ECG Refresher Session by V8OKI3ub


									               Gaby Plimmer
Cardiology Nurse Practitioner
  Imperial College NHS Trust
           St Mary’s Hospital
   Each small square is 0.04
    secs (300 large squares
    in a minute)
   PR interval - 0.12 - 0.2
    secs (3-5 small squares)
   QRS complex- < 0.12
    secs (< 3 small squares)
   ST segment = isoelectric
   T wave = usually positive,
    except AVR (possibly
 Is  there any electrical activity?
 Is the QRS rhythm regular or irregular?
 What is the ventricular (QRS) rate?
 Is the QRS complex width normal or
 If the QRS width is prolonged, why?
 Is atrial activity present?
 How is atrial activity related to
  ventricular activity?
•   ST segment elevation represents
    myocardial tissue injury and occurs in
    the leads overlying the area of infarction

•   Accompanied by reciprocal ST

•   Chest pain and new left bundle branch
    block = acute MI
 V1-V4     – Anterior
 I,    AVL, V5-V6 – Lateral
 V1-V3     – Antero-septal
 II,   III, AVF – Inferior
Q wave is at least 1 small square wide (0.04
Q wave is greater than 25% in depth
 compared to the height of the R wave in the
 same complex
 Asa Q wave forms the height of the R wave
 Pathological Q waves occur in a territory,
 not in an isolated lead, eg II, III, AVF.
 Is aVR Negative
 Are there any signs of ST elevation, ST
  depression or T wave inversion
 If ST elevation is present is there any
  reciprocal ST depression
 Are there any pathological Q waves
 Are there any tall R waves or deep S
  waves, meeting criteria for LVH
Any questions?

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