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Thu, Oct. 13th, 2005, 09:05 pm
relliott: How to read wavy lines and sound like you know something (part I)

...or more commonly: ECG Interpretation



You should be able to at least recognise the following by finals:

  • Myocardial infarction

  • VF/VT

  • Heart Block

  • Tachy- and Bradyarrythmias

  • Things with funny names - Like Wolff-Parkinson-White syndrome



Funny names usually crop up somewhere and if you have at least heard it before then you stand half a chance of realising it's to do with the heart and not the liver or something.

Reading the ECG
Look at each part in turn.

Yes, that's all there is to it. You are aiming for a description of what you see, not on the spot diagnosis

Rate

  • 300 divided by the number of big squares between peaks e.g. 300/4 = 75 bpm

  • Normal between 60 and 100 bpm at rest



Rhythm
It is unlikely you will be expected to identify a complex arrythmia.

Normal

  • P wave before every QRS

  • PR interval less than 5 small squares

  • QRS interval less than 3 small squares



Ectopics

  • Ventricular - wide, bizarre QRS complexes

  • Atrial - unusual P wave shape or timing



Tachyarrhythmias

  • Supraventricular - QRS width normal and rate over 100


    • sinus tachy. - p waves before QRS

    • supravent. tachy - p waves small or absent

    • atrial fibrillation - irregularly irregular rate, no p waves


  • Ventricular - irregular shaped QRS


    • VT - no p waves (usually) and broad QRS

    • VF - bizarre squiggle




Bradyarrhythmias

  • Sinus brady - P waves present, QRS normal

  • Nodal - no p waves, QRS normal

  • Heart block - a-v increasingly refractory (impulses not transmitted)


    • First degree - long PR but all p waves transmitted

    • 2nd degree (FUNNY NAME ALERT)


      • Wenckebach (Mobitz type I) - PR interval increases til a beat is dropped

      • Mobitz type II - regular dropped beat - 2:1 block and 3:1 block


    • 3rd degree - COMPLETE heart block - LOW rate and no relation of p to QRS



And now a handy heart block picture:






Thats all I have time for just now. I'll go on to axis and interval changes, QRS abnormalities and ST segments next time

Mon, Oct. 31st, 2005 10:16 pm (UTC)
yumyum82: Oops

In response to your last post should probably say who i am..I'm Nadine, a final year medic at Glasgow. I'm absolutely terrified of finals, more so of the osce than the written paper. I think it would be a good idea to get a group of us to meet up somewhere and practise random stuff that it's hard to do elsewhere i.e ethics stations, breaking bad news, psychiatric drugs explanations, obs/gyn histories (nearly impossible to get enough practice in on real patients!)
Should also say that the real studying will have to kick in sooner rather than later so how about a study group? Say once a week? It could become a focus for solo studying and really motivate each other early on.
OK random rant over! Ruth, as I've said before, I can guarantee there will be LOADS of interest in this journal as the exams approach!! let me know what you think!!
Nadine

Mon, Oct. 31st, 2005 10:20 pm (UTC)
yumyum82: utterly clueless

ps. can you tell me how to post word files up( for the tutorials and SNQ's). have been trying for a while now and getting nowhere fast.
Cheers, Nadine

Thu, Nov. 24th, 2005 09:16 pm (UTC)
___grey___

I'm afraid I'd recognize only the first 4...