45 NOTES TO PG

Dr. Ankit Yadavendra, M.B.B.S., Dr.V.M.G.M.C., Solapur

34-ECG, EEG, EMG

ECG
William Einthoven discovered in 1895, got Nobel prize in 1924
12lead
6precordial(V1-V6), 6limb(bipolar I,II,III+ unipolar aVR,aVL,aVF)
V1-rt 4ICS
V2-lt 4ICS
V3-b/n V2&V4
V4-5ICS MCL
V5-5ICS AAL
V6-5ICS MAL
Einthoven triangle
RA(), LF(++)
Einthoven rule
II=I+III
1mm ht=0.1mV
1mm width=0.04s
speed=25mm/s
HR=1500/small sq
HR in AF=no. of Rwave in 15large sq20
jn rhythm
intrinsic=50/min
accelerated=50-100/min
jn tachycardia>100/min
idioventric rhythm
extra impulse fr ventricle, atria get impulse fr SA node
intrinsic=40/min
accelerated=40-100/min
VT>100/min
lead II-tachycardia, bradyarrhythmia, AV block, dyselectrolemia, drug effect, atrial
enlargement, P wave abnorm
V1-RVH/RBBB
V5/6-LVH,LBBB
P(atr depolarization)-II
<2.5mm-duration, amplitude
absent-AF, jn rhythm
saw tooth-atrial flutter

P-Mitrale-broad&notched, deep ve in V1(Morris index+ve)-LA enlargem(MS)

P-Pulmonale-tall&Pointed>2.5mm-RA enlargem
inverted-jn tachycardia
hidden-PSVT
2P wave-block of conduction through AV node
small-hyperkalemia
PR interval=0.12-0.20s=3-5mm
short-bypass tract(WPW synd)
long-1st AV block, adr antag, digoxin, CCB, hyperkalemia, RF, atazanavir
delta(slurring of initial part of QRS)
WPW synd, Ebstein
QRS complex(ventricular depolarisation)=0.12s=3mm
naRRow-noRmal, hypeRcalcemia, a/c MI, hypeRmagnesemia
broad-RBBB, LBBB, hyperkalemia, ventricular premature complex, WPW synd,
hypocalcemia
broad, M shape, Monophasic R-LBBB(V5,6)
broad, rSR(RaBBit ear)-RBBB(V1)
alternate sinus rhythm, ventricular premature complex-bigeminy(digoxin)
QRS
tall-glycogen storage ds
low-CCP, RCM
QRS axis-I,aVF
normal=30-+100
I-,aVF--normal
I-,aVF--LAD[LVH, inf wall MI(Q in aVF), lt ant fascicular block, TV atresia, AS, HTN,
HCM, ostium primum ASD]
I-,aVF--RAD(Rt hands meet)[RVH, lat wall MI(Q in I), lt post fasc block, TOF, ASD,
VSD]
R(ventr depol)
V1 V6( +)
LVH-R(V5,V6)+S(V1)>35mm(Sokolov& Lyon criteria)
RVH-R>S(V1)
QT interval=0.28-0.44s=7-11mm
long-ventr arrhythmia(sudden death), hypocalcemia, hypomagnesemia,
hypokalemia(false), torsades de pointes, quinidine(IA), sotalol(III), phenothiazine, TCA
antidepressant, cisapride, mosapride, tegaserod, terfenadine, sevoflurane,
bedaquiline, dolosetron, trimetazidine, ranolazine, ziprasidone, sibutramine,
gatifloxacin
shoRt-hypeRcalcemia, digoxin
ST
elevation-a/c MI, prinzmetal angina, a/c pericarditis(all lead except aVR), a/c
myocarditis, LV aneurysm, hyperkalemia, hypercalcemia, early repolarization variant

depression-a/c post MI, stable angina, unstable angina, hypokalemia, AS(V5,V6)

