60-100 dep. on heart rate PR Interval OT Interval ECG Normal Values HR ate Us (/min) max. (s)_(s) 60 oz 0.35-0.43 70 0.19 0.32-0.40 80 0.18 0.30-0.37 90 [0.17 0.29-0.35 100 0.16 0.27-0.33 Pyrd Right Atrial Enlargement Elevated, peaked P wave > 0.2 mV, particularly in I, il and aVF. Left Atrial Enlargement Widening of P wave > 0.15, partic. in |, Il and V,-V3, In Vy often biphasic P with a marked negative deflection. vie Priauee aun Sokolow index: R Vz + SVs > 1.05 mV; right axis deviation, left axis deviation ot c ERE en ete Peis as No widening of the ORS, but left axis deviation. mss No widening of the ORS, but right axis deviation. ee) Widening of the QRS > 0.10 s, but < 0.12 s, often R-reduction over the anterior wall. periods in ms, amplitudes in mV 120° Axis Deviation Widening of the ORS > 0.12 s, delay of terminal negativity in \Vg > 0.05 s, freq. loss of R on ‘ant. wall, left precordial repo- lariz. disturb. and ST-elevation. Qiooners Widening of the QRS > 0.12s, delay of terminal negativity in 'V, > 0.03 s, freq. rSr’ compl. in Vj. tepolar. disturb. in V;-Vs. CRC Tae acy eases ‘Consistent delay in conduction, PR interval > 0.20 s. ae Peo Intermitt. conduction failure ‘with missing QRS complexes, progressive prolongation of PR interv. until a P wave is blocked. Pe oe Intermittent failure of the AV conduction, the PR interval remains within normal limits. Ny ~ 3° AV Block (Total Block) Complete conduction block of all electrical impulses between atria and ventricles, atria and ventricles beat independently. errs, Acute Pericarditis Simultaneous ST elevations on the anterior and posterior wall, typically originating from the S wave, can be misinter- preted as Ml. aVF 90° Hypertrophic (Obstructive) end ‘Signs of left ventricular hyper- ‘trophy (Sokolow index), ‘varying ST segment changes without classic localization and deep inverted T waves. keene Nonspecif. repolariz. disturban. Petienn ae Puen au 1, Upper Junctional Rhythm: P waves in |, Il, Ill, aVE are neg., PR Interval can be short. 2. Central Junction. Rhythm: P waves are hidden in the ORS. '3. Lower Junctional Rhythm: P waves are negative in I, Il, Il and located behind QRS compl. hee ls Prolong. of sinoatrial condu ‘tion time. Not visible on ECG. Pes eA sacel Progress. prolongation of the ‘SA conduct. with an ultimate interruption in conduction. ‘Sinus intervals shorten until a break occurs which is shorter [than two PP intervals. ALAA Intermitt. sinus pauses that are ‘a multiple of the sinus interval. ceed Complete block. Cardiac arrest, escape rhythm from a junction. lor ventricular depolar. sit Pewee 1. Carotid Sinus Syndrome Pressure on the carotid sinus ‘can cause sinus bradycardia and AV block, sometimes with \vasodilat, and hypotension. s 80 90 0 20 OL vl ZL (sjumsz) 07 BL OL | 002 00€ OO» || Aduanbai4 SZL OSL | z (s/w gz) yu x 0] - eee 06 OOL | | | | ii Sh Ov (s/uw os) YuXxL se“a us Bere ite Cams nice Gal) Orthodr. Tachycard. in WPW: | Sustained E gen. Syneop j= & |Stimulat.ofmechanoreceptors | {Regular tachycardia, narrow us ws [left ventric) results in brady- ||RS complex, P waves at the | Broad ORS complexes at a rate = |cardia and peripheral vasodila- | end of ORS in the early ST —_| of > 90 beats/min. & tation leading to hypotension. | |segment, no Delta waves. Atrial Fibr. with Bradycardia } Antidro. Tachycard. in WPW: A & |No P waves, an irregular Regular tachycardia, signifi- é d isoelectric line, bradycardia _||cant delta waves, short PR eS CEST DALE 5 and absolute arrhythmia interval, broad QRS complex. _||Chaotic ventricular electrical oe |__| Ciscoe. Ss Variable RR intervals (absolute | | wwe io LEDER TOTES arrhythmia), delta wave of Long OT Syndrom: FM Sinus Tachycardia enengina morpho! onyevatt= Abnormal prolongation of the able ORS complexes. st |Supraventr. tachycardia with 2 | Pompe are eorreeked GTi Intsrvaly ” Pb da tte Lethe, Regular P waves at rate of 100 3 -200 beats/min, some of the P TTT A Atrial Fibrillation waves are neg. in Il, Ill and aVF. Fi LOLA ND S |No P waves, irreg. iscelec. line, | SIRLSSUIEES UE IOUTS — | — |atrial frequency of > 300/min ||Alternating tachycardic (atrial bee . disor S |with absol. arrhythmia and a_||fibrillation, atrial flutter, atrial Se Re ventric. rate of > 90 beats/min.| tachycardias) and bradycardic ||P". Thy 7 LJ |[attvtnmis sinoatrial block, ia TU waves. _19 sinus bradycardia), sometimes | (AN/SAEUSUIE) 7 oan an AV block occurs. Tall, peaked T Atrial frequency of 240-300 | [ur aaUcnemScnertetnem) |Waves that later beats/min, sawtooth-like P| lExtra beats with a broad Be 3 waves with reg or irreg. vent. |1( 0,125) and bizarre ORS. |[ORS complex. conduct. through the AV node. ||Sometimes compensat. pause. | |FiNally, tachycardic arrhyth- AA mias can occur resulting in 3 bradycardia and asystol © NMEATRETSACENTEIN |pigeminy: Every sinus beat is Narrow ORS, P waves hidden in || followed by a premature Shortening of —2 ORS, AV reentry can lead to_||ventricular contraction (PVC). ||the corrected QT FH |repolar. disturb. and ST depr. Interval (OTe). “8 HEE de = E Trigeminy: Every second sinus ||Prolongation —3 © [eis beat is followed by a PVC. lof the QT _¢ , SEES eee _ aay = , : rn © & |Short. PRintervals, delta waves, | falj simultan. to T of prev. beat. -- - —B x |ORS> 0.125, repolar. disturb. Shallow ST ot depressions. AV 3 LAA ALA blocks possible. =» SLL —s ~ Ime nine —2 . (i 2 = Horizontal or a descending ewer Afew E st depression. EO | _ minutes _2 3 Diam stage | ies — Early Stage: _ & [Tall Twave. ee > stows = © |stage I: Stage — % |STelevation and R waves are present, S % |no Q waves, T waves are still positive. Next Stage} Days ~a Intermediate Stage: ST elevation and R wave decrease, Q waves Stage Ill Residual _3 arise and inverted T waves appear. a : ee gw (Seat Singer i Infarct Localization —S FS |Qwaves develop, R wave will disappear. : SUE S_|Stage Ill (chronic): — —8 © |Loss of R wave in the ant. leads, Q waves may be _ ‘ ane = S_ |found across the ant. myocard. wall, T wave Ieraroeent| AG 3 S [becomes pos. again and ST elevat_ disappears. | [io s Fell Non-Q-Wave Myocardial Infarction a a = uu ; Posterolat. | [4] 2 ‘Subendocardial infarction of the anterior wall . z a with T wave inversion over anterior precordial | |!nferior | le o —¢— leads, no ST elevations, no R loss, no Qwaves. | |Rightventr| | [+] [+] +04ECG Evaluation po Inter- costal space Ics: Zs Paes Ea ees (Wa ND~-5S C) aVR Inter- costal space ICS: Paice] at} See Nm eel ee Bipolar leads. The amplitude is positive if the depolarization moves towards the positive electrode marked with@. right leg: black ground cable 2. Wilson's chest (precordial) leads (V1-V6) Unipolar leads. They measure the voltage of any one electrode relative to a constructed zero potential. Vi | 4" ICS at the right sternal border V2 | 4" ICS at the left sternal border V3 |_midway between V2 and V4 V4 |_ Si ICS at the midclavicular line V5 [_5" ICS at the left anterior axillary line V6 |S ICS at the left midaxillary line Re Cur eT mE) Unipolar leads. They measure electrocardiographic changes on the inferior cardiac wall. Limb cables (red, yellow, green) as well as V1-V3 or V4-V6 could be attached. 