Back to Medical School ECG interpretation

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Back to Medical SchoolECG interpretation made
easy !

• Dr Rob Sapsford
• The Yorkshire Heart Centre
• Leeds General Infirmary

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ECGs have become more convenient
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LA
LV
RA
RV
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Lead error
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Lead error
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Normal ECG
4 large squares
300/large squares rate
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Machine reported as old inferior infarct

• Pathological Q-wave
• gt25 r wave
• gt1 small square across
• Clinical context

Be wary of overly sensitive ECG machine computer
reports
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Incomplete RBBB
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RBBB
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LBBB
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1.
QT interval Normal up to 12 small squares
(dependent rate) (0.450s)
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QT Interval Calculation
QT Interval QT / R-R interval
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Case studies
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LVH (several criteria) simple rule Limb lead (I
/ AVL) 12 mmHg gt Chest leads (V1 S V5/6 R) gt
35 mmHG
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Atrial fibrillation fast ventricular response
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Sinus tachycardia
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SOB 60 yr old woman
Left Bundle Branch Block
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(No Transcript)
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Intermittent palpitations at rest
Ventricular ectopy
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1st degree AV block (heart block)
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2nd degree AV block (Mobitz type II) 21 AV block
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Exercise intolerant 73 yr old man
3rd degree AV block (complete heart block)
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Atrial flutter with 21 block
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AF and complete heart block
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(No Transcript)
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78 year old woman chest pain yesterday
acute coronary syndrome- widespread ischaemia
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Chest pain - acute
Anterior septal acute coronary syndrome
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Sharp chest pain worse lying flat
Pericarditis
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Acute inferior ST elevation MI
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Palpitations
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Broad complex tachycardia
RVOT VT
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Summary

• Review of ECG interpretation
• Rate, Rhythm, (Axis)
• P wave, QRS and relationship
• Common pitfalls
• Can be difficult
• The computer is overly sensitive, but can be
  helpful
• Someone to discuss with is reassuring