1. ECG
ABC in
SAAD A. SHETA
MBChB, MA, MD
Assoc. Prof.
MDS Department
KSU

2. How To Read ECG
Rate?
QRS Duration?
Stability?

3. Anatomy of Heart and ECG signal
Normal ECG signal
Conducting System of Heart

4. Measurements Small square = 0.04 sec.
Large square = 5 small square = 0.2 sec.
One second = 5 large square
One minute = 300 large square

5. 3, 3, 3 and 5 Remember This P duration = 3 small sqs = 0.12 sec.
P height = 3 small sqs = 0.12 sec.
QRS duration = 3 small sq = 0.12 sec.
P-R interval = 5 small sqs = 0.2 sec.

6. SAN:
AVN :
Bundle Branch:
Three Levels:

7. Rate: RATE may be: Normal 60 -100 Bradycardia < 60
If regular : Divide 300/ number of large squares between 2 Rs = HR
If irregular: Count number of complexes in 6 sec. and multiply by 10
RATE may be:
Normal
Bradycardia < 60
Tachycardia > 100
P = Sinus
No P = Non sinus

8. QRS Duration:
Slim lady
Obese lady

9. Stability: * Stable patient: think of drug therapy
* Unstable patient: think of electric therapy

10. Supraventricular Rhythm
Rate > 100.
QRS: Narrow.
Stable or unstable
Rate < 60.
QRS: Narrow.
Stable or unstable
Sinus bradycardia
1st degree HB
2nd degree HB
Complete HB
Sinus tachycardia
Atrial flutter
Atrial fibrillations
PAT, PNT

11. Supraventricular Rhythm: Tachycardia
Sinus Tachycardia

12. Supraventricular Rhythm: Tachycardia
Atrial Flutter

13. Supraventricular Rhythm: Tachycardia
Atrial Fibrillations

14. Supraventricular Rhythm: Tachycardia
Paroxysmal SVT

15. Supraventricular Rhythm: Bradycardia
Normal Sinus Rhythm
Sinus Bradycardia

16. Supraventricular Rhythm: Bradycardia
1st Degree HB

17. Supraventricular Rhythm: Bradycardia
2nd Degree HB: Mobitz 1 Wenckebach.
Progressive lengthening of the P-R interval with intermittent dropped beat

18. Supraventricular Rhythm: Bradycardia
2nd Degree HB: Mobitz 2
Sudden drop of QRS without prior P-R changes

19. Supraventricular Rhythm: Bradycardia
3rd Degree HB

20. Idioventricular Rhythm.

21. Accelerated Idioventricular Rhythm.

22. Ventricular Rhythm

23. Ventricular Rhythm

24. Ventricular Rhythm
Pacer Rhythm

25. Treatment Supraventricular Rhythm: Stable = Drugs = Alii A denosine
L anoxine
I soptin
I nderal
Unstable = Electric
DC with 25 joules, +++

26. Treatment Ventricular Rhythm: Stable = Drugs = AlP A miodarone.
L idocaine.
P rocainamide.
Unstable = Electric
DC with 200 joules, 300, 3600.

27. Myocardial Ischemia
Due to lack of adequate blood flow to the myocardium
Ischemia is reversible.
Changes in ECG:
T wave peaking
Symmetric T wave inversion
ST segment elevation

28. Different ECG Signals Normal Signal ST segment elevated signal
ECG with T wave inversion
ECG Signal with peak T waves

29. THANK YOU