kim Eagle, M.D., 2009 License: Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution–Share."— Presentation transcript:

1 Attribution: Kim Eagle, M.D., 2009 License: Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution–Share Alike 3.0 License: http://creativecommons.org/licenses/by-sa/3.0/ We have reviewed this material in accordance with U.S. Copyright Law and have tried to maximize your ability to use, share, and adapt it. The citation key on the following slide provides information about how you may share and adapt this material. Copyright holders of content included in this material should contact open.michigan@umich.edu with any questions, corrections, or clarification regarding the use of content. For more information about how to cite these materials visit http://open.umich.edu/education/about/terms-of-use. Any medical information in this material is intended to inform and educate and is not a tool for self-diagnosis or a replacement for medical evaluation, advice, diagnosis or treatment by a healthcare professional. Please speak to your physician if you have questions about your medical condition. Viewer discretion is advised: Some medical content is graphic and may not be suitable for all viewers.

2 Citation Key for more information see: http://open.umich.edu/wiki/CitationPolicy Use + Share + Adapt Make Your Own Assessment Creative Commons – Attribution License Creative Commons – Attribution Share Alike License Creative Commons – Attribution Noncommercial License Creative Commons – Attribution Noncommercial Share Alike License GNU – Free Documentation License Creative Commons – Zero Waiver Public Domain – Ineligible: Works that are ineligible for copyright protection in the U.S. (17 USC § 102(b)) *laws in your jurisdiction may differ Public Domain – Expired: Works that are no longer protected due to an expired copyright term. Public Domain – Government: Works that are produced by the U.S. Government. (17 USC § 105) Public Domain – Self Dedicated: Works that a copyright holder has dedicated to the public domain. Fair Use: Use of works that is determined to be Fair consistent with the U.S. Copyright Act. (17 USC § 107) *laws in your jurisdiction may differ Our determination DOES NOT mean that all uses of this 3rd-party content are Fair Uses and we DO NOT guarantee that your use of the content is Fair. To use this content you should do your own independent analysis to determine whether or not your use will be Fair. { Content the copyright holder, author, or law permits you to use, share and adapt. } { Content Open.Michigan believes can be used, shared, and adapted because it is ineligible for copyright. } { Content Open.Michigan has used under a Fair Use determination. }

3 Kim A. Eagle, M.D. University of Michigan Health System ElectrocardiogramElectrocardiogram Cardiovascular Sequence Fall 2008

4 Electrocardiogram The Normal EKG: Outline Electrical Measurement - Single Cell EKG Reference System - Technical Considerations - Sequence of Activation Interpretation - Calibration - Rhythm - Rate - Intervals - QRS Axis - P-waves - QRS - ST-T wave abnormalities

5 Electrical Measurement Single Cell Key Concepts - Resting state - polarized - Depolarization - Repolarization - Directionality

6 Lilly. Pathophysiology of Heart Disease, 4th Ed. Lippincott Williams, 2007. Page 81

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8 Lilly. Pathophysiology of Heart Disease, 4th Ed. Lippincott Williams, 2007. Page 82

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11 EKG Lead Reference System Unipolar Bipolar Chest Leads

12 Lilly. Pathophysiology of Heart Disease, 4th Ed. Lippincott Williams, 2007. Page 83

13 Lilly. Pathophysiology of Heart Disease, 4th Ed. Lippincott Williams, 2007. Page 84

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15 Lilly. Pathophysiology of Heart Disease, 4th Ed. Lippincott Williams, 2007. Page 86

16 Lilly. Pathophysiology of Heart Disease, 4th Ed. Lippincott Williams, 2007. Page 85

17 Magnitude and Direction of Electrical Activity Key Principles: –Electrical force directed at (+) pole of a lead generates upward EKG deflection –Forces directed away from (+) pole generate downward deflection –Magnitude of deflection reflects how parallel the electrical force to lead –Forces directed perpendicular to a lead generate no activity or flat line

18 Lilly. Pathophysiology of Heart Disease, 4th Ed. Lippincott Williams, 2007. Page 85

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22 Lilly. Pathophysiology of Heart Disease, 4th Ed. Lippincott Williams, 2007. Page 87

23 Sequence of Normal Cardiac Activation

24 Lilly. Pathophysiology of Heart Disease, 4th Ed. Lippincott Williams, 2007. Page 87

25 A Lilly. Pathophysiology of Heart Disease, 4th Ed. Lippincott Williams, 2007. Page 89

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27 DE Lilly. Pathophysiology of Heart Disease, 4th Ed. Lippincott Williams, 2007. Page 89 (Both Images)

