1. Back to Medical School ECG interpretation – made easy ! Dr Rob Sapsford The Yorkshire Heart Centre Leeds General Infirmary

2. ECG’s have become more convenient

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7. 7/126 LV RV LA RA

8. Lead error

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10. Lead error

11. Normal ECG 4 large squares 300/large squares = rate

12. Machine reported as “old inferior infarct” Pathological Q-wave >25% r wave >1 small square across Clinical context Be wary of overly sensitive ECG machine computer reports

13. Incomplete RBBB

14. RBBB

15. LBBB

16. 1. QT interval Normal up to 12 small squares (dependent rate) (0.450s)

17. QT Interval Calculation Tangent BaselineQTR-R interval QT Interval = QT / R-R interval

18. Case studies

19. LVH (several criteria) simple rule: Limb lead (I / AVL) – 12 mmHg > Chest leads (V1 S + V5/6 R) => 35 mmHG

20. Atrial fibrillation – fast ventricular response

21. Sinus tachycardia

22. SOB 60 yr old woman Left Bundle Branch Block

24. Intermittent palpitations at rest Ventricular ectopy

25. 1 st degree AV block (heart block)

26. 2nd degree AV block (Mobitz type II) 2:1 AV block

27. Exercise intolerant 73 yr old man 3rd degree AV block (complete heart block)

28. Atrial flutter with 2:1 block

29. AF and complete heart block

31. 78 year old woman; chest pain yesterday acute coronary syndrome- widespread ischaemia

32. 32/126 Chest pain - acute Anterior septal acute coronary syndrome

33. Sharp chest pain worse lying flat Pericarditis

34. Acute inferior ST elevation MI

35. Palpitations

36. Broad complex tachycardia RVOT VT

37. Summary Review of ECG interpretation Rate, Rhythm, (Axis) P wave, QRS and relationship Common pitfalls Can be difficult –The computer is overly sensitive, but can be helpful –Someone to discuss with is reassuring