EKG

05/14/2011

EKG

EKG

EKG

Preload

EKG

z
z
z
z
z
z(action potential )
EKG

EKG

12

EKG

++
++++++++

++++++++
++

++++++++++

++++++++++

EKG
8

EKG

(SA Node)

:SA Node (AV Node)

P
P
(QRS)
Bundle of His
Bundle branches(L & R)
Purkinje fibers
EKG

ECG Components
P:,
, III &V1,
II, AVR
QRS:
RV1
V5
T:

10

ECG Components

(Interval):
(segment):

PR Interval:
ST segment:
QT interval:
EKG

11

EKG

12

Einthoven
+=
:
:LA
:RA
:LL

:II, III, AVF

:I, AVL

Einthoven

EKG

13

QRS

QRS
QRS 0+90

EKG

15

25 mm
: 1 mm : 0.04 sec
: 5 mm : 0.2 sec (300/)

ECG 1 mV

EKG
17

EKG
14

P
P

150-750
P
aVF

EKG

16

V1
V2
V3V2V4
V4
V5V4V6
V6V4

EKG

18

Lead I

12 Leads
3D

:aVRaVLaVF
: V1~V6
V1& V2
V3& V4
V5&V6
V1 V2V3 V4
I, AVL, V5,V6
II, III, AVF

EKG

19

Lead II

EKG

EKG

20

Lead III

zP
zT

P
Q0.03
T

21

aVR

EKG

22

aVL

EKG

T
QRS
EKG

23

24

V1

aVF

EKG

Q
25

V2

EKG

26

V3

EKG

Q
S

EKG

27

V4

P
S

V5

Q R
T

EKG

28

EKG
29

30

V6

QRS
QRS P

P QRS
)
Ex : + ()
Sinus Tachycardia

EKG
31

EKG
32

(RVH)

Problematic ECG

100o
R/SV11V61

QRS

: LVHRVHRAELAE
: RBBBLBBB
(CAD) : AMI
(arrhythmia) : VPCAPCAfAF

V1&V2
V5&V6

EKG

33

EKG

34

(LVH)

QRS

ST-T

AVLR13mm
AVFR 21mm
IR 14mm
IRIIIS 25mm

S-T
QRS-T

EKG

35

V1&V2 S
V5+V6 RV1+V235 mm
V5 R26mmV6 R18mm
V6 RV5 R
EKG

36

ECG aVF
P
P

SV1SV2 + RV5RV6 35 mm
V1V2 V5 V6 25 mm

ST-T

EKG

(RAE)

37

(LAE)

EKG
38

V1 P
P

P
RAE
LAE

V1 P
RAE
LAE

EKG

V1

39

Conduction Block

EKG

EKG

40

Conduction Block
Sinus node block
AV Block:
Bundle branch block: RBBB&LBBB

41

EKG

42

1o AV Block

AV Block

AV Node & His Bundle

PR interval 0.2
PQRS

1o AV Block
2o AV Block
Wenckebach block(Morbitzs Type I)
Morbitas Type II

3o AV Block

EKG

43

2o AV Block-Wencebach
AV node
34AV node
PR intervalPQRS

EKG

Frank G. Yanowitz,45M.D
, copyright 1997

2o AV Block Mobitz Type II

EKG

2o AV Block Mobitz Type II

P: QRS2:13:2
34AV node
PR interval
PQRS

EKG

http://www.ncbi.nlm.nih.gov/bookshelf/br.fcgi?book=cardio&part=A548

46

3o AV Block

PR intervalQRS

pacemaker

EKG

44

47

http://library.med.utah.edu/kw/ecg/mml/ecg_third_av1.html

EKG

48

Bundle branch block

RBBB

(RBBB)

check QRS 0.12 sec

V1-V2R
, V5 & V6 S

QRS

(LBBB)

EKG
49

EKG

LBBB

LBBB

QRS 0.12 sec

V1 - V3 QRS
I,V5,V6 QRS

EKG

50

aVLV5V6
Q

51

www.unm.edu~lkravitz/MEDIA2/RBBB.jpg

EKG

52

www.unm.edu/~lkravitz/MEDIA2/RBBB.jpg

T
S-T
Q

Myocardial Infarction

www.frca.co.uk/.../ECG/ECGresource44.jpg
EKG

53

EKG

AMIEKG

54

Non-Q MI

Q Wave & AMI

Q

Q0.04QRSR1/3

EKG

T ST

55

EKG

56

Inferior MI

AMI Location

II, III & AVF Q

Infero-lateral : II, III, aVF, V5, V6
Infero-posterior I: inferior & posterior

AMI
LAD & LCX
LAD
LCX
P
Posterior
Anterior
Inferior
Lateral wall
EKG

57

Lateral wall MI

58

Anterior MI

LCX
I, AVL, V5 & V6 ST segment
II, III, AVF Q

EKG

EKG

(LAD)

