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Ecg for beginners
Dr. Awadhesh Kumar Sharma is an accomplished interventional cardiologist with a gold medal in MD and numerous accolades, including the Chief Minister’s Medal and GEMS International Award. He has performed over 10,000 invasive cardiac interventions and is involved in various medical journals and professional organizations. Currently, he serves as an assistant professor of cardiology at LPS Institute of Cardiology, focusing on public health awareness and ECG interpretation.
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Profile of Dr. Awadhesh Kr Sharma highlighting his education, awards, publications, and current role.
Introduction to ECG interpretation and the historical significance of the ECG, including Einthoven's contributions.
Description of the heart's conduction system including nodes and bundle branches along with phases of heart activity.
Explains different ECG machines (single, three, twelve channels) and lead arrangements.
Details on electrode placement, calibration, and standardization needed for ECG interpretation.
Methods to calculate heart rate for regular and irregular rhythms, discussing tachycardia and bradycardia.
Explanation of the hexaxial system for alignment of the heart's electrical activity and P wave genesis.
Identifies ECG wave abnormalities, PR intervals, QRS complexes, and implications such as LVH and RVH.
Discussion on acute coronary syndrome, J point significance, ST segment shapes, indicating cardiac conditions.
Presentation of various anatomic groups relevant to ECG interpretation and implications in cardiac assessment.
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Ecg for beginners
- 1. Dr Awadhesh KrSharma, MBBS,MD,DM,FACC,FSCAI Assistant Professor LPS Institute of Cardiology, Kanpur, UP
- 2. Dr. AwadheshKumar Sharma is a young, diligent and dynamic interventional cardiologist. He did his graduation from GSVM Medical College Kanpur and MD in Internal Medicine from MLB Medical College Jhansi. Then he did his super specilization(Doctoral) degree DM in Cardiology from Atal Bihari Vajpai institute of medical sciences & DR Ram Manohar Lohia Hospital New Delhi. He had excellent academic record with Gold medal in MD . He was also awarded chief minister’s medal in 2009 for his academic excellence by former chief minister of UP Hon. Km Mayawati in 2009.He is also receiver of GEMS international award. He had many national & international publications. He had special interest in both invasive & non invasive cardiology. He had performed more than 10000 invasive cardiac intervention procedures successfully till date including coronary angiography, simple & complex angioplasty, peripheral vessels angiography & angioplasty, carotid angiography & angioplasty, ASD ,PDA device closures, Mitral & pulmonary valvotomy. He is also in editorial board of many national & international journal- Journal of clinical medicine & research(JCMR),Clinical cardiology update, United Journal of Cardiology and Cardiovascular Medicine ,EC Pulmonology and Respiratory Medicine,EC Cardiology. He is also active member of reviewer board of many journals. He is also trainee fellow of American college of cardiology. He is active member of many professional bodies including Indian Medical Association, Cardiological Society of India, APVIC, ICC,API. He had worked in NABH Approved the Gracian Superspeciality Hospital Mohali as Consultant Cardiologist since 2014-2016. Currently he is working as Assistant Professor of cardiology at LPS Institute of Cardiology, GSVM Medical college, Kanpur(UP)under Govt of UP. He was awarded with prestigious fellowships of American college of cardiology(FACC) and FSCAI. He is actively involved in creating public awareness on different health issues pertaining to heart via his You tube channel- Happy & Healthy Heart.
