Transcript Appendix D Basic 12-Lead Interpretation

Appendix D
Basic 12-Lead Interpretation
Gail Walraven, Basic Arrhythmias, Sixth Edition
©2006 by Pearson Education, Inc., Upper Saddle River, NJ
Myocardial Damage
Caused by lack of oxygen to heart muscle
 Ischemia: Initial insult
 Injury: Damage caused by continued
hypoxia
 Infarction: Tissue death from prolonged
hypoxia
Gail Walraven, Basic Arrhythmias, Sixth Edition
©2006 by Pearson Education, Inc., Upper Saddle River, NJ
Infarction Location
Surface
Facing Leads
Anterior
V1, V2, V3, V4
Lateral
I, aVL, V5, V6
Inferior
II, III, aVF
Gail Walraven, Basic Arrhythmias, Sixth Edition
©2006 by Pearson Education, Inc., Upper Saddle River, NJ
Infarction Location
These leads…
Are directly over these surfaces
V1
Anterior wall of the right ventricle
V2 & V3
Anterior wall over the septum
V3 & V4
Anterior wall of the left ventricle
Gail Walraven, Basic Arrhythmias, Sixth Edition
©2006 by Pearson Education, Inc., Upper Saddle River, NJ
Grades of Myocardial Damage
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Extent of Infarction
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Ischemic Changes
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Age of Infarction (Transmural MI)
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Infarction Location
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Anterior Wall Infarction (EKG)
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Anterior Wall Infarction (Surfaces)
Gail Walraven, Basic Arrhythmias, Sixth Edition
©2006 by Pearson Education, Inc., Upper Saddle River, NJ
Lateral Wall Infarction (EKG)
Gail Walraven, Basic Arrhythmias, Sixth Edition
©2006 by Pearson Education, Inc., Upper Saddle River, NJ
Lateral Wall Infarction (Surfaces)
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©2006 by Pearson Education, Inc., Upper Saddle River, NJ
Inferior Wall Infarction (EKG)
Gail Walraven, Basic Arrhythmias, Sixth Edition
©2006 by Pearson Education, Inc., Upper Saddle River, NJ
Inferior Wall Infarction (Surfaces)
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©2006 by Pearson Education, Inc., Upper Saddle River, NJ
Atrial Enlargement
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Ventricular Enlargement
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Rule of 35
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Right Bundle Branch Block
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Left Bundle Branch Block
Gail Walraven, Basic Arrhythmias, Sixth Edition
©2006 by Pearson Education, Inc., Upper Saddle River, NJ
Gail Walraven, Basic Arrhythmias, Sixth Edition
©2006 by Pearson Education, Inc., Upper Saddle River, NJ
Gail Walraven, Basic Arrhythmias, Sixth Edition
©2006 by Pearson Education, Inc., Upper Saddle River, NJ
Gail Walraven, Basic Arrhythmias, Sixth Edition
©2006 by Pearson Education, Inc., Upper Saddle River, NJ
Gail Walraven, Basic Arrhythmias, Sixth Edition
©2006 by Pearson Education, Inc., Upper Saddle River, NJ
Gail Walraven, Basic Arrhythmias, Sixth Edition
©2006 by Pearson Education, Inc., Upper Saddle River, NJ
Gail Walraven, Basic Arrhythmias, Sixth Edition
©2006 by Pearson Education, Inc., Upper Saddle River, NJ
EKG Abnormalities –
P Waves
Abnormality
• Wide, flat P waves
• No P waves
Suggestive of
Hyperkalemia
Gail Walraven, Basic Arrhythmias, Sixth Edition
©2006 by Pearson Education, Inc., Upper Saddle River, NJ
EKG Abnormalities –
QRS Complexes
Abnormality
Suggestive of
 Widening of QRS
 Merging QRS and T
Hyperkalemia
 Widening of QRS
Hypokalemia
 Prolonged QT interval
Hypercalcemia
 Short QT interval
Hypocalcemia
 Short QT interval
Digitalis Toxicity
Gail Walraven, Basic Arrhythmias, Sixth Edition
©2006 by Pearson Education, Inc., Upper Saddle River, NJ
EKG Abnormalities –
ST Segments
Abnormality
Suggestive of
 Disappearing ST segments
Hyperkalemia
 ST depression
Hypokalemia
 Sloping ST segments
 Depressed, “scooped” ST segments
 Elevated, concave ST segments
Digitalis Toxicity
Pericarditis
Gail Walraven, Basic Arrhythmias, Sixth Edition
©2006 by Pearson Education, Inc., Upper Saddle River, NJ
EKG Abnormalities –
T Waves
Abnormality
Suggestive of
 Tall, peaked T waves
Hyperkalemia
 Flattening of T wave
Hypokalemia
 Diphasic or inverted T waves
Digitalis Toxicity
Gail Walraven, Basic Arrhythmias, Sixth Edition
©2006 by Pearson Education, Inc., Upper Saddle River, NJ
EKG Abnormalities –
U Waves
Abnormality
 Development of U waves
Suggestive of
Hyperkalemia
Gail Walraven, Basic Arrhythmias, Sixth Edition
©2006 by Pearson Education, Inc., Upper Saddle River, NJ
Analysis Format for 12-Lead EKG
Interpretation
Gail Walraven, Basic Arrhythmias, Sixth Edition
©2006 by Pearson Education, Inc., Upper Saddle River, NJ
Gail Walraven, Basic Arrhythmias, Sixth Edition
©2006 by Pearson Education, Inc., Upper Saddle River, NJ
Gail Walraven, Basic Arrhythmias, Sixth Edition
©2006 by Pearson Education, Inc., Upper Saddle River, NJ
Gail Walraven, Basic Arrhythmias, Sixth Edition
©2006 by Pearson Education, Inc., Upper Saddle River, NJ
Gail Walraven, Basic Arrhythmias, Sixth Edition
©2006 by Pearson Education, Inc., Upper Saddle River, NJ
Gail Walraven, Basic Arrhythmias, Sixth Edition
©2006 by Pearson Education, Inc., Upper Saddle River, NJ
Gail Walraven, Basic Arrhythmias, Sixth Edition
©2006 by Pearson Education, Inc., Upper Saddle River, NJ
Gail Walraven, Basic Arrhythmias, Sixth Edition
©2006 by Pearson Education, Inc., Upper Saddle River, NJ
Miscellaneous Abnormalities, cont.
