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E C G to continue…. Interval changes assessment. PR (PQ) interval. Normally .12 s - .20 s (that is 3 – 5 mm of horizontal distance) Shorter (e.g.) in preexcitation syndromes Longer (e.g.) in AV block of first degree Dependent of the frequency For 60 beats / s is around 0.45 s.

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ECG to continue….


Interval changes assessment


PR (PQ) interval

  • Normally .12 s - .20 s

  • (that is 3 – 5 mm of horizontal distance)

  • Shorter (e.g.) in preexcitation syndromes

  • Longer (e.g.) in AV block of first degree

  • Dependent of the frequency

  • For 60 beats / s is around 0.45 s

QT interval


Preexcitation syndromes

Accessory signal pathway

Orientation of QRS complex vector depends on the direction of propagation of the signal

Sy Wolff-Parkinson-White

has “delta” wave

Sy Lown-Ganong-Levin (without “delta” wave)

Risk of supraventricular paroxysmal tachycardia


type A type B


Reentry tachyarrythmias

Reentry in Wolff-Parkinson-White’s Syndrome

Accessorypathway

Ectopic atrial extrasystole

tachycardia

wave

Short PR


AV block

1-st degree: Long PR inteval

2-nd degree

type one

type two

3-rd degree: No connection between atria and ventriculi


AV block of 2-nd degree

Wenkebach’s periods

(Mobitz II)


AV block of 3-rd degree


Short PR interval

preexcitation sy,

sympathetic act.,

hypoK,

AV nodal rhythms from the beginning of it

Long PRinterval

AV block1-stdegree

parasympathetic act.,

hyperK,

IHD,

medicaments(e.g. beta blockers)

Short QT intervalDigitalis,

hyperCa

(hyperK – tallpointing T wave)

Long QT

hypertension, after MI

hypoCa,

(hypoK– U wave),

Congenital (risk of sudden death)

Other causes of interval changes


Sokolow’s index: R in (V5 or V6) + S inV1

> 35mm

Attention young slim individuals (heart as a voltage source is closer to the chest leads – bigger voltage on the leads without hypertrophy)

QRS – left ventricular overload

Left heart hypertrophy

physiological


QRS – right ventricular overload

Vertical electrical axis (> 100°)

in V1: R >= 7mm or qR (volume overload)

in avR: r > 4 mm

in V6: R smaller/equal S(volume overload)

Physiological Pressure overload Physiological Volume overload


QRS - right BBB

  • Causes: Dilatation and/or overload of right heart, MI,

    sometimes“physiological”

  • QRS > 0,11 s

  • If complete, then R’(r’) wave is bigger then R(r ) in V1

  • Repolarization changes


QRS – left BBB

  • Causes: IHD, hypertension,

    cardiomyopathy,

    valvular disease,

    unknown

  • QRS >0,11s (with complete block)

  • Discordant T! and discordant dinivelization of ST


QRS – Q wave myocardial infarction

  • In the Q-wave MI, there is necrosis throughout the cardiac wall, while in the non-Q wave, necrosis affects the endocardial zone only.

  • Pathological Q-wave

    Appears in the first 0,04 s of QRS

    Appears in the leads where there should be no Q or overlays the normal R (r) (e.g. in V1 to V5) – absence of the R-wave

    Deeper then 2mm (6mm in III)

    Q > 0,25 R for I, II, avL, (avF)

    Q > 0,15 R forV1 to V6


QRS – Q wave MI

  • There is no Q-wave in the beginning, but so-called “Pardee’s”wave (elevation of ST+ negative T)

  • We imagine the (left) heart as pyramid to describe the MI location.

  • Anterior

  • Septal (right)

  • Lateral (left)

  • Inferior (down side at the apex)and it’s posterior extension (close to the base of the pyramid)


Combination of BBB and MI


QRS – serious embolism, fibrosis, hydropericardium


Beware – some changes are result of lead displacement


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