EKG Analysis: Difference between revisions

Latest revision as of 04:32, 19 August 2009

Calibration

paper speed is normally 25mm/second
- therefore each 1mm box in the x axis = 0.04sec
a 1mV test pulse is normally over 10 mm
- therefore each 1mm box in the y axis = 0.1 mV

Rhythm

P wave upright in I, II, AVF
PR interval > 0.12
P wave for every QRS

Rate

300,150,100,75, 60, 50 rule
If rythm is not normal count the number of QRS complexes in 25 big boxes (5 seconds) and multiply by 12
tachycardia >100bpm
bradycardia <60bpm

Axis

QRS upright in I and aVF
If not upright in aVF look @ II
- If upright then axis is normal
- If not then there is left axis deviation

Intervals

PR 0.12-0.20 (3-5 squares)
QRS < 0.10 (2.5 square)
QT <0.44 (11 squares)

Atrial enlargement

Right atrium - lead II - p wave wave's initial component is enlarged, taller 2.5mm
Left atrium - Lead V1 - p wave downward deflection of terminal component

Ventricular hypertrophy

Right ventrical - tall R waves in V1 and V2, deep S in V6
Left ventrical - tall R wave in V6, deep S in V1, plus one of
- R in V5/6 > 26mm
- S in V1 or 2 + R in V5 or V6 > 35 mm
- R+S in any chest lead > 45mm

- R in aVL > 11mm
- R in I > 15mm

Bundle Branch Blocks

note: normally depolarization of the ventricular septum is stimulated by a branch of the left bundle

incomplete block: QRS 0.10-0.12 (2.5-3 squares) complete block: QRS > 0.12 (3)

RBBB

R' in V1
S in V6

LBBB

absent normal R in V1 and Q in V6 (initial depolarization directed to LV)
terminal R' in V6 and downward deflection in V1

LAFB

Q wave in I, aVL
initial R wave in II, III, aVF

LPFB

Q in II, III, aVF
initial R wave in I, aVL

Q waves

may be normal in V6 and aVL
pathologic > 0.04, depth >25% QRS height

Inferior: II, III, aVF RCA Anteroseptal: V1-V2 LAD Anteroapical: V3-V4 LAD (distal) Aterolateral: V5-V6, I, aVL CFx Posterior: V1-V2 (tall R, no Q) RCA

MI

ST elevation - returns to baseline in days
T wave inversion - weeks to months
Q wave - persists
if ST remains elevated - fibrotic scar (ventricular anurysm) developed

Pericarditis

diffuse ST elevation
PR depression

Hyperkalemia

tall "peaked" T waves
flat p
wide QRS

Hypokalemia

U wave
ST depression
flat T

Hypercalcemia

decreased QT interval

Hypocalcemia

increased QT interval

Other OSCE modules

@@ Line 1: / Line 1: @@
-Rhythm
+==Calibration==
+*paper speed is normally 25mm/second
+**therefore each 1mm box in the x axis = 0.04sec
+*a 1mV test pulse is normally over 10 mm
+**therefore each 1mm box in the y axis = 0.1 mV
+{{ntnes}}
+==Rhythm==
 *P wave upright in I, II, AVF
 *PR interval > 0.12
+*P wave for every QRS
-Rate
+==Rate==
-*300,150,100,75, 60, 50
+*300,150,100,75, 60, 50 rule
+*If rythm is not normal count the number of QRS complexes in 25 big boxes (5 seconds) and multiply by 12
+*tachycardia >100bpm
+*bradycardia <60bpm
-Axis
+==Axis==
 *QRS upright in I and aVF
 *If not upright in aVF look @ II
@@ Line 12: / Line 22: @@
 **If not then there is left axis deviation
-Intervals
+==Intervals==
 *PR 0.12-0.20 (3-5 squares)
 *QRS < 0.10 (2.5 square)
 *QT <0.44 (11 squares)
-Atrial enlargement
+==Atrial enlargement==
 *Right atrium - lead II - p wave wave's initial component is enlarged, taller 2.5mm
 *Left atrium - Lead V1 - p wave downward deflection of terminal component
-Ventricular hypertrophy
+==Ventricular hypertrophy==
 *Right ventrical - tall R waves in V1 and V2, deep S in V6
 *Left ventrical - tall R wave in V6, deep S in V1, plus one of
-**R in V5 or V6 > 35 mm
+**R in V5/6 > 26mm
+**S in V1 or 2 + R in V5 or V6 > 35 mm
+**R+S in any chest lead > 45mm
 **R in aVL > 11mm
 **R in I > 15mm
-[[Category:Osce]]
+==Bundle Branch Blocks==
+note: normally depolarization of the ventricular septum is stimulated by a branch of the left bundle
+incomplete block: QRS 0.10-0.12 (2.5-3 squares)
+complete block: QRS > 0.12 (3)
+===RBBB===
+*R' in V1
+*S in V6
+===LBBB===
+*absent normal R in V1 and Q in V6 (initial depolarization directed to LV)
+*terminal R' in V6 and downward deflection in V1
+===LAFB===
+*Q wave in I, aVL
+*initial R wave in II, III, aVF
+===LPFB===
+*Q in II, III, aVF
+*initial R wave in I, aVL
+==Q waves==
+*may be normal in V6 and aVL
+*pathologic > 0.04, depth >25% QRS height
+Inferior:  II, III, aVF    RCA
+Anteroseptal: V1-V2   LAD
+Anteroapical:  V3-V4   LAD (distal)
+Aterolateral:  V5-V6, I, aVL   CFx
+Posterior:  V1-V2 (tall R, no Q)  RCA
+==MI==
+*ST elevation - returns to baseline in days
+*T wave inversion - weeks to months
+*Q wave - persists
+*if ST remains elevated - fibrotic scar (ventricular anurysm) developed
+==Pericarditis==
+*diffuse ST elevation
+*PR depression
+==Hyperkalemia==
+*tall "peaked" T waves
+*flat p
+*wide QRS
+==Hypokalemia==
+*U wave
+*ST depression
+*flat T
+==Hypercalcemia==
+*decreased QT interval
+==Hypocalcemia==
+*increased QT interval
+==Other OSCE modules==
+{{OSCE2}}
+[[Category:OSCE]]
+[[Category: Clinical Skills]]

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