Basics of ECG
Basics of ECG
Heart Rate [ Ventricular rate ]
Rhythm – Regular (same R-R intervals): 1500 / No. of small squares between 2 R- waves.
Rhythm – Irregular (different R-R intervals): No. of R- waves in 15 large squares × 20
Atrial Rate
In Total Heart Block, It Is Different From The Ventricular Rate
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Atrial rate = 1500 / No. of small squares b/w 2 P- waves
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Axis deviation
Study I & III
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Normal QRS complexes are predominantly upwards in both these leads
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Left Axis Deviation
Left Axis Deviation– LVH, LBBB & inferior Wall infarct
Right Axis Deviation
Right Axis Deviation- RVH, RBBB & anterior Wall infarct
“Left Leaves & Right Reaches”
ATRIAL HYPERTROPHY/ ENLARGEMENT
Contour Of P- Wave
Seen Best In II
P- Wave Represent Depolarisation Of Both Right & Left Atria. The SA Node Starts Depolarisation In Right Atrium So That Initial Part Of P- Wave Is Contributed By Right Atrium & The Later Part Of P- Wave Is Contributed By Left Atrium.
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Left Atrial Enlargement: 2nd Part Is Delayed & Prominent, Wide (> 2.5 Small Squares) & Notched P- wave (since common in mitral valve diseases → P-mitrale )
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Right Atrial Enlargement: Initial Component Is Prominent: Tall (> 2.5 Small Squares) & Peaked P- wave (since common in pulmonary hypertension → P-pulmonale )
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BiLateral Atrial Enlargement : P- wave → taller > 2.5 small squares & wider > 2.5 small squares
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VENTRICULAR HYPERTROPHY
Diagnosed From Pattern And Amplitude Of QRS Complexes In The Chest Leads V₁ To V₆
Left Ventricular Hypertrophy
Pattern Normal
Amplitude Increases
Amplitude Of S- Wave In V₁ Or V₂ (Which Ever Is Larger) & Amplitude Of R- Wave In V₅ Or V₆ (Which Ever Is Larger)
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SV₁ > 25 Mm
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RV₆ > 25mm
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SV₁ + RV₆ > 35mm
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Usually associated with LAD
May Be associated with P- Mitrale
Right Ventricular Hypertrophy
Pattern Changed
Prominent R- Wave In V₁ & Deep S- Wave In V₆
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RV₁ > 7mm
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SV₆ > 7mm
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RV₁ + SV₆ > 10 Mm
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May Or May not associated with RAD
Often associated with P- Pulmonale
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