Scribd
Upload
184 views

An Approach To Ekgs: By: Siraj Mithoowani & Richa Parashar 2012 Medical Education Interest Group

This document provides an overview of an EKG lecture series for medical students. The series aims to provide an introduction to EKG interpretation, focusing on clinically relevant material, and allows students to practice and learn from mistakes in a safe environment. The six-week course will cover topics like cardiac anatomy, the components of the EKG waveform, arrhythmias, conduction abnormalities, and ischemic changes. Recommended resources for further learning are also provided.

Uploaded by

Ali Mulla
Copyright
© Attribution Non-Commercial (BY-NC)
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PPTX, PDF, TXT or read online on Scribd
184 views

An Approach To Ekgs: By: Siraj Mithoowani & Richa Parashar 2012 Medical Education Interest Group

This document provides an overview of an EKG lecture series for medical students. The series aims to provide an introduction to EKG interpretation, focusing on clinically relevant material, and allows students to practice and learn from mistakes in a safe environment. The six-week course will cover topics like cardiac anatomy, the components of the EKG waveform, arrhythmias, conduction abnormalities, and ischemic changes. Recommended resources for further learning are also provided.

Uploaded by

Ali Mulla
Copyright
© Attribution Non-Commercial (BY-NC)
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PPTX, PDF, TXT or read online on Scribd
You are on page 1/ 34

An Approach to EKGs

By: Siraj Mithoowani & Richa Parashar 2012 Medical Education Interest Group

The EKG Lecture Series


What these lectures are:
An introduction to EKG interpretation Focused on clinically relevant material A safe forum to participate, practice and make mistakes

What these lectures arent:


A comprehensive course in electrophysiology

Schedule
Week One: Introduction, Cardiac Physiology and Electrophysiology Week Two: Approach to EKG Intepretation, Rate, Rhythm Week Three: Axis and Hypertrophy Week Three: Tachyarrhythmias Week Four: Bradyarrhythmias, Conduction Abnormalities Week Five: Ischemic Changes & Electrolyte Abnormalities Week Six: Review and Q&A

Check the medportal calendar/forums/facebook for updates!

Recommended resources
Dubins Rapid Interpretation of EKGs Lilly, EKG Chapter ECG Wave Maven (Harvard) (http://ecg.bidmc.harvard.edu) ECG Made Simple (UofT) (http://www.ecgmadesimple.com/) BMJ ABCs of EKGs (on Medportal IM Clerkship page) Our Medportal forum posts Your tutors, preceptors, residents...

Agenda
Why study EKG interpretation? What does the EKG tell you? Basic cardiac anatomy/physiology Introduction to EKGs Lead placement Physiology of the waveform (P, QRS, T)

Why study EKG interpretation?


Theyre everywhere! Relevant to all specialties
(Yes, even Psychiatry)

The earlier you learn, the earlier you start practicing in real life Look like a superstar (superclerk?) on the wards

What does the EKG tell you?


Ischemia/infarction Conduction
Heart block, bundle branch block...

Rhythm
Atrial fibrillation, ventricular tachycardia...

Anatomy
Left ventricular hypertrophy...

Electrolytes
Hyperkalemia, hypocalcemia...

Remember, the EKG is a non-invasive diagnostic test that can be performed in minutes

Anatomy and blood flow


SVC/IVC
Right Atrium Right Ventricle Pulmonary Artery LUNGS Pulmonary Vein Left Atrium Left Ventricle

Aorta
Illustration: NIAAA/Chung, M.K., and Rich, M.W. Introduction to the cardiovascular system. Alcohol Health and Research World 14(4):269276, 1990.

The cardiac cycle

Illustration: Guyton's: Textbook of Medical Physiology, 10th Edition. 2000. Chapter 9 . Page 99.

Blood Supply

The conduction system


SA node (60 100 bpm) AV node (40 60 bpm) Bundle of His Left Bundle Branch (2) and Right Bundle Branch Purkinje Fibers Myocardial cells (20 40 bpm) (endocardium outwards)

Illustration: University of the West of England, Bristol. http://hsc.uwe.ac.uk/rcp/cs-heart-inside.aspx

Ye olde action potential

Illustration: Wikipedia (Cardiac action potential). http://en.wikipedia.org/wiki/Cardiac_action_potential.

At last... the EKG

EKG: University of Nebraska, Department of Internal Medicine. http://www.unmc.edu/intmed/geriatrics/ekgs.htm.

EKG paper

Amplitude: Time:

1 small box = 1 mm = 0.1 mV 1 small box = 40 ms = 0.04 seconds 1 large box = 200 ms = 0.2 seconds Length of EKG paper = 10 seconds

Illustration: Wikipedia (ECG). http://upload.wikimedia.org/wikipedia/commons/9/96/ECG_Paper_v2.svg.

EKG Leads
Electrodes placed on the skin that pick up the current View the heart from different directions Current towards the electrodes, or repolarization going away = positive deflection on the EKG Current going away the electrodes = negative deflection

Lead Axes
12 leads in a standard EKG Imagine the body sectioned two ways:
Frontal represents the zones of the limb leads Transverse represents the zones of the precordial leads

Limb leads: I, II, II, avR, avL, avF Precordial leads: V1 to V6

Precordial leads: V1 to V6

Limb leads: I, II, II, avR, avL, avF

Inferior: II, III, AVF

Anterior: V1, V2, V3, V4


Lateral: I, AVL, V5, V6

The Typical Wave Form

P wave
Represents atrial depolarization
Starting at the sinus node

The first and second halves represent right and left atrial depolarization respectively Atrial repolarization is usually buried in the QRS complex
<0.12 seconds (3 small squares)

P-R Interval
From the beginning of the P wave to the first deflection after Represents conduction through the AV node (delay) and the His-Purkinje system. Anatomically, this delay allows for ___ ?
Normal length: 0.12 to 0.20 s (3 to 5 small squares)

QRS Complex
Represents ventricular depolarization
Septal depolarization from left to right Ventricular depolarization (dominated by the left ventricle) Endo- to epicardium

Q waves: marker for infarcts Width of the QRS complex


Normal width: </= 0.12 s (3 small boxes)

QRS Complex

ST Segment
Represents the isoelectric period between depolarization and repolarization Elevation/depression can be a marker for ischemia

T wave
Represents ventricular repolarization Normally upright (inverted in avR and III)

QT Interval
Represents the whole of ventricular depolarization and repolarization Long QT predisposes patient to lethal arrhythmias Changes with heart rate QTc

U wave
??? May represent repolarization of the HisPurkinje system Present in hypokalemia Can be confused for T waves

TP segment
BASELINE

Putting it all togetherwhew!

Next week
Begin reading EKGs! Rate, rhythm, axis, intervals Email: [email protected], [email protected] FB page and medportal

You might also like