ECG (EKG)

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ECG (EKG)

• ?? ??? ??
• ?????? ??????

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????

• http//medlib.med.utah.edu/kw/ecg/
• http//www.ecglibrary.com/
• http//www.rnceus.com/course_frame.asp?exam_id16
  directoryekg

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Normal EKG
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ECG ??????
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ECG??????

• ????, ????
• ???????, ???????????.
• ????, ??????.

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• QRS complex
• ???????????

• RR interval ????

• ST-T wave ??????

P wave ???????????

• QT interval
• ????????????

• PR interval
• ????????????????????

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??????

• P wave ???????????
• QRS complex ???????????
• ST-T wave ??????
• U wave ??????? (afterdepolarization)
• PR interval ????????????????????.
• QRS duration???????????.
• QT interval ????????????.
• RR interval ????.
• PP interval????.

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Normal Sinus Rhythm

• ??? P wave ???? QRS
• P waves normal for the subject.
• P ??????? 60-100 ?, ??? lt10.
• ?? lt60 bradycardia
• ?? gt100 tachycardia
• ?? gt10 sinus arrhythmia.

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Normal QRS axis

• ??? 30 ? 90

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Left axis deviation
Normal axis
Right axis deviation
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-30
0
30
60
90
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Frontal Leads
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• RAE
• normal finding in children and tall thin adults
• right ventricular hypertrophy
• chronic lung disease even without pulmonary
  hypertension
• anterolateral myocardial infarction
• left posterior hemiblock
• pulmonary embolus
• Wolff-Parkinson-White syndrome - left sided
  accessory pathway
• atrial septal defect
• ventricular septal defect

• LAE
• left anterior hemiblock
• Q waves of inferior myocardial infarction
• artificial cardiac pacing
• emphysema
• hyperkalaemia
• Wolff-Parkinson-White syndrome - right sided
  accessory pathway
• tricuspid atresia
• ostium primum ASD
• injection of contrast into left coronary artery

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??? P waves

• ? lt 2.5 mm (???) in lead II
• ? lt 0.11 seconds (???) in lead II
• Abnormal P
• RAE
• LAE
• APCs
• Hyperkalemia

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?????
?????
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???PR interval

• 0.12-0.20 s (?????).

• ??
• WPW.
• LGL.
• HoCM.
• Muscular distrophies Duchenne.

• ??
• ??AV block.
• Trifascicular block.

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WPW syndrome
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??????? (????????)
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????

1.   Sino-Atrial Exit Block
2.  Atrio-Ventricular (AV) Block  1st Degree AV
   Block  Type I (Wenckebach) 2nd Degree AV Block
    Type II (Mobitz) 2nd Degree AV Block
    Complete (3rd Degree) AV Block  AV Dissociation
   
3. Intraventricular Blocks  Right Bundle Branch
   Block  Left Bundle Branch Block  Left Anterior
   Fascicular Block  Left Posterior Fascicular
   Block  Bifascicular Blocks  Nonspecific
   Intraventricular Block  Wolff-Parkinson-White
   Preexcitation

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???QRS complex

• lt 0.12 s (???)
• ???QRS??
• RBBB
• LBBB
• ???rhythm (? VT) (????????????????????????, ???).
• ????.
• ??????? (RVH, LVH) ???? 0.10-0.12 s.

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????????
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RBBB
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LBBB
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???QT interval

• QT modifying factors
• ?????, QT interval ???.
• QT is longer in leads V2 and v3
• ?????, ??QTc (Bazetts ??)
• QTc QT/(sqrt RR Interval)
• QTc is normally lt0.44

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QT interval ???

• QT ??
• Familial long QT Syndrome
• Congestive Heart Failure
• Myocardial Infarction
• Hypocalcemia
• Hypomagnesemia
• Type I Antiarrhythmic drugs
• Rheumatic Fever
• Myocarditis
• Congenital Heart Disease

• QT ??
• Digoxin (Digitalis)
• Hypercalcemia
• Hyperkalemia
• Phenothiazines

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Hereditary

• Romano Ward Syndrome
• ??????,????.
• ????.
• QT ??.
• ??????VT, ?????? Torsade de Pointes.
• Jervill, Lange Nielson Syndrome
• ????, ????.

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Drug induced

• Cisapride (Prepulside or Prisic)

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1. Supraventricular arrhythmias
Premature atrial complexesPremature junctional
complexesAtrial fibrillationAtrial
flutterEctopic atrial tachycardia and
rythmMultifocal atrial tachycardiaParoxysmal
supraventricular tachycardiaJunctional rhythms
and tachycardias 2. Ventricular arrhythmias
Premature ventricular complexes
(PVCs)Aberrancy vs. ventricular
ectopyVentricular tachycardiaDifferential
diagnosis of wide QRS tachycardiasAccelerated
ventricular rhythmsIdioventricular
rhythmVentricular parasystole
????
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???ST segment

• ???, ?????????.

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• ST elevation myocardial infarction (??, ?????)
• ST depression myocardial ischemia (??, ????????.

myocardial ischaemia digoxin effect ventricular
hypertrophy acute posterior MI pulmonary
embolus LBBB
acute MI (e.g. anterior, inferior) LBBB Acute
pericarditis
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T wave tall T waves

• Hyperkalaemia
• Hyperacute myocardial infarction
• Left bundle branch block (LBBB)

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T waves small, flattened or inverted

• Ischemia
• age, race
• hyperventilation, anxiety, drinking iced water
• LVH
• drugs (e.g. digoxin)
• pericarditis, PE,
• intraventricular conduction delay (e.g. RBBB)
• electrolyte disturbance

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??????????
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Acute inferoposterior MI (note tall R waves
V1-3, marked ST depression V1-3, ST elevation in
II, III, aVF)
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Old inferoposterior MI (note tall R in V1-3,
upright T waves and inferior Q waves)
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Normal EKG

• http//www.ecglibrary.com/norm.html

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A man with liver cirrhosis EKG finding?
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THANK YOU VERY MUCH!