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05/14/2011
EKG
EKG
EKG
Preload
EKG
z
z
z
z
z
z(action potential )
EKG
EKG
12
EKG
++
++++++++
++++++++
++
++++++++++
++++++++++
EKG
8
EKG
(SA Node)
ECG Components
P:,
, III &V1,
II, AVR
QRS:
RV1
V5
T:
10
ECG Components
(Interval):
(segment):
PR Interval:
ST segment:
QT interval:
EKG
11
EKG
12
Einthoven
+=
:
:LA
:RA
:LL
Einthoven
EKG
13
QRS
QRS
QRS 0+90
EKG
15
25 mm
: 1 mm : 0.04 sec
: 5 mm : 0.2 sec (300/)
ECG 1 mV
EKG
17
EKG
14
P
P
150-750
P
aVF
EKG
16
V1
V2
V3V2V4
V4
V5V4V6
V6V4
EKG
18
Lead I
12 Leads
3D
:aVRaVLaVF
: V1~V6
V1& V2
V3& V4
V5&V6
V1 V2V3 V4
I, AVL, V5,V6
II, III, AVF
EKG
19
Lead II
EKG
EKG
20
Lead III
zP
zT
P
Q0.03
T
21
aVR
EKG
22
aVL
EKG
T
QRS
EKG
23
24
V1
aVF
EKG
Q
25
V2
EKG
26
V3
EKG
Q
S
EKG
27
V4
P
S
V5
Q R
T
EKG
28
EKG
29
30
V6
QRS
QRS P
P QRS
)
Ex : + ()
Sinus Tachycardia
EKG
31
EKG
32
(RVH)
Problematic ECG
100o
R/SV11V61
QRS
: LVHRVHRAELAE
: RBBBLBBB
(CAD) : AMI
(arrhythmia) : VPCAPCAfAF
V1&V2
V5&V6
EKG
33
EKG
34
(LVH)
QRS
ST-T
AVLR13mm
AVFR 21mm
IR 14mm
IRIIIS 25mm
S-T
QRS-T
EKG
35
V1&V2 S
V5+V6 RV1+V235 mm
V5 R26mmV6 R18mm
V6 RV5 R
EKG
36
ECG aVF
P
P
SV1SV2 + RV5RV6 35 mm
V1V2 V5 V6 25 mm
ST-T
EKG
(RAE)
37
(LAE)
EKG
38
V1 P
P
P
RAE
LAE
V1 P
RAE
LAE
EKG
V1
39
Conduction Block
EKG
EKG
40
Conduction Block
Sinus node block
AV Block:
Bundle branch block: RBBB&LBBB
41
EKG
42
1o AV Block
AV Block
1o AV Block
2o AV Block
Wenckebach block(Morbitzs Type I)
Morbitas Type II
3o AV Block
EKG
43
2o AV Block-Wencebach
AV node
34AV node
PR intervalPQRS
EKG
Frank G. Yanowitz,45M.D
, copyright 1997
EKG
EKG
http://www.ncbi.nlm.nih.gov/bookshelf/br.fcgi?book=cardio&part=A548
46
3o AV Block
PR intervalQRS
pacemaker
EKG
44
47
http://library.med.utah.edu/kw/ecg/mml/ecg_third_av1.html
EKG
48
RBBB
(RBBB)
V1-V2R
, V5 & V6 S
QRS
(LBBB)
EKG
49
EKG
LBBB
LBBB
EKG
50
aVLV5V6
Q
51
www.unm.edu~lkravitz/MEDIA2/RBBB.jpg
EKG
52
www.unm.edu/~lkravitz/MEDIA2/RBBB.jpg
T
S-T
Q
Myocardial Infarction
www.frca.co.uk/.../ECG/ECGresource44.jpg
EKG
53
EKG
AMIEKG
54
Non-Q MI
Q0.04QRSR1/3
EKG
T ST
55
EKG
56
Inferior MI
AMI Location
AMI
LAD & LCX
LAD
LCX
P
Posterior
Anterior
Inferior
Lateral wall
EKG
57
Lateral wall MI
58
Anterior MI
LCX
I, AVL, V5 & V6 ST segment
II, III, AVF Q
EKG
EKG
(LAD)
59
EKG
60
Posterior MI
Angina
V1STR
V1V2 STT
ST
T
S+T
EKG
61
EKG
62
P
P QRS
P-R 0.12 sec ~ 0.2 sec
60- 100 /
P-R
R-R
Sinus block
P
ECG
P-P
P-QRS
Sinus arrest
P-QRS
EKG
63
EKG
64
Risky Arrhythmia
Arrhythmia
: His Debs
Hypoxia
Ischemia
Sympathetic stimulation
Drugs
Electrolyte disturbance
