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1433/2012

ECG >>> DR / HOSAM MWAFI

.


.
/
.

/



-


.


[]The ECG made easy

.

26 12 & 1433 2012

ECG >>> DR / HOSAM MWAFI

Elgawadm@yahoo.com
ECG





] ] 1
[ve
[ [ ve ] +

] ]1



.

ECG >>> DR / HOSAM MWAFI

<<< +
<<<<<

CHEST LEADS ] <<< [2

ve+
<<< ve
. 3

ECG >>> DR / HOSAM MWAFI

] ] 3

atrium & ventricle

atrium
ventricle
right ventricle septum
left ventricle

left right ventricle septum
ventricle 4

ECG >>> DR / HOSAM MWAFI

4] ]

ECG >>> DR / HOSAM MWAFI

septum
left bundle
right bundle
. <<
sickness of the wave
muscle
.
septum

4 -3
<<<<<:
4
L.V. R . V. septum

] ]5

electrode
septum s
>>>>>> SEPTUM
. ve+

ECG >>> DR / HOSAM MWAFI

. electrode
>>>>> ve+ R . V.
5
. >>>> ve+
WAVE
L.V. >>>>>>>>>>> ve
electrode

electrode
<<<<<<<<<<
.
>>>>>>>>>>> wave ve +
R
>>>>>>>>>>

wave
Q

>>>> R wave
S

CAPITAL
SMALL
CAPITAL SMALL
CAPITAL
6
ELECTRODE WAVE

ECG >>> DR / HOSAM MWAFI

] ]6

: >>>

] ]7

] [98 , Einthoven
<<<<<<<
.

ECG >>> DR / HOSAM MWAFI

HOMOGENOUS CONDUCTOR
.

] ]8

] ]9
......


] ]

.
+

ECG >>> DR / HOSAM MWAFI

:
>>>> I
>>>> II
>>>> III
BIBOLAR LIMB LEADS
:
Precordial
Leads

Limb Leads

I, II, III

Bipolar

)(standard limb leads

V1-V6

aVR, aVL, aVF (augmented

)limb leads

Unipol
ar

LEADS
:
--------RIGHT ARM
------------LEFT ARM
--------------{ SPLEEN } LEFT LEG
------------RIGHT LEG

LEADS :::

ECG >>> DR / HOSAM MWAFI

>> LEADS
MISLEADED

..... 18




UNIBOLAR LEADS 3

VR , VL, VF


WAVES
AUGMENTED
:aVR, aVL, aVF
LEADS 6

12 :
chest leads 6

OESOPHAGEAL LEADS
. === UNIPOLAR
BUT THE STANDARD LEADS NOW ARE 12 LEADS

ECG >>> DR / HOSAM MWAFI

3 BIPOLAR 3 UNIPOLAR 6 CHEST LEADS
:

. :
:
ECG

. ECG
? : WHAT IS THE RATE OF THE HEART
RATE
TAHYCARDIA OR BRADYCARDIA
TACHYARRYTHMIA OR
BRADYARRYTHMIA

ARRYTHMIA ECG
SUBSEQUENT HYPERTROPHY IHD
LEAD *****
1500
]
] [ ]
RAETE OF THE HEART >>>>>>>>
Q TWO WAVES 1500 Q R-R S-S.
RATE OF THE ATRIUM
P P

ECG >>> DR / HOSAM MWAFI

:
1500
.
REGULAR

<<< = 5
. 3
.
IRREGULAR RATE
DIFFERENT WAVES ::::
4 WAVES
The rate of the heart is approximately
is ......................................
----------------------------------------------------------------------------------? : WHAT THE RYTHM
THE RHYTHM OF H.R. OF THE CLINICAL
PATIENT

