ECG Basics

Liberties with LIFL

CCU ECGs

From the inter webs... a classic

~80 bpm (78 bpm)

-p upright I, II, inverted aVR

p before QRS with normal PR interval (0.12-0.2s)

From the inter webs... a classic : SINUS RHYTHM

HR:

300/RR interval
300, 150, 100, 75, 60, 50 ...
#R waves * 6

~80 bpm

-p upright I, II, inverted aVR

p before QRS with normal PR interval (0.12-0.2s)

From the inter webs... a classic : SINUS RHYTHM

~80 bpm

-p upright I, II, inverted aVR

p before QRS with normal PR interval (0.12-0.2s)

Axis normal

From the inter webs... a classic : SINUS RHYTHM

From the inter webs... a classic

Sinus tachycardia

HR 150 bpm

p seen within the preceding t waves

64M presenting with heart failure

Sinus tachycardia HR ~100

P prior to QRS, PR interval normal

Biphasic p in II with V1 = and - deflection biatrial enlargement

Sinus tachycardia HR ~100

P prior to QRS, PR interval normal

Biphasic p in II with V1 = and - deflection biatrial enlargement

Syncope

Cardiac Syncope on ECG

Bradyarrhytmia/ Heart Block-
- AV block
- Sick sinus syndrome
- Pause (conversion)
Tachyarrhytmias
- SVTs
- VT
- VF
- Drugs --> Arrythmia
Ischemia
Pacemaker dysfunction

Cardiac Syncope on ECG

Bradyarrhytmia/ Heart Block-
- AV block
- Sick sinus syndrome
- Pause (conversion)
Tachyarrhytmias
- SVTs
- VT
- VF
- Drugs --> Arrythmia
Ischemia
Pacemaker dysfunction

LOOK FOR ECG ABNORMALITIES

Diurnal sinus bradycardia
Diurnal sinus pauses >3 seconds
Bifascicular block
QRS >120 ms
Mobitz II or 3rd ' AV block
Pre-excitation
QT abnormalities (long or short)
Early repolerization
Q-waves

65 year old lady with syncope from Tillsonburg

HR 54 (atrial rate ~96)

Mobitz II: AV association with dropped beats

Wide escape (LBB)

65 year old lady with syncope from Tillsonburg

HR 54 (atrial rate ~96)

Mobitz II: AV association with dropped beats

Wide escape (LBB)

65 year old lady with syncope from Tillsonburg

HR 54 (atrial rate ~96)

Mobitz II: AV association with dropped beats

Wide escape (LBB)

QRS >120 ms

V1: Dominant S

Broad R (I, aVL, V5-6)

No Q: I, V5-6

Prolonged R peak > 60 ms (V5-6)

65 year old lady with syncope from Tillsonburg

HR 54 (atrial rate ~96)

Mobitz II: AV association with dropped beats

Wide escape (LBB)

From the online world... 82F with syncope

HR 54

Atrial Fibrillation with heart block

Wide escape (ventricular)

From the online world... 82F with syncope

HR 54

Atrial Fibrillation with heart block *REGULAR QRS*

Wide escape (ventricular)

From the online world... 82F with syncope

HR 54

Atrial Fibrillation with heart block *REGULAR QRS*

Wide escape (ventricular)

78 year old man with syncope in Tillsonburg with a 6 second pause

Sinus HR 78

Incomplete RBB

No evidence of heart block or pause

78 year old man with syncope in Tillsonburg

Sinus HR 78

Incomplete RBB = some features of RBB ... here not wide (<120ms)

No evidence of heart block or pause

78 year old man with syncope in Tillsonburg

RSR' V1-3

Wide, slur S: 1, aVL, V5-V6

Typical RBB