How to analyze EKGs

1. Rate 2. Intervals 3. Rhythm 4. Axis 5. P wave abnormalities 6. QRS Abnormalities 7. ST segment and T Wave abnormalities

How to analyze EKGs

1. Rate 2. Intervals 3. Rhythm 4. Axis 5. P wave abnormalities 6. QRS Abnormalities 7. ST segment and T Wave abnormalities

Rate

300 150 100 75 60

How to analyze EKGs

1. Rate 2. Intervals 3. Rhythm 4. Axis 5. P wave abnormalities 6. QRS Abnormalities 7. ST segment and T Wave abnormalities

Normal Intervals
PR: >120ms & <200ms
3-5 small squares

QRS: <100ms
Smaller than 1/2 of a large square

QTc:

<440ms

QT Should be <1/2 distance b/t consecutive QRS complexes

How to analyze EKGs

1. Rate 2. Intervals 3. Rhythm 4. Axis 5. P wave abnormalities 6. QRS Abnormalities 7. ST segment and T Wave abnormalities

Rhythm
Lead II is your rhythm strip
Why?

Questions to consider:
Supraventricular Rhythm? Ventricular Rhythm? AV block?

Supraventricular Rhythm
Normal sinus rhythm

What kind of rhythm is this?

Atrial Fibrillation

No clear P wave

Irregularly irregular QRS complexes

Ventricular Rhythms
Ventricular Tachycardia (fast) Accelerated Idioventricular Rhythm (slower)

Ventricular Tachycardia
AV dissociation with AV rate Vent. rate

QRS > 100 ms

HR > 100 bpm

Accelerated Idioventricular Rhythm

Found in Lead II followed by sinus rhythm
QRS > 100ms HR < 100bpm

Ventricular rhythm (below AV node)

QRS = 130 ms 90 bpm

QRS = 80 ms

AV blocks
1st degree
Benign

2nd degree Mobitz type 1

Benign

2nd degree Mobitz type 2

Not benign

3rd degree
Not Benign

1st Degree AV Block

Prolonged PR interval

2nd Degree Mobitz Type I AV Block

Grouped beats

Increasing PR interval until dropped beat

2nd Degree Mobitz Type II AV Block

No PR prolongation before dropped beat

3rd Degree (Complete) Heart Block

No P waves get through Rhythm is from AV node

How to analyze EKGs

1. Rate 2. Intervals 3. Rhythm 4. Axis 5. P wave abnormalities 6. QRS Abnormalities 7. ST segment and T Wave abnormalities

Axis Label

Normal : -30 to 90 Right Axis Deviation : +90 to 180 Left Axis Deviation : -30 to -90 Superior Axis : -90 to 180

Determining Axis
Look at leads I and II
If both are positive, axis is normal If either is negative axis is abnormal

Find most isoelectric lead

See if perpendicular lead is (+) or (-) Determine axis

Axis Label

Normal : -30 to 90 Right Axis Deviation : +90 to 180 Left Axis Deviation : -30 to -90 Superior Axis : -90 to 180

Axis?

How to analyze EKGs

1. Rate 2. Intervals 3. Rhythm 4. Axis 5. P wave abnormalities 6. QRS Abnormalities 7. ST segment and T Wave abnormalities

 p > 2.5 mm tall in Lead II + deflection > 1.5 mm in Lead V1 tall in II, positive in V1

notched p > 120 ms wide in Lead II negative p in Lead V1 > 1 box wide in II, big negative in V1

How to analyze EKGs

1. Rate 2. Intervals 3. Rhythm 4. Axis 5. P wave abnormalities 6. QRS Abnormalities 7. ST segment and T Wave abnormalities

QRS Abnormalities
Bundle branch blocks RVH or LVH

RBBB:
QRS > 120ms rsR or rSR in V1 and V2 Wide S in I, V5 and V6

LBBB:
QRS > 120ms Broad notched R in I, V5 or V6 No Q in I, V5 or V6

LAFB:
Left axis
(-45 to -90)

qR in I or aVL rS in II, III, aVF

LPFB:
Right axis
(90 to 180)

rS in I or aVL qR in II, III, aVF

Diagnosis?

RBBB
QRS > 120 ms

Wide S in I, V5 and V6

V1 or V2

Diagnosis?

LBBB
QRS > 120ms

Wide R in I, V5 and V6

No Q in I, V5, V6

Diagnosis?

LAFB
qR pattern (I or aVL) Left axis deviation

rS pattern (II, III, aVF)

 RVH: R > S in V1 or V2

LVH: R > 20mm (I) or R > 30 mm (V5/V6)

How to analyze EKGs

1. Rate 2. Intervals 3. Rhythm 4. Axis 5. P wave abnormalities 6. QRS Abnormalities 7. ST segment and T Wave abnormalities

Ischemia, Injury, Infarction

T wave inversion ST Inversion T wave segment elevation

ST Segment Elevation Q waves Q wave only