Gail Walraven, Basic Arrhythmias, Sixth Edition
©2006 by Pearson Education, Inc., Upper Saddle River, NJ
Miscellaneous Abnormalities, cont.
Gail Walraven, Basic Arrhythmias, Sixth Edition
©2006 by Pearson Education, Inc., Upper Saddle River, NJ
Miscellaneous Abnormalities, cont.
Gail Walraven, Basic Arrhythmias, Sixth Edition
©2006 by Pearson Education, Inc., Upper Saddle River, NJ
12-Lead EKG
(Practice Tracing #1)
Gail Walraven, Basic Arrhythmias, Sixth Edition
©2006 by Pearson Education, Inc., Upper Saddle River, NJ
12-Lead EKG
(Practice Tracing #2)
Gail Walraven, Basic Arrhythmias, Sixth Edition
©2006 by Pearson Education, Inc., Upper Saddle River, NJ
12-Lead EKG
(Practice Tracing #3)
Gail Walraven, Basic Arrhythmias, Sixth Edition
©2006 by Pearson Education, Inc., Upper Saddle River, NJ
12-Lead EKG
(Practice Tracing #4)
Gail Walraven, Basic Arrhythmias, Sixth Edition
©2006 by Pearson Education, Inc., Upper Saddle River, NJ
12-Lead EKG
(Practice Tracing #5)
Gail Walraven, Basic Arrhythmias, Sixth Edition
©2006 by Pearson Education, Inc., Upper Saddle River, NJ
12-Lead EKG
(Practice Tracing #6)
Gail Walraven, Basic Arrhythmias, Sixth Edition
©2006 by Pearson Education, Inc., Upper Saddle River, NJ
12-Lead EKG
(Practice Tracing #7)
Gail Walraven, Basic Arrhythmias, Sixth Edition
©2006 by Pearson Education, Inc., Upper Saddle River, NJ
12-Lead EKG
(Practice Tracing #8)
Gail Walraven, Basic Arrhythmias, Sixth Edition
©2006 by Pearson Education, Inc., Upper Saddle River, NJ
12-Lead EKG
(Practice Tracing #9)
Gail Walraven, Basic Arrhythmias, Sixth Edition
©2006 by Pearson Education, Inc., Upper Saddle River, NJ
12-Lead EKG
(Practice Tracing #10)
Gail Walraven, Basic Arrhythmias, Sixth Edition
©2006 by Pearson Education, Inc., Upper Saddle River, NJ
12-Lead EKG
(Practice Tracing #11)
Gail Walraven, Basic Arrhythmias, Sixth Edition
©2006 by Pearson Education, Inc., Upper Saddle River, NJ
12-Lead EKG
(Practice Tracing #12)
Gail Walraven, Basic Arrhythmias, Sixth Edition
©2006 by Pearson Education, Inc., Upper Saddle River, NJ
12-Lead EKG
(Practice Tracing #13)
Gail Walraven, Basic Arrhythmias, Sixth Edition
©2006 by Pearson Education, Inc., Upper Saddle River, NJ
12-Lead EKG
(Practice Tracing #14)
Gail Walraven, Basic Arrhythmias, Sixth Edition
©2006 by Pearson Education, Inc., Upper Saddle River, NJ
12-Lead EKG
(Practice Tracing #15)
Gail Walraven, Basic Arrhythmias, Sixth Edition
©2006 by Pearson Education, Inc., Upper Saddle River, NJ
12-Lead EKG
(Practice Tracing #16)
Gail Walraven, Basic Arrhythmias, Sixth Edition
©2006 by Pearson Education, Inc., Upper Saddle River, NJ
12-Lead EKG
(Practice Tracing #17)
Gail Walraven, Basic Arrhythmias, Sixth Edition
©2006 by Pearson Education, Inc., Upper Saddle River, NJ
12-Lead EKG
(Practice Tracing #18)
Gail Walraven, Basic Arrhythmias, Sixth Edition
©2006 by Pearson Education, Inc., Upper Saddle River, NJ