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: : :
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(
)

ECG

 ECG
Waves

waves
p wave T wave
tachycardia P T
you can discriminate P T P complex
T complex
P T

wave wave
wave


Paper ECG

5 0.20
5 amplitude
wave wave

5
0.5
0.5 0.2
..... timeduration
0.2
ECG


5

 speed 5
5 .....
0.2 ....

3

5 .....
3
15

3
3 15
3
6
6

6

waves ECG
p waves
QRS complex
ST segment

T wave

P wave atrial depolarization
complex ventricular depolarization
ST segment T wave ventricular repolarization

( ) depolarization
repolarization
action potential Influx

session ECG

ten minutes
ECG

 depolarization atrial activity P wave

ventricular activity ST segment T complex


PR interval
time of passage of impulse across A.V. node
A.V. node impulse
P wave atrium
ST segment T complex ventricle
PR A.V. conduction .... conduction
interval
Measurement of P-R interval

measurement of P-R interval

from the beginning of P wave to the beginning of Complex
P-R interval complex P

Normally not more than 1 big square
P-R interval normally not more than one big square
complex P P-R interval

complex P
Iso-electric line
ST segment
depressed elevated ST segment


P wave .... iso- electric line
positive wave
T wave negative wave


waves ECG P, complex and T
P wave wave
T wave wave
complex complex QRS
ECG 12
QRS complex


QRS
12
.....
.... ...
12
QRS complex S R Q
QRS complex
10
( 10

)

 normal complexes abnormal complexes

P ..... P T T

complex
10 complexes normal abnormal


complexes
the first negative wave wave complexNegative
Q
complex
negative wave Q (
areas
)

the first positive wave R R

negative wave preceded by R wave Negative wave
R wave ( S negative wave
Q S S R wave
)

second positive wave Positive R second positive
wave ECG ' ( R ) ( R capital )

10


6, 7 complex wave wave

complex one negative wave

One wave Negative
Q S
wave one negative wave
complex QS
QS
QR 9,8
QR Q first negative wave R
first positive wave in complex

q small letter R capital
capital small

QR Q Q Q
capital Q capital
complex

Q r small

ECG
qRs

 wave one positive wave R

RS Positive Positive R
Negative wave
Negative wave R complex S
RS
RQ ECG
rS r small S Capital

Rs
capital letter small letter

 Q capital
'rsR

A
...
complex
B
complex
complex

standard mark
...


wave
... wave



complex ECG

wave
fat ECG leads

wave









ECG







normal ECG
ECG 12 12
12 heart















12
12 Lead
... ...


ECG
... ...

 6 leads
lead 3 lead 2 lead 1
Lead a V f Lead a V l Lead a V r
6 leads Limb leads
Leads limb leads
Limb leads


Heart Limbs

V1 V V6
V1 V6 chest leads
Normal
Normal
abnormal

normal chest lead pattern

 chest leads normal

models A, B and C
Models chest leads Normal
waves chest leads
variation


A
complex V1 r
complexr S .... V2
complexR S ... V3
complexR s .... V4
R
complexq R .... V5
complexq R... V6

R wave amplitude V6
V1

B

 complexr S ... V1
complexr S ... V2
complexR S .... V3
complexR S .... V4
complexR S .... V5
complexq R .... V6

rS
RS
Rs
qR
qR
qR


Notice
R wave progression chest leads
R wave progression
r V1 start small ... r V1 V6
r wave V1 small
amplitude of R wave gradually toward V6 R wave
progression
r V1 V6
... R wave
progression ....

A S wave
A ... r S V1
V2r S
V3R S
R s V4
V 5q R
V 6q R
V 6 q R q R
No S wave in V 6 No S wave in V6
V6 S wave V
chest leads

value of chest leads


....

target V6 V1


value of chest leads

in V1 and V6 diagnosis of ventricular enlargement
ventricles
chest leads
V6 V1



anterior wall infraction diagnosis of anterior wall ischaemia
left ventricle anterior wall
left ventricle

e.g. for example
V6 V1 finding anterior wall infraction
anterior aspect of the left V6 V1
ventricle
findings anterior wall ... infraction
V6 V1
chest leads
finding of lateral wall ischaemia V6 V5
lateral wall infraction

septal spetal infraction finding V1 and V2
ischaeamia

septum

anterior aspect of the left ventricle
anterior
Lateral septum
anterior aspect of the left ventricle V6 V1 ...

 Lateral V6 V5
septum V2 V1
valuechest leads

bundle branch block
bundle branch block V1

value

right ventricular strain
diagnosed in V1 and V2
V anterior

....

sharp
value
Left ventricular strain
V5 and V6
strain
... left ventricle strain
strain
Pressure load
right ventricle strain pressure load
pulmonary hypertension
left ventricle
load
Infraction Ischaemia
bundle branch block
chest leads
limb leads

limb lead

 Lead 1 Limb lead

complex positive Negative
Positive

a V f complex positive negative

notice
complex Positive Lead a V f lead 1

Positive Positive

complex a V r
complex Positive Negative complex Negative

notice
complex in a V rnegative

negative complex in a V r
heart sinus rhythm


value of limb leads

 : :
: :
( : :

) .:
: - : - [ :]
value
diagnosis of sinus rhythm sinus rhythm

diagnosis of axis deviation

limb leads sinus rhythm axis
deviation

diagnosis of inferior wall infraction or ischaemia
Inferior wall left ventricle finding
finding leads Lead lead 3 Lead 2 :
a V f Inferior leads
Inferior aspect of left ventricle ischaemia
limb leads