The second part explains the theory underpinning the recording of an ECG to begin a basic interpretation of the 12 leads. To do this place a piece of scrap paper over the ECG and mark a dot next to the top of a QRS complex, draw another dot next to the top of the next QRS then slide the paper along the ECG. If the rhythm is regular you should see that your two dots match to the tops of the QRS complexes throughout the ECG. If pulseless: start CPR, follow ACLS protocol for defibrillation, ET intubation, and administration f epinephrine or vasopressin, lidocaine, or amiodarone; ineffective consider magnesium sulfate. Count the number of QRSs on one line of the ECG (usually lead II – running along the bottom) and multiply by six. Dual chamber atrial pacing, implantable atrial pacemaker, or surgical maze procedure may also be used.

The atrial impulse is getting to the ventricle by a faster shortcut instead of conducting slowly across the atrial wall. This accessory pathway can be associated with a delta wave (see below). The lead with the most positive deflection is most aligned with the direction the heart’s electrical activity is travelling. An ECG lead is a graphical representation of the heart’s electrical activity which is calculated by analysing data from several ECG electrodes.This great book helps the reader to accept that the ECG is easy to learn and that its use is only a natural continuation of getting the patient’s history and performing a physical examination. It guides users of the electrocardiogram to straightforward and precise identification of normal and strange ECG patterns. This point can be elevated, resulting in the ST segment that follows it being raised (this is known as “high take-off”). When the rate is fast it can be difficult to see the irregularity but careful measurement will show it. AF is often asymptomatic and is increasingly common with age. Other common fast narrow complex tachycardias include supraventricular tachycardias (SVTs) or atrioventricular nodal re-entrant tachycardias. These are usually fast, regular rhythms associated with palpitations generally in a younger age group. ST-elevation is significant when it is greater than 1 mm (1 small square) in 2 or more contiguous limb leads or >2mm in 2 or more chest leads. If lead I has a positive deflection and aVF has a negative deflection then there is left axis deviation

Follow ACLS protocol for administration of atropine for symptoms of low cardiac output, dizziness, weakness, altered LOC, or low blood pressure.High-takeoff is where there is widespread concave ST elevation, often with a slurring of the j-point (start of the ST segment). It is most prominent in leads V2-5, is usually in young health people and is benign. Keeping this in mind will help you to interpret what you are seeing and identify which areas of the heart may be “hurting” or have damage. Tall complexes imply ventricular hypertrophy (although can be due to body habitus e.g. tall slim people). There are numerous algorithms for measuring LVH, such as the Sokolow-Lyon index or the Cornell index.

ECG is the abbreviated term for an electrocardiogram. It is used to record the electrical activity of the heart from different angles to both identify and locate pathology. Electrodes are placed on different parts of a patient’s limbs and chest to record the electrical activity. When confronted with an ECG it is best to start with the basics: rate, rhythm and axis. Then consider the PQRST complexes in all the leads with some basic questions in mind: It represents the time taken for the ventricles to depolarise and then repolarise. The components of an ECG Amjid Rehman has created an innovative, interactive online application to assist in honing and refining your ECG interpretation skills.In some cases there can be a notched (or bifid) p-wave known as “p mitrale”, indicative of left atrial hypertrophy which may be caused by mitral stenosis. There may be tall peaked p-waves. This is called “p-pulmonale” and is indicative of right atrial hypertrophy often secondary to tricuspid stenosis or pulmonary hypertension.