ECG reading the common and dangerous

Microsoft PowerPoint ECG Workshop Simon Simon AbouAbou JaoudJaoudéé Cardiology DepartmentCardiology Department HôtelHôtel DieuDieu ECG reading the common and dangerous ECG reading the ECG reading the.

Simon Abou Jaoudé

Review essential technical aspects of ECG recording

Content and Objectives

Distinguish between “normal” and “abnormal” ECG findings

List the criteria for heart blocks and WPW

Recognize arrhythmia type during sustained tachycardia

Identify main ECG abnormalities caused by MI and ischemia

common technical pitfalls

Lead placement

F I L T E R

O N

Paper Speed

motion

artifact

-breathing

stop breathing Auto mode

Lead Inversion

L R

Normal ECG ??

• 62 y

• 62 y

• emergency department

• chest pain

T wave polarity depends on

T wave axis

II

III

Frontal Plane

T wave is always positive in leads I and II

may be negative in lead III.

T wave is always positive in precordial

leads.

(except V1: may be negative)

• 75 y W

• elective cholecystectomy

• pre op ECG

Normal ECG ??

I

Expiration Inspiration Positional Q waves (septal Q waves) often disappears with change in heart orientation associated with deep inspiration

• 33 y M

• ER

• chest pain x 3 hours

Normal ECG ??

“Early Repolarisation Syndrome” “High take-off ST segment”

Tachycardia

Atrial Fibrillation

Tachycardia (HR > 100/min)

RegularIrregular

Atrial Fibrillation

SVT

Tachycardia (HR > 100/min)

RegularIrregular

VT

“ SVTs ” + WPW + BBB

VT

P wave ?

Identifying P wave: several approaches

- Spontaneous on surface ECG

(compare with previous tracings)

- Lewis lead (DI on chest)

Sinus Atrial Atrial Atrial

tachy tachy flutter fibrillation

sinus tachycardia

Regular narrow QRS tachycardia at 150/min Adenosine

Regular P waves at 150/min Adenosine

1/1 Atrial Tachycardia

ATP Regular P waves at 300/min

Adenosine

2003 ACC/AHA/ESC Guidelines for Management of SVA

ECG in CAD

ECG in CAD

Q wave

ST changes

T wave changes

depolarization abnormalitiesirreversible

I nfa rc t ion:

1/ elevated ST 2/ depressed ST

repolarisation abnormalitiesreversible

I njury :

1/ inverted T wave 2/ Peaked T wave

repolarisation abnormalitiesreversible

I sc he m ia :

ECG in CAD

Lateral view

Localization of ischemic changes

anterior view

V2

V3

V4 V5 V6

Heart blocks and WPW

PR > 0,2 sec

« progressive » AV block

Mobitz 1 AV block

constant PR

blocked P wave

Mobitz 2 AV block

P wave

QRS

Complete AV block

AV dissociation

sinus arrest

junctional escape rhythm

Sinus dysfunction

Wolf Parkinson White Syndrome

Zone ventriculaire préexcitée

Zone excitée normalement

Wolf Parkinson White Syndrome