{"id":1612,"date":"2017-07-31T12:24:06","date_gmt":"2017-07-31T12:24:06","guid":{"rendered":"http:\/\/papergp.com\/index.php\/data-interpretation\/ecg\/"},"modified":"2023-01-24T11:25:25","modified_gmt":"2023-01-24T11:25:25","slug":"ecg","status":"publish","type":"page","link":"https:\/\/papergp.com\/index.php\/data-interpretation\/cardiology\/ecg\/","title":{"rendered":"ECG"},"content":{"rendered":"<div class=\"content-box-blue\"><strong>Rate<\/strong><\/p>\n<ul>\n<li>300\/number of large squares between two complexes\n<ul>\n<li>If irregular rhythm\n<ul>\n<li>count the number of complexes on the rhythm strip (each strip is 10 seconds long) then multiply the number of complexes by 6 (giving you the average number of complexes in one minute)<\/li>\n<li>calculate ventricular and atrial rate separately<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<p><strong>Rhythm<\/strong><\/p>\n<ul>\n<li>Look for irregularly irregular rhythms<\/li>\n<\/ul>\n<p><strong>Axis<\/strong><\/p>\n<ul>\n<li>Normal axis\n<ul>\n<li>II most positive lead<\/li>\n<\/ul>\n<\/li>\n<li>Left axis deviation\n<ul>\n<li>I positive<\/li>\n<li>II negative<\/li>\n<li>III negative<\/li>\n<\/ul>\n<\/li>\n<li>Right axis deviation\n<ul>\n<li>I negative<\/li>\n<li>III positive<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<p><strong>P-waves<\/strong><\/p>\n<ul>\n<li>Are P-waves present?<\/li>\n<li>Is each P-wave followed by a QRS complex<\/li>\n<li>Check P-wave duration, shape<\/li>\n<\/ul>\n<p><strong>P-R interval<\/strong><\/p>\n<ul>\n<li>First degree heart block &#8211; fixed prolonged PR interval<\/li>\n<li>Second degree heart block\n<ul>\n<li>Mobitz type 1 &#8211; progressively prolonged PR interval followed by dropped QRS beat<\/li>\n<li>Mobitz type 2 &#8211; fixed prolonged PR interval with dropped beats e.g. 2:1, 3:1<\/li>\n<\/ul>\n<\/li>\n<li>Third degree heart block (complete heart block) &#8211; P waves and QRS are unrelated<\/li>\n<li>Wolff Parkinson White &#8211; if shortened PR interval (which is usually physiological) associated with delta wave and tachyarrhythmia<\/li>\n<\/ul>\n<p><strong>QRS complex<\/strong><\/p>\n<ul>\n<li>Duration\/width<\/li>\n<li>Narrow<\/li>\n<li>Broad &#8211; consider ventricular ectopics, bundle branch block, VT\/VF<\/li>\n<li>Tall &#8211; consider LVH<\/li>\n<\/ul>\n<p><strong>Q waves<\/strong><\/p>\n<ul>\n<li>Only of relevance if in an entire territory for evidence of previous MI<\/li>\n<\/ul>\n<p><strong>QT interval<\/strong><\/p>\n<ul>\n<li>QT interval = 9-11 small squares (0.36 &#8211; 0.44 seconds)<\/li>\n<\/ul>\n<p><strong>J point segment<\/strong><\/p>\n<ul>\n<li>The point where the S wave joins the ST segment<\/li>\n<li>Can be elevated in young patients (i.e. high take off \/ benign early repolarisation) &#8211; typically young patients, in multiple ECG territories<\/li>\n<\/ul>\n<p><strong>ST segment<\/strong><\/p>\n<ul>\n<li>Significant elevation\n<ul>\n<li>&gt;1 small square in two or more limb leads<\/li>\n<li>&gt;2 small squares in two or more chest leads<\/li>\n<\/ul>\n<\/li>\n<li>Significant depression\n<ul>\n<li>&gt; half small square in two or more contiguous leads<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<p><strong>T waves<\/strong><\/p>\n<ul>\n<li>Tall &#8211; hyperkalaemia, hyperacute STEMI\n<ul>\n<li>&gt; 5 small squares