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ECG diagnosis

ECG diagnosis. Aims. 10 ECG rules ECG signs of M.I. Evolution of changes in M.I. Classical Appearences. R. r. qR. qRs. Qrs. QS. Qr. Rs. rS. qs. rSr’. rSR’. QRS waveform nomenclature. aVR aVL aVF. V1 V2 V3. V4 V5 V6. I II III. The 10 rules for a normal ECG. .2. PR

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ECG diagnosis

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  1. ECG diagnosis

  2. Aims • 10 ECG rules • ECG signs of M.I. • Evolution of changes in M.I. • Classical Appearences

  3. R r qR qRs Qrs QS Qr Rs rS qs rSr’ rSR’ QRS waveform nomenclature

  4. aVR aVL aVF V1 V2 V3 V4 V5 V6 I II III The 10 rules for a normal ECG .2

  5. PR interval Rule 1 1.0 R PR interval should be 120 to 200 milliseconds or 3 to 5 little squares 0.5 T P Millivolts Q 0 S -0.5 0 200 400 600 Milliseconds

  6. R T P Q S Rule 2 1.0 The width of the QRS complex should not exceed 110 ms, less than 3 little squares 0.5 Millivolts 0 -0.5 QRS 0 200 400 600 Milliseconds

  7. aVR aVL aVF I II III Rule 3 The QRS complex should be dominantly upright in leads I and II

  8. aVR aVL aVF I II III Rule 4 QRS and T waves tend to have the same general direction in the limb leads

  9. P T S Q Rule 5 All waves are negative in lead aVR

  10. Rule 6 V6 V5 V4 V3 V2 V1 The R wave in the precordial leads must grow from V1 to at least V4

  11. aVR aVL aVF V1 V2 V3 V4 V5 V6 I II III Rule 7 The ST segment should start isoelectric except in V1 and V2 where it may be elevated

  12. aVR aVL aVF V1 V2 V3 V4 V5 V6 I II III Rule 8 The P waves should be upright in I, II, and V2 to V6

  13. aVR aVL aVF V1 V2 V3 V4 V5 V6 I II III Rule 9 There should be no Q wave or only a small q less than 0.04 seconds in width in I, II, V2 to V6

  14. aVR aVL aVF V1 V2 V3 V4 V5 V6 I II III Rule 10 The T wave must be upright in I, II, V2 to V6

  15. Characteristic changes in AMI • ST segment elevation over area of damage • ST depression in leads opposite infarction • Pathological Q waves • Reduced R waves • Inverted T waves

  16. R ST P Q ST elevation Occurs in the early stages Occurs in the leads facing the infarction Slight ST elevation may be normal in V1 or V2

  17. R ST P T Q Deep Q wave Only diagnostic change of myocardial infarction At least 0.04 seconds in duration Depth of more than 25% of ensuing R wave

  18. R ST P T Q T wave changes Late change Occurs as ST elevation is returning to normal Apparent in many leads

  19. Bundle branch block Anterior wall MI Left bundle branch block aVR aVL aVF V1 V2 V3 V4 V5 V6 aVR aVL aVF V1 V2 V3 V4 V5 V6 I II III I II III

  20. Sequence of changes in evolving AMI R R R ST ST T P P P T Q Q S Q 1 minute after onset 1 hour or so after onset A few hours after onset R ST T ST P P P T T Q Q Q A few months after AMI A day or so after onset Later changes

  21. aVR aVL aVF V1 V2 V3 V4 V5 V6 I II III Anterior infarction Anterior infarction Left coronary artery

  22. aVR aVL aVF V1 V2 V3 V4 V5 V6 I II III Inferior infarction Inferior infarction Right coronary artery

  23. aVR aVL aVF V1 V2 V3 V4 V5 V6 I II III Lateral infarction Lateral infarction Left circumflex coronary artery

  24. Location of infarct combinations I aVR V1 V4 ANT POST LATERAL ANT SEPTAL aVL II V2 V5 ANT LAT V3 V6 aVF III INFERIOR

  25. Diagnostic criteria for AMI • Q wave duration of more than 0.04 seconds • Q wave depth of more than 25% of ensuing r wave • ST elevation in leads facing infarct (or depression in opposite leads) • Deep T wave inversion overlying and adjacent to infarct • Cardiac arrhythmias

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