Electrocardiogram Interpretation

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1Introduction

What is a 12 lead ECG?

Recording the 12 lead ECG

Chest leads (anterior/septal/lateral views of the heart)
Limb leads (inferior view of the heart)

Complexes

2Rate

3. Rhythm

  Bradyarrhythmias <60bpm  
  Sinus bradycardia  
  Atrioventricular block (heart block)  
   
  Tachyarrhythmias >100bpm  
  Atrial Sinus tachycardia
    Atrial fibrillation
    Atrial flutter
  Junctional AVNRT/AVRT
  Ventricular Ventricular tachycardia
    Ventricular fibrillation

4. Axis

 

Under development:

5.  P waves Present =Sinus rhythm
  Not present =Atrial fibrillation (mcc)
     
6.  PR interval  Normal 3-5 small squares from start of P to start of R
  Long =Heart block
  Short =Wolff-Parkinson-White
     
7.  Q >2mm =Previous full-thickness MI
     
8.  R Progression Poor progression V1-V6
    = previous ischaemia
     
9.  QRS Wide = Ventricular arrhythmia/
    Bundle branch block
    (>0.12ms/ 3 small squares)
  Narrow = Supraventricular rhythm
     
10.  ST Elevation =Acute coronary syndrome (STEMI)
  Depression =Acute coronary syndrome (possible NSTEMI)
     
11.  T Inversion =Acute coronary syndrome (possible NSTEMI)
  Saddle =Pericarditis
  Peaked =Hyperkalaemia
     

 

 

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Thinking Medicine
2007