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ECG
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> rate .. RtoR - 1 large square = 300 / min (2 - 150, 3 - 100, 4 - 75 ...) PR - 0.12-0.2 secs (3-5 sm sq) QRS <0.12 (3smsq) leads - I II III aVr aVl aVf (east, SE, SW, NW, NE, S) ... V1-2 (R vent) V3-4 (septum and ant left vent) V5-6 (ant+lat left vent) Axis - look at I II III deflection is up as wave goes towards lead - so aVr is mostly down R axis - III biggest positive, I - negative - R vent hypertrophy L axis - III and II negative - L vent hypertrophy ? conduction defect Heart block 1st degree - prolonged PR - CAD, digitalis, electrolyte 2nd degree Mobitz 2 - constant PR Wenkebach - increasing PR then drop beat 2to1 or 3to1 - set conducting 3rd degree - no relationship P and QRS BBB - widened QRS - makes interpretation difficult (R) or impossible (L) RBBB - RSR in V1, LBBB - M in V6 Rhythm Sinus - tachy, brady Supraventricular - normal narrow QRS - Atrial (abN P), Junctional (no P) Ventricular - wide QRS and abN T (beware SVT with BBB QRS is wide from BBB) May be brady, tachy, or extrasystole (occasional) if disorganised - fibrillation Remember WPW - delta wave with re-entry tachycardia abN P tall - R atrial hypertrophy - Tricuspid stenosis - pulmonary HT broad - L atrial hypertrophy - Mitral stenosis abN QRS broad - BBB, ventricular tall - hypertrophy means big R - R - V1, L - V6 abN ST elevation - infarction or pericarditis (more widespread) depression - ischaemia (if sloping think digoxin) abN T ... Note PE - R dominant so R axis, R atrial and vent hypertrophy (tall P and big R in V1), RBBB, S1Q3T3 (S in I - Raxis, Q in III and inverted T in V3)
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