assalamualaikum w.b.t...
so this one is continuation of previous ECG entry here..
this is actualy the next step on how we wanna easily interpret ECG..again, ni my way of understanding..if anyone ada different opinion can share below :)
RULE 1: NORMAL PR INTERVAL
PR interval should be 120-200 miliseconds [3-5 little square]
- if P wave present w/o QRS, maksudnya complete heart block (3rd degree heart block)
- if ada shortened PR --> WPW (w presence of delta wave)
**tapi tak semua delta wave indicate WPW..maybe just indicate tachyarrythmias..cuma WPW memang ada delta wave
- >5square - 1st deg heart block
- >5square w drop QRS/ absent QRS - 2nd deg heart block [MT1] (conduction problem)
- intermittent drop of QRS - Mobit T2, can also be 3rd deg heart block
RULE 2: QRS COMPLEX WIDTH
Should not exceed 3 small square
if narrow
-problem w purkinje fibre
if broad
-RBBB --> Mpattern in v1/v2/v3
-LBBB --> Mpattern in v6/v4/v5 together w T inversion
RULE 3: QRS COMPLEX POSITION/ DIRECTION
Should be dominantly upright in lead I & II
RULE 4: QRS & T WAVE DIRECTION
this one untuk tengok axis..
Should have same/similar general direction in limb leads
-boleh tengok kat lead I&aVF too :)
-tengok too kat lead V1&V6 --> if peak means LVH
in short,
1) ^, ^ = normal
2) ^, v = LAD
3) v, ^ = RAD
RULE 5: aVR LEAD
All waves are negative in lead aVR
RULE 6: RS WAVE
- R wave must grow from V1 to atleast V4
- S wave must grow from V1 to atleast V3 ; then regress and disappear in V6
*maksudnya, graph tu makin naik
*if ada poor progression of RS means ada previous MI (tapi in obese pt boleh jadi normal)
RULE 7: ST SEGMENTS
Should start isoelectric except V1 & V2
**maksudnya reading tu makin turun
-if ST elevation, means ada acute MI
-if ST depression means myocardial ischemia
RULE 8: P WAVE
Should be upright in I, II, V2 to V6
in short,
1) if ada p-pulmonale appearance (^) = RA enlargement
2) if ada p-mitrale appearence (m-pattern) = LA enlargement
3) sawtooth appearance (^^^^) = atrial flutter
4) flat appearance (____) = atrial fibrillation
5) inverted p-wave (v) = ectopic atrial rhythm RULE 9: Q WAVE
There should be no Q wave or only small q (less than 0.04sec) in width in I, II, V2-V6
RULE 10: T WAVE
Must be upright in I, II, V2 – V6
-normal one should be asymmetrical
-can be dua possibilities: tall/inverted T-wave
**thats all dulu :) if ada nak tanya anything feel free to comment below..insyaAllah yanie jawab if mampu :) im not expert in ECG but will try to help as much as i can :)
xoxo,
yanie
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