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| == General ==
| | #REDIRECT[[ECG (main)]] |
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| *1 small box = 1mm = 0.04 sec = 40 miliseconds
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| *5 small boxes = 1 big box = 5mm = 0.2 sec = 200 miliseconds
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| == Intervals ==
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| {| border="1" cellspacing="1" cellpadding="1" style="width: 500px; "
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| |-
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| | Interval
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| | Time (s)
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| | boxes
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| |-
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| | PR
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| | 0.12 - 0.20
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| | 3-5
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| |-
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| | QRS
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| | .06 - 0.10
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| | 1.5-2.5
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| |-
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| | QTc
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| | <0.44
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| | N/A
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| |}
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| <span class="Apple-style-span" style="font-size: 18px; font-weight: bold; ">Axis</span>
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| #axis and ventricular hypertrophy cannot be measured correctly in presence of BBBs.... | |
| #Anterior hemiblock-left axis deviationgreater than-45 to -60. and small q in 1 and avl. RS in 2,3, avf. Intrinsicoid deflection in avl greater than .045.
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| #posterior hemiblock-right axis deviation and S1Q3.
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| #Axis-check lead 1 and AVF..If both are positive then axis is normal .
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| #Find isoelectric lead. Axis is perpendicular.
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| #Horizontal axis-find isoeletric chest lead. If shifted to V1 or V2 then counterclockwise rotation. If shifted to V5 or V6 then clockwise rotation.
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| == Q waves ==
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| #sig Q waves are @ least 1 mm (1 box) wide or @ least 1/3 of the entire QRS amplitude.
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| #Early Repolarization:
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| ##STE most prominent in lat precord leads (V4-6) but no reciprocal chngs. T waves here usu broad, tall (usu > 5mm) & upright.
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| ##limb leads may also have ste, rarely >2 mm
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| == T waves ==
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| #T waves are normally upright in 1,2,V3 to V6. Negative in AVR.
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| ##if T wave is greater than 2/3 height of R wave it is abnormal.
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| == RAE ==
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| #P amplitude >2.5 mm in II.
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| #Rarely isolated finding (usu rvh/rad too).
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| #large diphasic p wave in V1. Right atrial hyper.-initial component is larger in V1 than V6 :tall p wave, bigger than 2.5 boxes in limb leads.
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| #p-mitrale-m notched p wave in leads 1 and 2. Greater than .12 seconds.
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| == LAE ==
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| #Biphasic P in V1 w/ wide, deep terminal component, >1mm depth & wide.
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| #Left atrial hyper.-terminal component is larger than .04 sec.
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| == LVH ==
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| #Sum of S in V1 or V2 & R in V5 or V6 is >35mm.
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| #Sum of highest R & deepest S in precord is >45mm
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| #R wave in V6 > 18mm
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| #R in AVL of >12mm
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| #L precordial leads may show ST depression & twi= LV strain pattern
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| #LVH-s wave in V1 or V2 (biggest) plus R in V5 or V6 (biggest) is greater than 35mm. LAD-with slightly wide QRS. Or r in avl greater than 11mm, r in 1 is greater than 12mm, or R in AVf is greater than 20mm.
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| == RVH ==
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| #Dominant R in V1 >7mm (also seen in WPW, RBBB, post MI, & nml var.)
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| #RSR in V1 w/ QRS < 0.12
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| #This dx usu also w/ RAE or strain (ST dep w/ twi in V1-V3).
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| #Less sens. & spec. than LVH, usu nl ecg
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| #RVH-R wave greater than S in V1, but gets progressively smaller from V1 to V6. S wave persists in V5 and V6. RAD with slightly wide QRS.
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| #(note: R :S ratio greater than 1 also in: 1.RBBB 2.WPW type A. 3. Post. Wall MI. 4.kids.)
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| == RBBB ==
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| #QRS > 0.12 in limb leads (all qrs intervals should be measured in limb leads)
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| #triphasic QRS (RSR') in ant precord leads (V1-V3), often w/ st dep & twi in these leads
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| #assoc w/ org heart dz (cant cause rad on own)
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| #QRS greater than .12.
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| #slurred s in 1 and V6.
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| #RSR' in V1 with R' taller than R.
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| #V1 must have a positive complex.
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| == LBBB ==
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| #QRS > 0.12 in limb leads, w/ lg, broad , notched or slurred R waves in lat precord leads (V5-V6) & lead I & avL, the st seg is usu depressed & twi in these leads!
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| #can cause lad, ste seen in ant leads but can call ant mi in rbb!
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| #duration equals .12sec
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| #broad monomorphic R waves in 1 and V6 without Q waves.
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| #broad monomorphic S waves in V1, may have a small r wave.
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| == LASH ==
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| (caused by CAD, valv. dis., cong. dis., cardiomyop., myocard.)
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| #Axis < -45 (L axis) w/QRS <0.10s
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| #deep S in II, III, and AVF
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| #exclude other cause of L axis (habitus, Inf. MI, hyperK, Vent. pre-excitation)
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| == L Post Inf Hemiblock ==
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| (USU. organic heart dis.)
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| #R axis (>110) w/ QRS < 0.10s
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| #R waves in II, III, AVF.
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| #Exclude other causes (COPD, RVH, Lat MI)
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| #(-w/ combined blocks cons. pacing only if sxs w/ bradyarrhythmias)
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| == Source ==
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| 9/09 DONALDSON (adapted from Niemann, Lampe, Pani)
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| <br/>[[Category:Cards]] <br/><br/>
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