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ECGforinterns

This document provides guidance on interpreting electrocardiograms (ECGs) for internal medicine interns. It reviews the essential steps for ECG interpretation, including evaluating rate, rhythm, axis, hypertrophy, intervals, P waves, QRS complexes, and ST segments/T waves. Five clinical cases are presented and their ECGs reviewed. Additional resources for further ECG learning include recommended websites, apps, and books. The goal is to establish a consistent approach to ECG interpretation and review essential cases for new interns.

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44 views

ECGforinterns

This document provides guidance on interpreting electrocardiograms (ECGs) for internal medicine interns. It reviews the essential steps for ECG interpretation, including evaluating rate, rhythm, axis, hypertrophy, intervals, P waves, QRS complexes, and ST segments/T waves. Five clinical cases are presented and their ECGs reviewed. Additional resources for further ECG learning include recommended websites, apps, and books. The goal is to establish a consistent approach to ECG interpretation and review essential cases for new interns.

Uploaded by

usmleusmle86
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as PPT, PDF, TXT or read online on Scribd
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ECG for Interns

UCI Internal Medicine Mini-Lecture


Learning Objectives

• Establish Consistent Approach to Interpreting ECGs

• Review Essential Cases for New Interns

• Provide Additional Resources for Future Learning


ECG Interpretation

What is your approach to reading an ECG?


•Rate
•Rhythm
•Axis
•Hypertrophy
•Intervals
•P wave
•QRS complex
•ST segment – T wave
Rate
Square Counting: 300-150-100-75-60-50-42A

Count QRS in 10 second rhythm strip x 6


Rhythm
• Are P waves present? 

• Is there a P wave before every QRS complex and a QRS


complex after every P wave?

• Are the P waves and QRS complexes regular?

• Is the PR interval constant?


Axis
Left or right axis deviation?
Look at limb leads I and aVF.
•Normal: I +, aVF +
•LAD: I +, aVF –
•RAD: I -, aVF +
Hypertrophy

LVH: S in V1 or V2 + R in V5 or V6 ≥ 35 mm.

RVH: V1 R/S ratio >1 or V6 S/R ratio >1.


Intervals

What is the normal PR interval?

•0.12 to 0.20 s (3 - 5 small squares). Short PR – Look for Wolff-


Parkinson-White. Long PR – 1st Degree AV block

What is the normal QRS?

•< 0.12 s duration (3 small squares). Long QRS - look for bundle
branch block, ventricular pre-excitation, ventricular pacing or
ventricular tachycardia

What is the normal QTc (QT/square root of RR)?

•< 0.42 s. Long QTc can lead to torsades to pointes.


P Waves
Evaluate the shape, height and width of P waves.
•Multiple morphologies  Wandering pacemaker or
Multifocal atrial tachycardia

•Notched (M-shaped) P-wave in I and II, > 0.12 s  P-


mitrale seen in severe left atrial enlargement
QRS complex
Poor R Wave Progression in V1 to V6: suggests prior anterior MI

Pathologic Q wave: previous MI. Q wave amplitude 25% or more


of the subsequent R wave, OR > 0.04 s in width + > 2 mm in
amplitude in more than one lead
ST segment & T wave
Case #1

70 year old male with history of diabetes mellitus and


hypertension occasionally feels lightheaded. He recently
fainted while standing.
Case #1 ECG
Case #2
58 year old female with no significant past medical
history presents with fatigue, lightheadedness and
shortness of breath.
Case #2 ECG
Case #3

78 year old female with history of HTN, DM, HL, CAD


admitted for syncope complains of palpitations and
lightheadedness.
Case #3 ECG
Case #4

67 year old male with history of diabetes, hypertension,


COPD presents with chest pain.
Case #4 ECG
Case #5

38 year old female with history of DM, HTN, CKD


presents with 2 days of nausea and abdominal pain.
Case #5 ECG
Case #6

60 year-old man with history of HTN, HL, CAD presents


with nausea, shortness of breath and chest pain.
Case #6 ECG
Additional Resources
Websites:
•http://en.ecgpedia.org/
•http://ecg.utah.edu
•http://ecg.bidmc.harvard.edu/maven/

Apps:
•ECG Guide by QxMD (iPad and iPhone)
•ECG Interpret (iPhone)

Books:
•12-Lead ECG: The Art of Interpretation, Tomas Garcia (perhaps the best
book on ECGs with detailed explanations and physiology.)
•Arrhythmia Recognition, Tomas Garcia
Summary

• Always keep a consistent approach.

• Do not rely upon machine reads.

• Practice makes perfect.

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