ECGs again Mary L Dohrmann MD Professor of

ECGs (again!) Mary L. Dohrmann, MD Professor of Clinical Medicine Division of Cardiovascular Medicine

ECG Interpretation Practice!

http: //ecg. bidmc. harvard. edu/maven main. asp What is ECG Wave-Maven? Proficiency in electrocardiogram (ECG) interpretation is an essential skill for medical students, housestaff, and clinicians. However, medical school and postgraduate resources to develop and upgrade the necessary high level of "ECG literacy" are severely limited. Further, current textbook and classroom instructional materials do not adequately integrate ECG interpretation into specific contexts where waveform findings must be correlated with other clinical data. We have begun to address the limitations in traditional approaches to ECG pedagogy by creating the infrastructure for a unique web-based tutorial.

ECG Interpretation Observation Conclusion Clinical context/significance

Rhythm Sinus Morphology Not sinus Supravent. Ventricular

Morphology Hierarchy WPW > LBBB > LVH > MI

The Normal ECG

The Normal ECG Sinus rhythm (P before @ QRS) Rate 50 – 100 bpm Axis +90 o to – 30 o Intervals: PR. 12 -. 21 sec QRS <. 10 sec QTc <. 46 sec (observed QT⁄ √ (RR) interval)

51 y/o male with chest pain 100% occlusion of a diagonal (also had 3 vessel disease, normal LVEF)

29 y/o with chest pain Diffuse ST elevation c/w pericarditis, ? PR segment depression

47 y/o male with chest pain Acute inferior MI – culprit vessel RCA

41 y/o male with severe SOB Extensive anterior/anterolateral MI

54 y/o male with exertional chest pain AMI, indeterminate age; RBBB and left axis

60 y/o comatose s/p MVA Low voltage Simple cifferential of low voltage: air, fat, fluid, no muscle

60 y/o with chest pain LVH with LAD, ST-T abn, & LAE In patient with angina and LVH, always think of aortic stenosis and hypertrophic cardiomyopathy in differential diagnosis

40 y/o with chest pain & palpitations short PR/delta wave c/w preexcitation (WPW) – note pseudo-Qs inferiorly

70 y/o with exertional chest pain LBBB If need stress test in this patient, use pharmacologic stress with adenosine combined with imaging modality (sestamibi or cardiac MRI)