EASY ECG GUIDE V se STEP 2: CHECKIN DETAILS: ST SEGMENT normal ST * isoelectric or slight concave upwards, from end of S to start of T * J point Is junction between QRS & ST ST elevation *> 1mm in limb leads after) or > 2mm in chest leads after J * STEMI, pericarditis, LVH, LBBB, with reciprocal depression if Mi ST depression *> 1mm in limb leads after | or > 2mm in chest leads after) * ischemia, posterior Mi, RVH, RBBB, with reciprocal elevation if Ml J wave (Obsorn wave) * sve deflection at | point sn | * hypothermia, hypercalcemia, hk A\ CNS insults (injury & hemorrhage) |—— |* normal T wave * eve deflection after QRS * height <5 mm in limb leads *helght<15mminchestleads |— * upright in all leads except aVR & V1 * tall and wide * early STM! before elevation flat T wave * flattened T wave * Ischemia & hypokalemiaEASY ECG GUIDE VI STEP 3: CHECK IN DETAILS ; U WAVE normal U wave * follows T in the same direction * seen in young athletes and when HR < 65 bpm best in V1 * height Inversiy with HR, <2 mm or < 25 %o of T wave large U wave * height > 2mm or > 25 % of T © bradycardia, hypokalemia, hypocalcemia and hypothermia inverted U wave * inverted post upright T * indicates CAD or HTN normal QT interval * from start of 0 to end of T, best seen in leads II, ¥5 and V6 * length 9-12 mm, inversly with HR long QT interval * length > 12 mm * congenital, antiarrhythmics, hypokalemia, hypocalcemia & ischemia short QT interval * length <9 mm * congenital, digitalis & hypercalcemia * changes of no cadiac origin, best seen In lead Il * artificial pacing, lead problems, patient movement* start in SA node, best seen in lead Il * normal symmetrical P + narrow ORS sinus tachycardia sinus bradycardia }- sinus oT | arrhythmia fee * start in AV node, best seen in lead Il * no or inverted P before or atter narrow QRS tachycardia Med dd tl nd od * start in atrial myocardium, best seen in lead Il * no or weird P + narrow QRS atrial fibrillation ele atrial ee a * start in ventricular myocardium, best seen in lead il || *no Ps wide ORS ventricular A hn) \ tachycardia N Vi v WW AA, NAA A AA \ y ventricular ie PAA fibrillation Mecdical Education Cards J Se ‘ =EASY ECG GUIDE VIII | SS CARDIAC ISCHEMIA AND INFARCTION * $7 elevation (f STEMI or depression If NSTEMI or ischemia * look for changes in two sucesesive beads in the same wall * look for reciprocal changes to confirm MI QUICK GUIDE FOR COMMON STEMI TYPES anterior STEMI * ST elevation in leads V1-V6 * reciprocal depression in leads Il, 1) & aVF * obstruction of left anterior descending artery (LAD) anteroseptal STEMI * ST elevation in leads V1-V4 * reciprocal depression in leads Il, 1 & aVF * obstruction of septal branches of LAD anterolateral STEMI * ST elevation in leads |, aVL & V4-V6 * reciprocal depression in Jeads Il, IN & aVF * obstruction of proximal LAD or LAD « left circumflex lateral STEMI © ST elevation in leads |, aVL, V5 & V6 * reciprocal depression in leads Il, IN & aVF * obstruction of Ist diagonal branch of LAD « obtuse marginal branch of left circumflex high lateral STEM! * ST elevation in leads 1 & aVb * reciprocal depression in leads Il, Ill & aVF * obstruction of Ist diagonal branch of LAD inferior STEMI * ST elevation In leads I, 1B aVE * reciprocal depression in leads | & aVL * obstruction of right coronary artery posterior STEMI * tall R (mirrored pathological Q) plus ST depression in Vi-V4 (mirrored ST elevation) * confirmed in 15 leads ECG (posterior leads V7-V9) * obstruction of posterior descending artery S , PMecdical Education Cards fi ee,EASY ECG GUIDE! P wave atrial depolarization PRinterval time before ventricular depolarization ‘Q wave septal depolarization ORS complex ventricular depolarization SYsegment time before ventricular repolarization T wave ventricular repolarization UO wave repolarization of Purkinji fibres QT interval all ventricular action positive approaching electrode negative going away from electrode VL 4th intercostal right to sternum V2 4th intercostal left to sternum ‘WS between V2 and V4 ¥4 Sth intercostal at mid clavicular line V5 horizontal to V4 at anterior axillary line V6 horizontal to V4 at mid axillary line STEP 1: CHECK ESSEMTIALS speede)>caliberation=> placement STEP 2: CHECK GENERALS rhythm co} rate oe aris STEP 3; CHECM IN DETAILS P=pPR Soo SIS Te ot ; Medical Education Cords Ae =if regular 1500 / small squares in A-R interval or 300 | large squares in R-A interval if Irregular QRS in 10 large squares x 30, in 20 large squares x 15 or in 30 large squares "10 RS in Vis Lt. hand & QRS in Il is Rt. hand normal (Up + Wi Up ‘left = 1Up right IDown « I UpEASY ECG GUIDE Ill STEP 3: CHECK IN DETAILS ; P WAVE normal P wave * first -ve deflection 2.5 x 2.5 cm * monophasic In (1 & biphasic in Vi * upright in ll & inverted in aVR absent P wave ‘ * non sinus rhythm Le P pulmonale * tall peaked P wave * right atrial enlargement P mitrale * wide notched P wove * left atrial enlargement double lesion * tall and wide P wave * biatrial enlargement short PR interval < 3 mm * with normal P in preexcitation disorders as WPW (notice Delta wave) * with Inverted F in nodal rhythm long PR interval > 5 mm * fixed long in 1st degree heart block * progressive tong till QRS dropped in 2nd degree heart block type 1 ® fixed normal or long with sudden QRS drop In 2nd degree heart block type 2 variant PR interval * complete dissociation between P & ORS in 3rd degree heart blockEASY ECG GUIDE IV Se STEP 3 : CHECK IN DETAILS ; Q WAVE normal Q wave * -ve deflection before R, present in left leads V5-V6 and absent in right leads V1-V3 = width <1 mm & height <2 mm * size < 25 %o of successive R Q wave * width > 1mm & height = 2 mm * size > 25 %o of successive R * in myocardial infarction STEP 3: CHECK IM DETAILS : QRS COMPLEX normal QRS * width < 2.5 mm & helght in bellslll » 15 mm) * deep § in Vi & dominant fin V6 * supraventricular rhythms wide QRS * width > 2.5 mm * ventricular rhythms & BBB low voltage © height < 5 mm in limb leads * height < 10 mm in chest leads * damping states as COPD & effusion reversed pattern * dominant R in VLA deep S in V6 * right ventricular hypertrophy (RVH) MarroW pattern * large terminal Rin V1& W shape in V6 | | * right bundle branch block (RBBB) | ~ pattern , wy! W * large terminal $ in Vi & M shape in V6 | '