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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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E c g to continue

ECG to continue….

Interval changes assessment

Interval changes assessment

Pr pq interval

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

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

type A type B

Reentry tachyarrythmias

Reentry tachyarrythmias

Reentry in Wolff-Parkinson-White’s Syndrome


Ectopic atrial extrasystole



Short PR

Av block

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

AV block of 2-nd degree

Wenkebach’s periods

(Mobitz II)

Av block of 3 rd degree

AV block of 3-rd degree

Other causes of interval changes

Short PR interval

preexcitation sy,

sympathetic act.,


AV nodal rhythms from the beginning of it

Long PRinterval

AV block1-stdegree

parasympathetic act.,



medicaments(e.g. beta blockers)

Short QT intervalDigitalis,


(hyperK – tallpointing T wave)

Long QT

hypertension, after MI


(hypoK– U wave),

Congenital (risk of sudden death)

Other causes of interval changes

Qrs left ventricular overload

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


Qrs right ventricular overload

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

QRS - right BBB

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


  • QRS > 0,11 s

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

  • Repolarization changes

Qrs left bbb

QRS – left BBB

  • Causes: IHD, hypertension,


    valvular disease,


  • QRS >0,11s (with complete block)

  • Discordant T! and discordant dinivelization of ST

Qrs q wave myocardial infarction

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

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

Combination of BBB and MI

Qrs serious embolism fibrosis hydropericardium

QRS – serious embolism, fibrosis, hydropericardium

Beware some changes are result of lead displacement

Beware – some changes are result of lead displacement

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