V1-V6 I & AVL

RCOPD

59

EKG

60

Posterior MI

Angina

V1STR
V1V2 STT

ST
T
S+T

EKG

61

Normal Sinus Rhythm

EKG

62

Abnormal Sinus Rhythm

Sinus tachycardia100
Sinus bradycardia60
Sinus arrhythmia

P
P QRS
P-R 0.12 sec ~ 0.2 sec
60- 100 /

P-R
R-R

Sinus block
P
ECG
P-P
P-QRS

Sinus arrest
P-QRS

EKG
63

EKG
64

Risky Arrhythmia

Arrhythmia
: His Debs
Hypoxia
Ischemia
Sympathetic stimulation
Drugs
Electrolyte disturbance
Bradycardia
Strech

EKG

Tachy & Brady

Regularly irregular
Irregularly irregular

Complete AV Block
2nd degree AV Block Type II
AF/RVR or SVR(60100)
Af/RVR or SVR (60100)
VPC

Atrial
Junctional
Ventricular

65

EKG

66

Atrial rhythm

Deadly Arrhythmia

Normal QRS
QRSP
PQRS
(PAC)
Atrial Flutter
(Atrial fibrillation, Af)
W-P-W syndrome
Wondering atrial pacemaker (WAP)

Ventricular tachycardia
Ventricular flutter
Ventricular fibrilization

EKG

67

(PAC)

69

(AF)

EKG

EKG

70

Atrial Fibrillation

250~350 /
II, III
2:1AV block
block

www.medvarsity.com/.../Atrial%20Flutter.gif

68

(PAC)

PAC

EKG

EKG

350 ~ 600 /
P QRS

R-R interval
Irregularly irregular
RR rate 60slow
ventricular response (SVR)
RR rate 100rapid
ventricular response (RVR)
71

EKG

72

Af v.s. NSR

Af v.s. AF

NSR

EKG

73

EKG

74

www.nature.com/.../n6868/images/415219a-f1.2.jpg

Wondering atrial pacemaker

(WAP)

Junctional Rhythm

100-200/
(p)

EKG

75

Junctional Rhythm

P
QRSQRS

PQRSPR
0.12
QRSRR40
60
HR:60100
HR100
EKG

76

Preexcitation

Wolff-Parkinson-White syndrome(W-P-W)
Lown-Ganong-Levine syndrome(L-G-L)

EKG

77

EKG

78

W-P-W Syndrome

W-P-W EKG

Wolff-Parkinson-White Syndrome
Type A: Delta
Type B : Delta
AVKent bundle
AV node
PSVTAf
EKG
PR interval0.12
QRSDelta

EKG

79

L-G-L Syndrome

EKG

80

Multifocal atrial tachycardia (MAT)

James fiber
delta
QRS
PR interval0.12

P
PPPRRR interval
COPDCAD

PQRS

http://odlarmed.com/?cat=23&paged=8
EKG

81

EKG

82

Paroxysmal atrial tachycardia (PAT)

(PVC)

100-200/
&

W-P-P syndrome

PVC: NSR=1:1 Bigeminy; 1:2Trigeminy

P QRS

EKG

83

EKG

84

Types of PVC

EKG

Types of PVC

85

Malignancy PVCs

EKG

PVC

87

EKG

88

PVC

P-R

EKG

86

PVC
PVC
PVC
PVCTR on TVT
AMIPVC

http://library.med.utah.edu/kw/ecg/mml/ecg_ront.html

EKG

PVC A-V
P

89

EKG

90

Torsades de Pointes

Ectopic Rhythms

VT200-250/
QTU
QRS
QT>500msec

EKG

reentry
Atrial premature beats
Junctional premature beats
P
QRS
PQRS

91

Supraventricular tachycardia
(SVT)
Treatment

EKG

92

Paroxysmal Supraventricular
Tachycardia (PSVT)
150-250/
AV junction

Vagal manoeuvres

Valsalva manoeuvre
Carotid sinus massage
Drugs

Adenosine
Verapamil
EKG

93

SVT v.s. PSVT

EKG

94

Carotid Massage
PSVT
SA nodeAV
node

10-15

EKG

EKG

95

EKG

96

Ventricular Tachycardia (VT)

VT v.s.PSVT

PVC
PQRSQRS
(0.12)
150-250/
PR

VT

EKG

97

PSVT

QRS

QRS

QRS

EKG

98

http://www.ncbi.nlm.nih.gov/bookshelf/br.fcgi?book=cardio&part=A548&rendertype=figure&id=A620

Ventricular Fibrillation (VF)

VT
PQRSQRS(0.12
)300-600/
PR

EKG

99

Pacemaker Rhythm

Hyperkalemia
AMIT
T
PR intervalP
QRST

EKG

Pacemaker Rhythm

PQRSSpike

EKG

101

EKG

102

:,
,aortic stenosis).
,

(aortic insufficiency)
(mitral insufficiency) .

,QRS;
,.

EKG

P
0.12 (3
2.5mm25

103

EKG

104

P90
P IIIAVF
(II,III,AVF)P2.5mm

EKG

105

EKG

106

+90+180
V1RS;V6 SR; Lead I QRS
V1.V2;V5.V6

EKG

V1&V2S35mm; V5&V6R26mm

107

EKG

108

Break Time
Lets move on to the
next topic
EKG

109