T
tall-a/c MI, hyperkalemia
flat-hypokalemia
inversion-unstable angina, hypokalemia
U
hypokalemia, digoxin
electrical alternans-cardiac tamponade
hyperkalemia
ECF K, RMP more ve, excitability
small P wave
AV nodal block(PR prolong)
broad QRS
ST narrow, elevated
tall(>10mm) T wave(1st sign)
sine wave pattern
ventr asystole
heart stop in diastole
hypokalemia
prolong PR interval
flattening&inversion of T wave
sagging of ST seg
false QT prolong
U wave
hypercalcemia
narrow QRS
short QT interval
ST elevat
heart stop in systole
hypocalcemia
prolong QT interval
hypernatremia
ECG-normal
hyponatremia
decre QRS amplitude
hypothermia
ST elevation
Osborn J wave
digoxin

prolong PR interval
ST-T depression(invert tick/hockey sign)
U wave
bradycardia
toxicity
QT short
Mobitz type1(never type2)
tachyarrhythmia(d/t automaticity)
ventr bigemini(ectopic)
jn tachycardia
bidirectional VT
change in MI
ST seg elevation
ant-V2-V5
sept-V1-V3
post wall-V1-V3
lat-V5-V6,I,aVL
antlat-V2-V6,I,aVL
inf-II,III,aVF
RVMI-RV4
1st change-tall T
2nd chang-ST(7-14d), >14d(LV aneurysm)
prom Q-6-24h-lifelong
T-24-48h
ECG poor in Dx-lt circumflex a
pericard effusion-low V ECG
AV block
1st-PR interval
2nd-QRS absent intermittent, PR interval-variable-Mobitz type I, xed-Mobitz type II
3rd-wide QRS
VT=100-200/min
V flutter>250/min
V brillation-irreg irreg
pulm embolism-S1Q3,T3
HIS BUNDLE ECG
A-SA nodal depolar
H-His bundle depolar
V-Ventricul depolar
AH=55-130ms-AV nodal block
HV=35-55ms-bundle br block
EEG
atypical abs sz-1-2Hz spike&wave ppt by hyperventilation

BDZ, barbiturate, etomidate, propofol, halothane-biphasic

O2-cerebral excitability diffuse EEG slowing
delirium, hypocarbia, hypothermia-slowing of brain activity
desflurane, sevoflurane-burst suspension
HSV encephalitis-localised discharge temporal lobe
O2-low amplit, fast freq
infantile spasm(West synd)-hypsarrhythmic(large, irregular) wave
ISOflurane-ISOelectric
Juvenil myoclonic epilepsy(Janz synd)- 4-6Hz spike&wave ppt by photic stimulation
ketamine-ampl, ampl, ampl
NO2-freq,amplitude
opioid-monophasic
pCO2
5-20%-cerebral excitability, sz threshold
30%-cerebral excitability, epileptic change
50%-wave
RAS on arousal-block
rolandic epilepsy-centrotemporal spike
typical absence sz-3Hz spike&dome
EMG
infantile spasm(West synd)-rhomboid
Abbreviations
a-artery, AA-amino acid, abtc-antibiotic, AI-autoimmune
bef-before, bel-below, b/l-bilateral, bld-blood, b/n-between, bn-benign, br-branch,
Bx-biopsy
ca-carcinoma, carb-carbohydrate, c/i-contraindication, c/l-contralateral,
conc-concentration, cong-congenital, Cx-cervix
d-day, def-deficient, ds-disease, d/t-due to, Dx-diagnosis
E-estrogen
fem-female, fr-from
gld-gland, glu-glucose
h-hormone
idiop-idiopathic, i/l-ipsilateral, inf-infection, inj-injury
lig-ligament, LL-lower limb, l/t-leading to
m-muscle, maj-major, mal-male, MC-most common, met-metastasis, min-minor,
mtx-methotrexate, Mx-management
n-nerve, norm-normal
P-progesterone, pl-plasma, prot-protein, pt-patient
Rx-treatment
SCC-squamous cell carcinoma, sr-serum, Sx-surgery, sz-seizure
tm-tumour, ts-tissue
UL-upper limb, u/l-unilateral
vag-vagina, VC-vocal cord, vel-velocity, vert-vertebra, vit-vitamin, vol-volume
w-week, wt-weight
Xr-X ray
y-year
#-fracture
-degree

-(N.B.-THESE NOTES ARE ONLY FOR THE PURPOSE OF GUIDANCE AND HELP
TO PG ASPIRANTS, NOT FOR COMMERCIAL OR OTHER PURPOSE. REFERENCE
HAS BEEN TAKEN FROM VARIOUS STANDARD TEXTBOOKS. FOR ANY
FEEDBACK/QUERY PLEASE CONTACT- ankit.yadavendra@facebook.com or
dr.ankityadavendra@gmail.com )