1. ECGs

2. ECG Interpretation
Practice!

3. What is ECG Wave-Maven?
Proficiency in electrocardiogram (ECG) interpretation is an essential skill for medical students, housestaff, and clinicians. However, medical school and postgraduate resources to develop and upgrade the necessary high level of "ECG literacy" are severely limited. Further, current textbook and classroom instructional materials do not adequately integrate ECG interpretation into specific contexts where waveform findings must be correlated with other clinical data. We have begun to address the limitations in traditional approaches to ECG pedagogy by creating the infrastructure for a unique web-based tutorial.

4. Clinical context/significance
ECG Interpretation
Observation
Conclusion
Clinical context/significance

5. Rhythm
Sinus
Not sinus
Morphology
Supravent.
Ventricular

6. WPW > LBBB > LVH > MI
Morphology Hierarchy
WPW > LBBB > LVH > MI

7. The Normal ECG

8. Sinus rhythm (P before @ QRS) Rate 50 – 100 bpm Axis +90o to –30o
The Normal ECG
Sinus rhythm (P QRS)
Rate 50 – 100 bpm
Axis +90o to –30o
Intervals: PR sec
QRS <.10 sec
QTc <.46 sec (observed QT⁄ √ (RR) interval)

9. 51 y/o male with chest pain 100% occlusion of a diagonal (also had 3 vessel disease, normal LVEF)

11. 29 y/o with chest pain Diffuse ST elevation c/w pericarditis,
29 y/o with chest pain Diffuse ST elevation c/w pericarditis, ?PR segment depression

12. 47 y/o male with chest pain Acute inferior MI – culprit vessel RCA

13. 41 y/o male with severe SOB Extensive anterior/anterolateral MI

14. 54 y/o male with exertional chest pain AMI, indeterminate age; RBBB and left axis

15. 60 y/o comatose s/p MVA Low voltage
Simple cifferential of low voltage: air, fat, fluid, no muscle

16. 60 y/o with chest pain LVH with LAD, ST-T abn, & LAE
In patient with angina and LVH, always think of aortic stenosis and hypertrophic cardiomyopathy in differential diagnosis

17. 40 y/o with chest pain & palpitations short PR/delta wave c/w preexcitation (WPW) – note pseudo-Qs inferiorly

18. 70 y/o with exertional chest pain LBBB
If need stress test in this patient, use pharmacologic stress with adenosine combined with imaging modality (sestamibi or cardiac MRI)