in the limb leads\n<ul>\n<li>and<\/li>\n<\/ul>\n<\/li>\n<li>&gt; 10 small squares in the chest laeds<\/li>\n<\/ul>\n<\/li>\n<li>Inverted\n<ul>\n<li>Physiological\n<ul>\n<li>lead III and V1<\/li>\n<\/ul>\n<\/li>\n<li>Pathology &#8211; ischaemia, bundle branch block, PE, LVH, hypertrophic cardiomyopathy, general illness\n<ul>\n<li>Other leads &#8211; comment on the distribution<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/li>\n<li>Biphasic or flattened &#8211; ischaemia, hypokalaemia<\/li>\n<\/ul>\n<p><strong>U waves<\/strong><\/p>\n<ul>\n<li>&gt; half a square deflection after the T wave &#8211; best seen in V2 or V3<\/li>\n<li>Uncommon finding<\/li>\n<li>Electrolyte imbalanes, hypothermia, antiarrhythmics (digoxin, amiodarone)<\/li>\n<\/ul>\n<\/div>\n<p>&nbsp;<\/p>\n<div class=\"content-box-blue\">\n<p><strong>Notes:<\/strong><\/p>\n<ul>\n<li>Avoid using the computer generated diagnosis &#8211; simple things like AF can be missed<\/li>\n<li>One small square (1mm square) = 0.04 seconds<\/li>\n<li>Normal durations\n<ul>\n<li>P wave = 2-3 small squares (0.8 &#8211; 0.11 seconds)<\/li>\n<li>PR interval = 3-5 small squares (0.12 &#8211; 0.20 seconds)<\/li>\n<li>QRS complex = 1.5 &#8211; 2.5 small squares (0.06 &#8211; 0.11 seconds)<\/li>\n<li>QT interval = 9-11 small squares (0.36 &#8211; 0.44 seconds)<\/li>\n<\/ul>\n<\/li>\n<li>ECG territories\n<ul>\n<li>II, III, aVF &#8211; inferior<\/li>\n<li>V1, V2 &#8211; septal<\/li>\n<li>V3, V4 &#8211; anterior<\/li>\n<li>I, aVL, V5, V6, &#8211; lateral<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/div>\n<p>&nbsp;<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Rate 300\/number of large squares between two complexes If irregular rhythm count the number of complexes on the rhythm strip (each strip is 10 seconds long) then multiply the number of complexes by 6 (giving you the average number of complexes in one minute) calculate ventricular and atrial rate separately Rhythm Look for irregularly irregular &hellip; <a href=\"https:\/\/papergp.com\/index.php\/data-interpretation\/cardiology\/ecg\/\" class=\"more-link\">Continue reading <span class=\"screen-reader-text\">ECG<\/span><\/a><\/p>\n","protected":false},"author":1,"featured_media":0,"parent":1618,"menu_order":35,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-1612","page","type-page","status-publish","hentry"],"jetpack_sharing_enabled":true,"_links":{"self":[{"href":"https:\/\/papergp.com\/index.php\/wp-json\/wp\/v2\/pages\/1612","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/papergp.com\/index.php\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/papergp.com\/index.php\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/papergp.com\/index.php\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/papergp.com\/index.php\/wp-json\/wp\/v2\/comments?post=1612"}],"version-history":[{"count":3,"href":"https:\/\/papergp.com\/index.php\/wp-json\/wp\/v2\/pages\/1612\/revisions"}],"predecessor-version":[{"id":1617,"href":"https:\/\/papergp.com\/index.php\/wp-json\/wp\/v2\/pages\/1612\/revisions\/1617"}],"up":[{"embeddable":true,"href":"https:\/\/papergp.com\/index.php\/wp-json\/wp\/v2\/pages\/1618"}],"wp:attachment":[{"href":"https:\/\/papergp.com\/index.php\/wp-json\/wp\/v2\/media?parent=1612"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}