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| ==General==
| | #REDIRECT[[ECG (main)]] |
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| 1 small box = 1mm = 0.04 sec = 40 mili-seconds
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| 5 small boxes = 1 big box = 5mm = 0.2 sec = 200 mili-seconds
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| *varries with HR
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| ==Intervals==
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| ECG Seconds mm (sm boxes) | |
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| P 0.10 2.5
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| PR 0.12-0.20 3-5
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| QRS 0.06-0.10 1.5-2.5
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| Q <0.04 1
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| *QT 0.33-0.42 8.25-10.5
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| QTc <0.44 NA
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| ==Axis==
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| axis and ventricular hypertrophy
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| cannot be measured correctly in presence of BBBs....
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| 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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| RBBB-
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| 1)QRS greater than .12.
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| 2) slurred s in 1 and V6.
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| 3) RSR' in V1 with R' taller than R.
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| 4)V1 must have a positive complex.
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| ==LBB==
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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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| LBBB-
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| 1.) duration equals .12sec
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| 2.) broad monomorphic R waves in 1 and V6 without Q waves.
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| 3.) 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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| [[Category:Cards]]
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