EKG Analysis: Difference between revisions
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Calibration | ==Calibration== | ||
*paper speed is normally 25mm/second | *paper speed is normally 25mm/second | ||
**therefore each 1mm box in the x axis = 0.04sec | **therefore each 1mm box in the x axis = 0.04sec | ||
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**therefore each 1mm box in the y axis = 0.1V | **therefore each 1mm box in the y axis = 0.1V | ||
Rhythm | ==Rhythm== | ||
*P wave upright in I, II, AVF | *P wave upright in I, II, AVF | ||
*PR interval > 0.12 | *PR interval > 0.12 | ||
*P wave for every QRS | *P wave for every QRS | ||
Rate | =Rate== | ||
*300,150,100,75, 60, 50 rule | *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 | *If rythm is not normal count the number of QRS complexes in 25 big boxes (5 seconds) and multiply by 12 | ||
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*bradycardia <60bpm | *bradycardia <60bpm | ||
Axis | ==Axis== | ||
*QRS upright in I and aVF | *QRS upright in I and aVF | ||
*If not upright in aVF look @ II | *If not upright in aVF look @ II | ||
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**If not then there is left axis deviation | **If not then there is left axis deviation | ||
Intervals | ==Intervals== | ||
*PR 0.12-0.20 (3-5 squares) | *PR 0.12-0.20 (3-5 squares) | ||
*QRS < 0.10 (2.5 square) | *QRS < 0.10 (2.5 square) | ||
*QT <0.44 (11 squares) | *QT <0.44 (11 squares) | ||
Atrial enlargement | ==Atrial enlargement== | ||
*Right atrium - lead II - p wave wave's initial component is enlarged, taller 2.5mm | *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 | *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 | *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 | *Left ventrical - tall R wave in V6, deep S in V1, plus one of | ||
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**R in I > 15mm | **R in I > 15mm | ||
Bundle Branch Blocks | ==Bundle Branch Blocks== | ||
note: normally depolarization of the ventricular septum is stimulated by a branch of the left bundle | note: normally depolarization of the ventricular septum is stimulated by a branch of the left bundle | ||
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complete block: QRS > 0.12 (3) | complete block: QRS > 0.12 (3) | ||
RBBB | ===RBBB=== | ||
*R' in V1 | *R' in V1 | ||
*S in V6 | *S in V6 | ||
LBBB | ===LBBB=== | ||
*absent normal R in V1 and Q in V6 (initial depolarization directed to LV) | *absent normal R in V1 and Q in V6 (initial depolarization directed to LV) | ||
*terminal R' in V6 and downward deflection in V1 | *terminal R' in V6 and downward deflection in V1 | ||
LAFB | ===LAFB=== | ||
*Q wave in I, aVL | *Q wave in I, aVL | ||
*initial R wave in II, III, aVF | *initial R wave in II, III, aVF | ||
LPFB | ===LPFB=== | ||
*Q in II, III, aVF | *Q in II, III, aVF | ||
*initial R wave in I, aVL | *initial R wave in I, aVL | ||
Q waves | ==Q waves== | ||
*may be normal in V6 and aVL | *may be normal in V6 and aVL | ||
*pathologic > 0.04, depth >25% QRS height | *pathologic > 0.04, depth >25% QRS height | ||
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MI | ==MI== | ||
*ST elevation - returns to baseline in days | *ST elevation - returns to baseline in days | ||
*T wave inversion - weeks to months | *T wave inversion - weeks to months | ||
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*if ST remains elevated - fibrotic scar (ventricular anurysm) developed | *if ST remains elevated - fibrotic scar (ventricular anurysm) developed | ||
Pericarditis | ==Pericarditis== | ||
*diffuse ST elevation | *diffuse ST elevation | ||
*PR depression | *PR depression | ||
Hyperkalemia | ==Hyperkalemia== | ||
*tall "peaked" T waves | *tall "peaked" T waves | ||
*flat p | *flat p | ||
*wide QRS | *wide QRS | ||
Hypokalemia | ==Hypokalemia== | ||
*U wave | *U wave | ||
*ST depression | *ST depression | ||
*flat T | *flat T | ||
Hypercalcemia | ==Hypercalcemia== | ||
*decreased QT interval | *decreased QT interval | ||
Hypocalcemia | ==Hypocalcemia== | ||
*increased QT interval | *increased QT interval | ||
==Other OSCE modules== | ==Other OSCE modules== | ||
{{OSCE2}} | {{OSCE2}} | ||
[[Category:OSCE]] | [[Category:OSCE]] | ||
[[Category:Medicine]] | [[Category:Medicine]] | ||
Revision as of 00:56, 18 May 2007
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 = 0.1V
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
Acute Confusion - Acute Coronary Syndrome Orders - Anemia - Arterial Blood Gasses - Asthma - Blood Pressure - Chest pain - Chest XRay - CHF - Coma - COPD - Cranial Nerves - Diabetic History - Diabetic Foot - Dysphagia - EKGs - Gallbladder and Liver - Liver Disease - Gait and Balance - Headache - Hematemesis - Hypertension - Jugular Venous Pulses - Knee Exam - Lymph Nodes - Community Acquired Pneumonia - Parkinson Disease - Peripheral Arterial Insufficiency - Pneumonia Examination - Precordial Exam - STD's - Spleen - Swollen Leg Exam - Thyroid Exam - Upper vs Lower Motor Neuron Lesions - Urinary Incontinence