? IS IT SINUS OR NOT
? IS IT REGULAR OR NOT
SINUS
SINUS

ECG >>> DR / HOSAM MWAFI

QRS P WAVES
>>>>>>>>> SINUS COPLEX
VENTRICLE ATRIUM

REGULAR OR NOT
TWO R ] [
R WAVES WAVES
TWO R WAVES
HEART RATE IS REGULAR
? : WHAT IS THE VOLTAGE


ELECTRLODES

........
VOLTAGE
??? LOW VOLTAGE OR NOT
] [R WAVES :
LEADS
>>>>>>>> LOW <<<<<<<< 15
VOLTAGE
>>>> HIGH VOLTAGE
R WAVES

ECG >>> DR / HOSAM MWAFI

CAUSES OF ABSCENT APEX

AS =========== EMPHYSEMA OBESITY
PERICARDIAL EFFUSION

.....
) ] ( normal standard] 1
.
half standard . 5 >>>

] ]10
ELECTRLODES
.
: is there rotation or not ? AND WHAT
? IS ITS TYPE
] [5,4

ECG >>> DR / HOSAM MWAFI

] ]11

RIGHT VENTRICLE V1 , V2
R V1
R V6
V1 V1
V6

V1 S
V6
V1 , V2------------ RIGHT VENRICULAR PATTERN
V3, V4 -----------------------------SEPTAL PATTERN
V5,V6-------------LEFT VENTRICULAR PATTERN
<<<<
V5,V6 >>>> V5,V6 >>>> SEPTUM

SEPTAL LEFT VENTRICULAR PATTERN

PATTERN

LEFT VENTRICULAR
SCAPULA

ECG >>> DR / HOSAM MWAFI

>>>>

V5,V6 SEPTAL PAEEERN

CLOCKWISE ROTATION

>>>>

V1, V2 SEPTAL PAEEERN

ANTICLOCKWISE ROTATION

R V3,V4 ECG <<<<

SEPTAL PAEEERN S

ANTICLOCKWISE ROTATION CLOCKWISE ROTATION

? : WHAT IS THE POSITION



HORIZONTAL HEART OR VERTICAL HEART
? : WHAT IS THE AXIS

ECG >>> DR / HOSAM MWAFI

] ] 12

. ] [ 13
LEADS ] [ 12
HEXA AXIAL SYSTEM

ECG >>> DR / HOSAM MWAFI

1:15



[ [ ve ] [ ve+ lead
lead I 6 leads
90+ 90- ]
avf [
] [ve+ 90- ] avf [ve-
90+
90+ <<<0
180 <<<<90-
90+ <<<0
>>>>> left axis deviation
>>>>> right axis deviation 120+
NORMAL AXIS
[ aVL lead :
LEAD + [
>>> II +
60 120- 120-
>>>> NORMAL AXIS 60+
=================

ECG >>> DR / HOSAM MWAFI

THE
QRS AXIS
13 : normal axis

axis
:
[

The QRS Axis ]

13 ] ] <<<<
:
1. Examine the QRS complex in leads I and aVF to
determine if they are predominantly positive or
predominantly negative. The combination should
place the axis into one of the 4 quadrants below.

ECG >>> DR / HOSAM MWAFI

14] ]
the Axis
predominantly
: :

15] ]

:
2. In the event that LAD is present, examine lead II
to determine if this deviation is pathologic. If the
QRS in II is predominantly positive, the LAD is nonpathologic (in other words, the axis is normal). If it is
predominantly negative, it is pathologic.

ECG >>> DR / HOSAM MWAFI

ECG

U ] [16 /
WAVE

ECG >>> DR / HOSAM MWAFI

: ][17

P WAVE >>>>> ATRIAL

} DEPOLARIZATION{ ACTIVATION
QRS >>>>> VENTRICULAR
} DEPOLARIZATION{ ACTIVATION
T WAVE >>>>>>> VENTRICULAR
} REPOLARIZATION{ RELAXATION

:
ATRIAL REPOLAIZATION
QRS ::: -----
: P WAVE
:
leads

>>>>> II & V1

V6 OR III
:
X <<<< 2.5 2.5
. 3
:
: P wave
M shape =====} P mitral
left atrial strain as mitral stenosis

ECG >>> DR / HOSAM MWAFI

P pulmonal ====== } peaked & high voltage

.
right atrial strain as pulmonary valve
stenosis or pulmonary hypertention

}{ biatrial strain
===== P mitral& P pulmonal
mitral stenosis -----} pulmonary
hypertention
biphasic p wave
lead V1
P mitral
.
. +