28 Lilly. Pathophysiology of Heart Disease, 4th Ed. Lippincott Williams, 2007. Page 90 (Both Images)

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30 Lilly. Pathophysiology of Heart Disease, 4th Ed. Lippincott Williams, 2007. Page 90

31 EKG Interpretation: 8 Steps 1.Check voltage calibration 2.Heart rhythm 3.Heart rate 4.Intervals (PR, QRS, ST) 5.Mean QRS axis 6.Abnormalities of P-waves 7.Abnormalities of QRS (hypertrophy, bundle branch block, infarction) 8.ST and T wave abnormalities

32 Lilly. Pathophysiology of Heart Disease, 4th Ed. Lippincott Williams, 2007. Page 91

33 Heart Rhythm Sinus Rhythm Rate > 60 BPM < 100 BPM

34 Lilly. Pathophysiology of Heart Disease, 4th Ed. Lippincott Williams, 2007. Page 93

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36 Lilly. Pathophysiology of Heart Disease, 4th Ed. Lippincott Williams, 2007. Page 94

37 Electrocardiographic Intervals IntervalNormal Decreased in Increased in PR 0.12-0.20 sec Pre excitation syndrome First-degree AV block (3-5 small boxes) Junctional rhythm QRS < 0.10 sec Bundle branch blocks (< 2.5 small boxes) Ventricular ectopic beat Toxic drug effect (e.g., quinidine) Toxic drug effect (e.g., quinidine) Severe hyperkalemia Severe hyperkalemia QT Corrected Qt a < 0.44 sec Hypercalcemia Hypocalcemia Tachycardia Hypokalemia ( QU interval due Tachycardia Hypokalemia ( QU interval due to U wave) to U wave) Hypomagnesemia Hypomagnesemia Myocardial ischemia Myocardial ischemia Congenital prolongation of QT Congenital prolongation of QT Toxic drug-effect (e.g., quinidine) Toxic drug-effect (e.g., quinidine) K. Eagle

38 Lilly. Pathophysiology of Heart Disease, 4th Ed. Lippincott Williams, 2007. Page 95

39 Atrial Abnormalities Lilly. Pathophysiology of Heart Disease, 4th Ed. Lippincott Williams, 2007. Page 97

40 Ventricular Hypertrophy Lilly. Pathophysiology of Heart Disease, 4th Ed. Lippincott Williams, 2007. Page 98

41 Ventricular Hypertrophy Lilly. Pathophysiology of Heart Disease, 4th Ed. Lippincott Williams, 2007. Page 98

42 Bundle Branch Blocks RBBB Lilly. Pathophysiology of Heart Disease, 4th Ed. Lippincott Williams, 2007. Page 99

43 Bundle Branch Blocks LBBB Lilly. Pathophysiology of Heart Disease, 4th Ed. Lippincott Williams, 2007. Page 99

44 The EKG of Myocardial Infarction Concept of ST elevation vs. Non STE Localization of MI Evolution of EKG changes in MI Concept of Q waves

45 Scan page 88 LILLY (4.25 transmural) Lilly. Pathophysiology of Heart Disease, 4th Ed. Lippincott Williams, 2007. Page 106

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47 Localization of MI Lilly. Pathophysiology of Heart Disease, 4th Ed. Lippincott Williams, 2007. Page 104

48 Localization of MI Anatomic SitesEKG LeadsCoronary Anatomy InferiorII, III, AVFRCA SeptalV 1, V 2 LAD AnteriorV 3, V 4 LAD (distal) AnterolateralI, AVLLCX AnteroapicalV 5, V 6 Any of 3 K. Eagle