Bradycardia
Strech
EKG
Regularly irregular
Irregularly irregular
Complete AV Block
2nd degree AV Block Type II
AF/RVR or SVR(60100)
Af/RVR or SVR (60100)
VPC
Atrial
Junctional
Ventricular
65
EKG
66
Atrial rhythm
Deadly Arrhythmia
Normal QRS
QRSP
PQRS
(PAC)
Atrial Flutter
(Atrial fibrillation, Af)
W-P-W syndrome
Wondering atrial pacemaker (WAP)
Ventricular tachycardia
Ventricular flutter
Ventricular fibrilization
EKG
67
(PAC)
69
(AF)
EKG
EKG
70
Atrial Fibrillation
250~350 /
II, III
2:1AV block
block
www.medvarsity.com/.../Atrial%20Flutter.gif
68
(PAC)
PAC
EKG
EKG
350 ~ 600 /
P QRS
R-R interval
Irregularly irregular
RR rate 60slow
ventricular response (SVR)
RR rate 100rapid
ventricular response (RVR)
71
EKG
72
Af v.s. NSR
Af v.s. AF
NSR
EKG
73
EKG
74
www.nature.com/.../n6868/images/415219a-f1.2.jpg
Junctional Rhythm
100-200/
(p)
EKG
75
Junctional Rhythm
P
QRSQRS
PQRSPR
0.12
QRSRR40
60
HR:60100
HR100
EKG
76
Preexcitation
Wolff-Parkinson-White syndrome(W-P-W)
Lown-Ganong-Levine syndrome(L-G-L)
EKG
77
EKG
78
W-P-W Syndrome
W-P-W EKG
Wolff-Parkinson-White Syndrome
Type A: Delta
Type B : Delta
AVKent bundle
AV node
PSVTAf
EKG
PR interval0.12
QRSDelta
EKG
79
L-G-L Syndrome
EKG
80
James fiber
delta
QRS
PR interval0.12
P
PPPRRR interval
COPDCAD
PQRS
http://odlarmed.com/?cat=23&paged=8
EKG
81
EKG
82
(PVC)
100-200/
&
W-P-P syndrome
EKG
83
EKG
84
Types of PVC
EKG
Types of PVC
85
Malignancy PVCs
EKG
PVC
87
EKG
88
PVC
P-R
EKG
86
PVC
PVC
PVC
PVCTR on TVT
AMIPVC
http://library.med.utah.edu/kw/ecg/mml/ecg_ront.html
EKG
PVC A-V
P
89
EKG
90
Torsades de Pointes
Ectopic Rhythms
VT200-250/
QTU
QRS
QT>500msec
EKG
reentry
Atrial premature beats
Junctional premature beats
P
QRS
PQRS
91
Supraventricular tachycardia
(SVT)
Treatment
EKG
92
Paroxysmal Supraventricular
Tachycardia (PSVT)
150-250/
AV junction
Vagal manoeuvres
Valsalva manoeuvre
Carotid sinus massage
Drugs
Adenosine
Verapamil
EKG
93
EKG
94
Carotid Massage
PSVT
SA nodeAV
node
10-15
EKG
EKG
95
EKG
96
VT v.s.PSVT
PVC
PQRSQRS
(0.12)
150-250/
PR
VT
EKG
97
PSVT
QRS
QRS
QRS
EKG
98
http://www.ncbi.nlm.nih.gov/bookshelf/br.fcgi?book=cardio&part=A548&rendertype=figure&id=A620
EKG
99
Pacemaker Rhythm
Hyperkalemia
AMIT
T
PR intervalP
QRST
EKG
Pacemaker Rhythm
PQRSSpike
EKG
101
EKG
102
:,
,aortic stenosis).
,
(aortic insufficiency)
(mitral insufficiency) .
,QRS;
,.
EKG
P
0.12 (3
2.5mm25
103
EKG
104
P90
P IIIAVF
(II,III,AVF)P2.5mm
EKG
105
EKG
106
+90+180
V1RS;V6 SR; Lead I QRS
V1.V2;V5.V6
EKG
V1&V2S35mm; V5&V6R26mm
107
EKG
108
Break Time
Lets move on to the
next topic
EKG
109