Hello everyone, In today's topic we are going to discuss about the what a standard 12 Lead ECG and how to interpret it in a simple 6 steps. I have made this content in a video format in Tamil and English. If you have any doubts kindly post in the comment section below.
TAMIL VIDEO:https://youtu.be/c1bxvGsCWKM
ENGLISH VIDEO:https://youtu.be/XfdchDKLS20
INTERPRETATION OF ECG:
ECG PAPER:
The ECG machine mostly runs at 25millimeter / second.
There are five small squares in one large square.
Small squares equals one minute (1500 x 0.04 = 60 seconds).
1 small square =0.04 seconds
1 LS = 0.2 seconds.
5 LS = 1 Second
30 LS = 6 Seconds.
We can also count the number of small squares in between 2 R waves and calculate the heart rate / minute.
1500 /n = heart rate / minute.
But usually the heart rate slows during expiration and speeds during inspiration.
In this time we can calculate the RR interval technique.
Count 30 large square
5 LS = 1 Second
30 LS = 6 Seconds.
Count the no of R waves in the 30 LS. There will be a indication in most of the ECG Paper.
Eg : 7 waves means 7 beats in 6 seconds .
So 60 seconds means 7*10= 70 b/ min.
P WAVE – Atrial contraction / atrial depolarization.
PQ – Time taken for the impulse to move from SA node to AV node.
QRS – Ventricular depolarization.
T Wave – Ventricular repolarization.
P wave is the first positive deflection .
Q wave is the first negative deflection.
P WAVE 0.08 -0.1 sec
PR interval 0.12-0.20 sec
QRS complex 0.06- 0.12 sec
QT interval 0.4 sec.
INTERPRETING ECG BY 6 STEPS:
1. Examine the P wave.
2. Measure the PR interval
3. Measure the QRS Complex.
4. Identify the Rhythm.
5. Evaluate the heart rate.
6. Interpret the ECG.
1. EXAMINE THE P WAVE:
The normal P wave will be present and upright.
Identify P wave for every QRS and P wave must be upright and uniform.
If the P wave is absent or inverted it indicates a form of dysrhythmia (junctional rhythm).
Generally the impulse originates from the SA node but if its originating from the AV node or Bundle of His is called as junctional rhythm.
This Junctional rhythm happen when there is a problem in the SA node, hyperkalemia etc..
2.MEASURE THE PR INTERVAL:
PR Interval must be measured from the beginning of the P wave to the beginning of the QRS Complex.
To measure it count the small boxes and multiply by 0.04 seconds .
The normal range is 0.12 – 0.20 sec
If its more than 0.20 sec it indicates dysrhythmia such as heart blocks.
This indicates the slowing of conduction between the atria and the ventricles.
If its less than 0.12 sec it indicates wolff Parkinson white syndrome, enhanced AV node conduction , junctional arrhythmias.
3. MEASURE THE QRS COMPLEX:
Measure the number of boxes in the QRS complex.
The normal range is 0.06 -0.12 sec .
The QRS interval duration is measured by counting the small squares and multiplying by 0.04.
If its more than 0.12 sec means Premature Ventricular Contraction (PVC).
It means the extra heartbeats that benign in one of the hearts two lower ventricles.
4. IDENTIFY THE RHYTHM:
Measure the distance between the R waves (RR interval i.e ventricular rate).
The rhythm can be regular or irregular.
You can measure this with a paper and pen . Mark the distance between 2 R waves and match it with the rest of the waves. IF the distance is same the the rhythm is regular . If the distance is not same then its irregular.
5.EVALUATE THE HEART RATE:
A) Count the number of R waves in a six (6) seconds strip (6 inches = 6 seconds).
Multiply the number of R waves by ten (10) to get a rhythm rate for one (1) minute.
60 seconds = 6* 10
B) Count the number of large squares between two (2) R waves. Divide 300 by that number. Best this method is used only if the rhythm is regular.
C) Count the number of small squares between two (2) R waves. Divide 1500 by that number.
Small squares equals one minute (1500 x 0.04 = 60 seconds). We can also count the number of small squares inbetween 2 R waves and calculate the heart rate / minute.
1500 /n = heart rate / minute
6.INTERPRET THE ECG
1. Normal Sinus Rhythm. 12. Ventricular Tachycardia
2. Sinus Bradycardia 13. Ventricular Fibrillation.
3. Sinus Tachycardia 14. Asystole
4. Sinus Arrhythmias
5. Premature Atrial Contraction.
6.Atrial Tachycardia
7. Supra Ventricular Tachycadia.
8. First degree, Second degree , Third Degree Heart Block.
9. Atrial Fibrillation.
10. Ventricular Fibrillation
11.Premature Ventricular Contractions.
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