- 3. To havebasic understanding of ECG waves & intervals. Interpretation of ECG Outline the criteria for the most common electrocardiographic diagnoses in adults. Describe critical aspects of the clinical application of the ECG
- 4. Still had sameclinical value. Einthoven with his string galvanometer Invented by Einthoven in 1901.(string galvanometer). In 1910 –emerged to clinical setting as fundamental diagnostic test to assess heart electrical activity. 1924 - The noble prize for physiology or medicine is given to William Einthoven for his work on ECG
- 5. Conduction system SA node-AVnode-LBB & RBB- His-purkinje system SA node AV node Bundle branch-Right bundle(RBB) & Left bundle-LBB(Left anterior fascicle-LAF and left posterior fascicle-LPF) His Purkinje system
- 6. Depolarization( systole,contraction)-Atrial & ventricular Repolarization(diastole, relaxation )- Atrial & ventricular
- 7. Single channel ECGmachine trace ECG trace from 3 channel machine Single channel ECG-one lead trace at a time. Three channel- four leads at a time 12 channel- 12 leads simultaneously
- 8. Augmented limbleads (increase voltage or amplitude by 50%) aVR (right arm), aVL (left arm), aVF (left foot) Color coding of limb electrode RA-Red, LA-yellow, LL-green, RL-black Standard bipolar limb leads I(LA &RA), II(LL & RA), III(LL & LA)
- 9. Precordial leads Precordialleads V1-V6 Views heart from horizontal plane
- 10. Standard Chest LeadElectrode Placement
- 12. 14 points tobe remembered 1. Standardization 2. Rate 3. Rhythm 4. Axis ECG Waves 1. P wave 2. Q wave 3. QRS wave/voltage 4. T wave 5. U wave Intervals/segments 1. PR interval 2. QRS interval/duration 3. ST segment 4. QT interval Precordial R wave progression
- 13. The firststep while reading ECG is to look for wheather standardization is properly done. Look for the vertical mark and see that the mark exactly covers two big squares(10 mm or 1mV) on the graph. Standard calibration 25 mm/s 0.1 mV/mm
- 14. ECG Paper ECGPaper Horizontal(x axis)-Speed 25 mm/sec 1 large square(5mm)= 0.2 sec 1 small square(1mm)=0.04 sec
- 15. Vertical(y axis)-amplitude 10 mm=1mVCaliberation
- 16. HR=300/No of largesquare For regular rhythm Rate=300/number of large square between two RR interval =1500/number of small square(more accurate) Rate- Normal- 60-100 beats/minute >100beats/minute- tachycardia <60 beats/minute- bradycardia
- 17. HR=8X10=80/minute For irregularrhythm 6 seconds rule Count number of QRS complex during 6 seconds i.e. 30 large squares and multiply it by 10. 1 large square=0.2 second 30 large square=30x0.2=6 seconds
- 18. Regular rhythm Ventricular Premature Complexes Regular-RR interval regular and fixed Regularly irregular-VPCs Irregularly irregular-AF Atrial fibrillation
- 19. Hexaxial system Verticalorientation or alignment of the heart in the thoracic cavity Normal axis(-30 to +90 degree) Left axis(-30 to -90 degree) Right axis(+90 to +180 degree) Indeterminate/north west axis(-90 to -180degree)
- 21. Negative in I-RAD Positivein I, negative in III- LEFT AXIS
- 22. P wave genesisP wave Due to atrial depolarization(contraction) No apparent wave because of atrial repolarization since it is of small amplitude and got hidden. Initial part is due to right atrial depolarization and later part is due to left atrial depolarization. Inter atrial conduction occurs through Bachmann bundle.
- 23. P wave abnormalities Left atrial abnormality Prolonged P wave duration that >120msec(3 small square) Notched P wave i.e. P mitrale Right atrial abnormality Peaked P wave with amplitude more than 0.25 mV(2.5mm) in lead II-P pulmonale Prominent initial positivity in V1 >1.5mm. LAA RAA
- 24. Prolonged PR interval Prolonged PR interval i.e. >200 milliseconds suggestive of first degree AV block. Can be due to drug effect like beta blockers.
- 25. QRS Complexes Firstnegative wave-q(first initial negative wave) or Q wave(first initial only negative deflection). First positive deflection-r or R wave Second negative deflection-s or S wave Second positive deflection- r’ or R’ wave
- 26. Suggestive ofold infarction or non viable myocardium
- 27. LVH 1. SV1+RV5>35mm(3.5mV) 2.R aVL >11mm(1.1mV) RVH 1. Tall R in V1>6mm(0.6mV) 2. Increased R/S in V1>1
- 28. Normal duration<120 m sec If QRS>120msec-intraventricular conduction defect LBBB 1. QRS>120msec 2. Deep S wave in V1 and V2 3. W pattern in V1 RBBB 1. QRS>120msec 2. Rsr’,rsR’ or Rsr’ pattern(M pattern) in leads V1 and V2
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- 30. From rin V1 to R in V6 Transition zone V3,V4 Slow progression of R wave- COPD,AWMI
- 31. Due toventricular repolarization. ST segment depression-myocardial ischemia ST segment elevation-myocardial infarction
- 32. Tall Twave-hyper acute injury Tall, tented T wave- hyperkalemia T wave inversion- myocardial ischemia
- 33. Duration ofventricular depolarization & repolarization QTc=QT/ (RR)½ QTc=QT+1.75(HR-60) Upper limit for QTc is 460 msec for women and 450msec for men.
- 34. Low amplitudewave Seen in lead V2,V3 at slower heart rates
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- 37. J point– where the QRS complex and ST segment meet ST segment elevation - evaluated 0.04 seconds (one small box) after J point The J Point
- 38. Coved shapeusually indicates acute injury. Concave shape is usually benign especially if patient is asymptomatic.
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