5 ICS at the left posterior axillary line 5 ICS at the midscapulary line ST ICS at the left paravertebral line right leg: black ground cable Cross section of the heart (V1-V9) If a right ventricular infarction is suspected, Var on the right side of the chest is useful Caution: Placing the electrodes improperly, for example in the second intercostal space, may lead to an R reduction in the anterior leads and may, therefore, be misinterpreted as an old anterior myocardial infarction. 4, Goldberger’s augmented leads aVR, aVL, aVF The augmented leads are obtained by recording voltages from the limbs. Their amplitudes are higher (’a" stands for “augmented"). aVR right arm aVL Teftarm aVF left leg 5. Nehb’s special leads Bipolar leads. They measure electrocardiographic changes at the posterior cardiac wall. Limb cables (red, yellow, green) could be attached. 24 ICS at the right sternal border St ICS at the apex of the heart 5t ICS at the left posterior axillary line Cross section of the heart (1-3) Possible ECG malfunction: disconnected electrodes, damaged cables, muscular shivering, incorrect polarization of limb/chest leads, mains noise“m Initials Date of birth Sex FM Main diagnosis: 1 Antiarrhythmics: Digitalis O RR Intervals regular Y N LU Sie Lis f min Tachycardia (> 90/min) O Bradycardia (< 50/min) O positive in 1, Il, Ill (sinus rhythm) YN regular, followed by QRS Y N= bsolute arrhythmia (atrial fibrillation) ‘sawtooth" (atrial flutter) O EMIT 0.12-0.20s Y N ---- shortened, < 0.12 s © prolonged, > 0.2 s (AV block) O 0, pattern (5, S, S,,-pattern) © xtreme right O right O extreme left O ORS Complex QRS Duration normal <0.1s Y N complete bundle branch block (0.10-0.12 s) complete bundle branch block (> 0.12 s) terminal deflection delayed in V, (> 0.03 s) > RBBB C t delayed in V, (> 0.05 s) > LBBB WR occcoc normal in V.=V._ YN --=--- insufficient R-Progression in VV. V. V. V. V. ms fen a ae 000 significantly pathological, in Y_N aniege Signs of Hypertrophy YN +S S V5 yo + Ry, > 3.5 mV (Sokolovle) OR > 1.05 mV (Sokolov ri, Vs SUS ss isoelectric Y N -- descend. positive in I-III, V\-V, YN negative T wave symmetr. © preterminalO terminalO. CSA iy QT (s) | corrected QT interval Bazett: —— aac Y N QTduration:, QT duration (QT) is RRS) ) L normal © borderline O pathological O signature {oO date,HELL ji 400 300 200 150 100 90 807570 65 60 55 50 7S och cbecbL LLL LLL hlelacbslanl 2xRR 25mm/s 1xRR 50mm/s Sale oo oo 40 35 30 2 2 5 Leal lll llieleedalee 35, wo S 55 0.33 0.37 9,41 0.45 0.49 0.53 3 (a) yw U 100-—600 __ ~ \ “AL Ae — O28 020 60 031 035 0.39 0.43 0.47 051 & 94 — 638 £ 65 0.30 0.34 0.37 0,41 0.45 0.49 uv 92 — 652 — 0.19 70 0.29 0.32 0.36 0.40 0.43 047 3} 50-100 = Oe s 75 0.28 0.31 0.35 0,38 0.42 0.45 o 120-200 60-100 ee 86 — 698 & 0.18 80 0.27 0.30 0.34 0.37 0.41 0.44 7 § 474 = 85 0.26 0.29 0.33 0.36 0.39 0.43 dep. on heart rate x ae 0.17 90 025 0.29 0.32 0.35 0.38 0.41 = PR Interval OT Interval = f 95 0.25 0.28 0.31 0.34 0.37 0.40 oO 78 — 769 of = ECG Wave Forms and Intervals [ms] aVF 3 0.16 100 024 0.27 0.30 0.33 0.36 039 S 72 — 833 110 0.23 0.26 0.29 032 0.35 037 [oven 70— 857 120 0.22 0.25 0.28 0.30 0.33 0.36 68 — 882 130 0.21 0.24 0.27 0.29 0.32 034 o o | | | | | | | | Is} i 7 ie 140 0.20 0.23 0.26 0.28 0.31 0.33 3 tls . = (C) ae 150 0.20 0.25 0.27 0.30 032 = ER 06 04 0.2 0 02 04 0.6 08 10 1.2 1.4 1.6 18 20 25mm/s $8 — 1034 a Cn crey £ 03 0.2 01 0 O01 02 03 04 05 06 07 0.8 09 1.0 50mm/s 2 iy - = 1 PR QRS 50—1200 GZ 08 $8 06 S600 Ol OZ! 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