49 Lilly. Pathophysiology of Heart Disease, 4th Ed. Lippincott Williams, 2007. Page 105

50 Lilly. Pathophysiology of Heart Disease, 4th Ed. Lippincott Williams, 2007. Page 103

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52 Additional Source Information for more information see: http://open.umich.edu/wiki/CitationPolicy Slide 6: Lilly. Pathophysiology of Heart Disease, 4th Ed. Lippincott Williams, 2007. Page 81 Slide 7: Lilly. Pathophysiology of Heart Disease, 4th Ed. Lippincott Williams, 2007. Page 81 Slide 8: Lilly. Pathophysiology of Heart Disease, 4th Ed. Lippincott Williams, 2007. Page 82 Slide 9: Lilly. Pathophysiology of Heart Disease, 4th Ed. Lippincott Williams, 2007. Page 82 Slide 10: Lilly. Pathophysiology of Heart Disease, 4th Ed. Lippincott Williams, 2007. Page 82 Slide 12: Lilly. Pathophysiology of Heart Disease, 4th Ed. Lippincott Williams, 2007. Page 83 Slide 13: Lilly. Pathophysiology of Heart Disease, 4th Ed. Lippincott Williams, 2007. Page 84 Slide 14: Lilly. Pathophysiology of Heart Disease, 4th Ed. Lippincott Williams, 2007. Page 84 Slide 15: Lilly. Pathophysiology of Heart Disease, 4th Ed. Lippincott Williams, 2007. Page 86 Slide 16: Lilly. Pathophysiology of Heart Disease, 4th Ed. Lippincott Williams, 2007. Page 85 Slide 18: Lilly. Pathophysiology of Heart Disease, 4th Ed. Lippincott Williams, 2007. Page 85 Slide 19: Lilly. Pathophysiology of Heart Disease, 4th Ed. Lippincott Williams, 2007. Page 85 Slide 20: Lilly. Pathophysiology of Heart Disease, 4th Ed. Lippincott Williams, 2007. Page 85 Slide 21: Lilly. Pathophysiology of Heart Disease, 4th Ed. Lippincott Williams, 2007. Page 85 Slide 22: Lilly. Pathophysiology of Heart Disease, 4th Ed. Lippincott Williams, 2007. Page 87 Slide 24: Lilly. Pathophysiology of Heart Disease, 4th Ed. Lippincott Williams, 2007. Page 87 Slide 25: Lilly. Pathophysiology of Heart Disease, 4th Ed. Lippincott Williams, 2007. Page 89 Slide 26: Lilly. Pathophysiology of Heart Disease, 4th Ed. Lippincott Williams, 2007. Page 89 Slide 27: Lilly. Pathophysiology of Heart Disease, 4th Ed. Lippincott Williams, 2007. Page 89 (Both Images) Slide 28: Lilly. Pathophysiology of Heart Disease, 4th Ed. Lippincott Williams, 2007. Page 90 (Both Images) Slide 29: Lilly. Pathophysiology of Heart Disease, 4th Ed. Lippincott Williams, 2007. Page 90 (Both Images) Slide 30: Lilly. Pathophysiology of Heart Disease, 4th Ed. Lippincott Williams, 2007. Page 90 Slide 32: Lilly. Pathophysiology of Heart Disease, 4th Ed. Lippincott Williams, 2007. Page 91 Slide 34: Lilly. Pathophysiology of Heart Disease, 4th Ed. Lippincott Williams, 2007. Page 93 Slide 35: Lilly. Pathophysiology of Heart Disease, 4th Ed. Lippincott Williams, 2007. Page 93 Slide 36: Lilly. Pathophysiology of Heart Disease, 4th Ed. Lippincott Williams, 2007. Page 94 Slide 37: K. Eagle Slide 38: Lilly. Pathophysiology of Heart Disease, 4th Ed. Lippincott Williams, 2007. Page 95 Slide 39: Lilly. Pathophysiology of Heart Disease, 4th Ed. Lippincott Williams, 2007. Page 97 Slide 40: Lilly. Pathophysiology of Heart Disease, 4th Ed. Lippincott Williams, 2007. Page 98 Slide 41: Lilly. Pathophysiology of Heart Disease, 4th Ed. Lippincott Williams, 2007. Page 98 Slide 42: Lilly. Pathophysiology of Heart Disease, 4th Ed. Lippincott Williams, 2007. Page 99 Slide 43: Lilly. Pathophysiology of Heart Disease, 4th Ed. Lippincott Williams, 2007. Page 99 Slide 45: Lilly. Pathophysiology of Heart Disease, 4th Ed. Lippincott Williams, 2007. Page 106 Slide 46: Lilly. Pathophysiology of Heart Disease, 4th Ed. Lippincott Williams, 2007. Page 106 Slide 47: Lilly. Pathophysiology of Heart Disease, 4th Ed. Lippincott Williams, 2007. Page 104 Slide 48: K. Eagle

53 Slide 49: Lilly. Pathophysiology of Heart Disease, 4th Ed. Lippincott Williams, 2007. Page 105 Slide 50: Lilly. Pathophysiology of Heart Disease, 4th Ed. Lippincott Williams, 2007. Page 103 Slide 51: Lilly. Pathophysiology of Heart Disease, 4th Ed. Lippincott Williams, 2007. Page 103

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