Page 5 of 7: Library: Learn ecg bed side easy way

tanmay_mehta · Credits: 17043 My Scrapbook My Reading List 3 Books

The Q wave is the first downward stroke of the QRS complex, and it is never preceded by anything in the complex. In the QRS complex, if there is any positive wave - even a tiny spike - before the downward wave, the downward wave is an S wave (and the upward wave preceding it is an R wave).

tanmay_mehta · Credits: 17043 My Scrapbook My Reading List 3 Books

If there are Q waves in lead I and lead AVL, there is a lateral infarction.

One might abbreviate Lateral Infarction as L.I. Just remember AVL for "Lateral" and "I" for Infarction (after all, Roman Numeral "I" for lead I is just a capital "i"). It's an easy way to recall the leads that demonstrate lateral infarction.

tanmay_mehta · Credits: 17043 My Scrapbook My Reading List 3 Books

Q waves in chest leads V1, V2, V3, or V4 signify an anterior infarction.

The chest leads are mainly placed anteriorly on the chest, so this is a good way to remember the leads for anterior infarction.

Statistically, anterior infarctions are very deadly, but fortunately, immediate treatment with intravenous thrombolytic medications or angioplasty with stenting has improved the survival rate substantially.

tanmay_mehta · Credits: 17043 My Scrapbook My Reading List 3 Books

A lateral infarction is caused by an occlusion of the Circumflex branch of the Left Coronary Artery. An anterior infarction is due to an occlusion of the Anterior Descending branch of the Left Coronary Artery.

Inferior ("diaphragmatic") infarctions are caused by an occluded
terminal branch of either the Right or the Coronary Artery.

So the diagnosis of inferior infarction does not necessarily identify
the artery branch that is occluded, unless you have a previous
coronary angiogram (an x-ray highlighting the coronary arteries)

tanmay_mehta · Credits: 17043 My Scrapbook My Reading List 3 Books

Left or Right Coronary "dominance" denotes which coronary artery is the major source of blood supply to the base of the left ventricle. Right Coronary dominance is by far most common in humans.

tanmay_mehta · Credits: 17043 My Scrapbook My Reading List 3 Books

A Premature Atrial Beat (PAB) originates suddenly in an irritable (see previous page) atrial automaticity focus, and it produces an abnormal P' wave earlier than expected. On EKG, a P' is atrial depolarization by a focus.

On EKG a PAB records as a P'. The P' may be difficult to detect when it's hiding on the peak of a T wave; the giveaway is a too-tall T wave - taller than the other T waves in the same lead.

tanmay_mehta · Credits: 17043 My Scrapbook My Reading List 3 Books

exercise testing

Exercise testing should not be done if the risk of testing exceeds the expected benefit, especially if testing can be deferred until after the patient's condition has stabilized or improved. All patients should give informed consent.

Absolute Contraindications

(1) A recent significant change in the resting electrocardiogram suggesting infarction or other acute cardiac event.

(2) Recent complicated myocardial infarction (unless the patient is stable and pain-free).

(3) Unstable angina.

(4) Uncontrolled ventricular arrhythmia.

(5) Uncontrolled atrial arrhythmia that compromises cardiac function.

(6) Third degree atrioventricular heart block without pacemaker.

(7) Acute congestive heart failure.

(8) Severe aortic valve stenosis.

(9) Suspected or known dissecting aneurysm.

(10) Active or suspected myocarditis or pericarditis.

(11) Thrombophlebitis or intracardiac thrombi.

(12) Recent systemic or pulmonary embolus.

(13) Acute infections.

(14) Significant emotional distress and/or psychosis.

Relative Contraindications

(1) Resting diastolic blood pressure > 115 mm Hg or resting systolic blood pressure > 200 mm Hg.

(2) Moderate valvular heart disease.

(3) Known electrolyte abnormalities (hypokalemia, hypomagnesemia).

(4) Fixed-rate pacemaker (now rarely used).

(5) Frequent or complex ventricular ectopy.

(6) Ventricular aneurysm.

(7) Uncontrolled metabolic disease (such as diabetes, thyrotoxicosis, or myxedema).

(8) Chronic infectious disease (such as infectious mononucleosis, viral hepatitis, or AIDS).

(9) Neuromuscular, musculoskeletal or rheumatoid disorders that are exacerbated by exercise.

(10) Advanced or complicated pregnancy.

vicky_mbbs · Credits: 172 My Scrapbook

work systematically through the ECG:
'The rate is...' To work out the rate take 300 and divide by the distance between two QRS complexes. Normal is 60 - 100 beats per minute in the average .
• 6 squares = 300/6 = 50bpm (bradycardia)
• 5 squares = 300/5 = 60bpm
• 4 squares = 300/4 = 75bpm
• 3 squares = 300/3 = 100bpm
• 2 squares = 300/2 = 150bpm (tachycardia)
'The rhythm is...' Is the rhythm regular? This can be worked out by marking the QRS distances on a piece of paper and shifting it along to see if the pattern always fits. If it is irregular, is it irregularly irregular? If there are P waves before each QRS and it is regular, the rhythm is 'sinus'.
The axis of the heart is the average direction of impulse flow. To assess this, look at leads I, II and III. For axis, look at the overall deflection of the QRS. Is it up (positive) or down (negative)? The normal axis of the heart is from +90° to -30°, measured from 3 o'clock as 0°.
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easiest way to think of this is as vectors. In the normal ECG all three leads are positive.

If lead I is negative, there is right axis deviation

If leads II and III are negative, there is left axis deviation
The P wave should be normal in shape and size (<2.5mm tall). It reflects the atrial depolarization. Abnormalities reflect changes in the atria and valves.
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QRS should be less than 3 small squares wide. Wider complexes imply abnormal depolarization. Very tall R waves can reflect left ventricular hypertrophy.
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'The T wave is...' Normal is <10mm tall. Abnormal T waves can be peaked or inverted.
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U waves are rarely seen in normal people or hypokalaemia
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Torsades de Pointes is a rapid ventricular rhythm caused by low potassium, medications (those that block potassium channels), or congenital abnormalities (e.g., Long QT Syndrome) that lengthen the QT interval. The rate is a variable 250 to 350 per minute, in brief episodes.
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legolassildarin · Credits: 2408 My Scrapbook My Reading List 19 Books

u guys have written a completed ecg textbook here
need not waste time reading the books.....
all what u have told is gonna suffice
FANTABULOS work
ciao

drshoaibsmc · Credits: 3066 My Scrapbook

these text will be more than useful for me who always dreaded ecg

thanks to all

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