ECG >>> DR / HOSAM MWAFI

:
P waves
rythm not sinus
:
atrial fibrillation or atrial flutter
** atrial flutter is non sinus regular rate
Saw tooth

** atrial fibrillation is non sinus irregular rate

ECG >>> DR / HOSAM MWAFI

] [ fibrillated flutter flutter
. H.R. >>> regular irregularity

fibrillation : :
coarse or fine
: PR interval
R P
0.12 3 4
SAN= AVN
kent bundle bundle
PR interval AVN
QRS
wide QRS R wave
kent bundle PR
PRE EXITATION SYNDROME
>>>> excitation of
. SAN
WOLF PARKINSON WHITE
}SYNDROME { WPWS
:
short PR interval.
) wide QRS. (normal QRS= 3 small squares
delta wave.

ECG >>> DR / HOSAM MWAFI

It is considered one of the causes of cardiac
sudden death

type type A

V1

-ve V1
PR
>>>>>
:
Fixed prolonged
1st degree of heart block

ECG >>> DR / HOSAM MWAFI

:
Progressive prolongation PR interval until drop of
beat
2nd degree of heart block
Wenckebach phenomenon or Mobitz type I

pacemaker

: atrioventricular dissociation
3rd degree of heart block

ECG >>> DR / HOSAM MWAFI

Complete heart block

] ] PR
QRS P

QRS
leads V 1 -6

ECG >>> DR / HOSAM MWAFI

electrode left ventricle

>>>> <<<<<
waves all of them are ve
QRS------Its name in this case is Q wave
pathological Q wave
Deep and wide
we can see it in myocardial infarction
MI
Non q wave & q wave MI
6 -1 leads v
: pathological q wave normal
ECG
Yes in 2 leads ==== lead aVR & lead V1 :

ECG >>> DR / HOSAM MWAFI

>>> V1 r
cavity of the heart >>> aVR

>> dextrocadia
aVL

No comment on Q waves IN==== lead Avr & lead

v1

pathological q waves
right ventricular hypertrophy
waves
sickness of the muscle wave

R right ventricle
V1 S R
S R wave
HYPERTROPHY
====
<<<< S 1 R
:

ECG >>> DR / HOSAM MWAFI

WPWS type A and other

causes
What are the causes of high R wave in V 1 ???
Right ventricular hypertrophy
Type A WPWS
Children less than 4 years
Negros
RBBB
Inferior infarction
Anticlockwise rotation
left ventricular hypertrophy

L.V.
WAVES
S V1
R V6
S == V1 & R == V6 35

ECG >>> DR / HOSAM MWAFI

voltage criteria
normal voltage
criteria

V1- V6 QRS

R

PR wide QRS
>>>> BBB{ bundle >> interval
} branch block
QRS

PR interval ==
>>> WPWS

RBBB & LBBB

} { bundle branch block
RBBB & LBBB
. V1
>>>> LBBB QRS

ECG >>> DR / HOSAM MWAFI

>>>>> RSR pattern QRS
RBBB
ECG

========

ST segment
T S

:
:

)(Sagging

ECG >>> DR / HOSAM MWAFI

:

)(Straight depression
:
J point
junction point
>> [ descending arm of the R with :
]the ST segment
(

) j point is isoelectric

DIGITALIS

st segment
ISCHEMIA

CHEST PAIN
EXERCISE
.
+ve STRESS ECG
exercise

ECG >>> DR / HOSAM MWAFI

<<< st segment
.
=========
ST segment
:
:

pericaditis
CONVEXITY <<<
pericaditis

:
ECG

>>>>superficial myocarditis :
:

ECG >>> DR / HOSAM MWAFI

MI
Non Q wave
CONVEXITY <<<

.
==============

T wave

ECG >>> DR / HOSAM MWAFI

Himalaya shape is present in hyperkalaemia

hyperkalaemia
{inverted T wave}:

ischemia
<<<<< <<<<<


very serious patient
.