ECG – A Technologists Guide to Interpretation Colin Tso MBBS PhD FRACP FCSANZ 1,2 , Geoff Currie BPharm MMedRadSc(NucMed) MAppMngt(Hlth) MBA PhD CNMT 1,4,5 , David Gilmore ABD CNMT RT(R)(N) 4,5 & Hosen Kiat MBBS FRACP FACP FACC FCCP FCSANZ FASNC DDU 1,2,3,4 1 Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia 2 Cardiac Health Institute, Sydney, Australia 3 Faulty of Medicine, University of New South Wales, Sydney, Australia 4 Faculty of Science, Charles Sturt University, Wagga Wagga, Australia 5 Faculty of Medical Imaging, Regis College, Boston, USA ABSTRACT Cardiac stress testing, gated cardiac imaging and monitoring critical patients expose the nuclear medicine technologist to the electrocardiogram (ECG). Basic ECG interpretation skills are essential for the nuclear medicine technologist to enhance patient care and to recognise key arrhythmias. This article provides an insight into the anatomy of an ECG trace, basic ECG interpretation and a case example typical in the nuclear medicine environment. J of Nuclear Medicine Technology, first published online October 15, 2015 as doi:10.2967/jnmt.115.163501 by on May 12, 2018. For personal use only. tech.snmjournals.org Downloaded from
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ECG – A Technologists Guide to Interpretation Colin Tso MBBS PhD FRACP FCSANZ1,2, Geoff Currie BPharm MMedRadSc(NucMed)
MAppMngt(Hlth) MBA PhD CNMT1,4,5, David Gilmore ABD CNMT RT(R)(N)4,5 & Hosen Kiat
MBBS FRACP FACP FACC FCCP FCSANZ FASNC DDU1,2,3,4
1Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia
2Cardiac Health Institute, Sydney, Australia 3Faulty of Medicine, University of New South Wales, Sydney, Australia 4Faculty of Science, Charles Sturt University, Wagga Wagga, Australia 5Faculty of Medical Imaging, Regis College, Boston, USA
ABSTRACT
Cardiac stress testing, gated cardiac imaging and monitoring critical patients expose the nuclear
medicine technologist to the electrocardiogram (ECG). Basic ECG interpretation skills are
essential for the nuclear medicine technologist to enhance patient care and to recognise key
arrhythmias. This article provides an insight into the anatomy of an ECG trace, basic ECG
interpretation and a case example typical in the nuclear medicine environment.
J of Nuclear Medicine Technology, first published online October 15, 2015 as doi:10.2967/jnmt.115.163501by on May 12, 2018. For personal use only. tech.snmjournals.org Downloaded from
1. Adams-Hamoda, MG, Caldwel,l MA, Stotts, NA & Drew, BJ 2003, Factors to consider when analyzing 12-lead electrocardiograms for evidence of acute myocardial ischemia, Am J Crit Care, 12(1):9-16.
2. McCance, KL & Huether, SE 2008, Pathophysiology: the biological basis for disease in adults and children, 5th edn, Mosby Elsevier Mosby, St Louis.
3. Marieb, EN 2001, Human anatomy and physiology, 5th edn, Benjamin Cummings, New York.
4. Chakrabarti, S & Stuart, AG 2005, Understanding cardiac arrhythmias, Arch Dis Child, 90(10):1086-1090.
5. Kligfield, P, Gettes, LS, Bailey, JJ, Childers, R, Deal, BJ, Hancock, EW, van Herpen, G, Kors, JA, Macfarlane, P, Mirvis, DM, Pahlm, O, Rautaharju, P, Wagner, GS, Josephson, M, Mason, JW, Okin, P, Surawicz, B & Wellens, H 2007, Recommendations for the standardization and interpretation of the electrocardiogram: part I: the electrocardiogram and its technology a scientific statement from the American Heart Association Electrocardiography and Arrhythmias Committee, Council on Clinical Cardiology; the American College of Cardiology Foundation; and the Heart Rhythm Society endorsed by the International Society for Computerized Electrocardiology, J Am Coll Cardiol, 13;49(10):1109-1127.
6. Horacek, B 1989, Lead theory, in: P.W. Macfarlane, T.D.V. Lawrie (Eds.), Comprehensive Electrocardiology: Theory and Practice in Health and Disease, Pergamon Press, New York, NY, pp. 291–314.
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List of figures Figure 1: ECG waveforms of a single heart beat in sinus rhythm. The normal duration of PR interval is 120-200ms. The width of a normal QRS complex is <100ms. The normal duration of the QT interval corrected to the heart rate (QTc) is <440ms. Standard ECG paper is a 1mm grid. As annotated, horizontally 1 small square is 0.04 seconds and 1 large square is 0.2 second and, thus, 5 large boxes (25 small boxes) is 1 second. The trace moves at a speed of 25mm per second and 10 small squares on the vertical axis equates to 1 mV.
QT interval PR interval
PR QRS ST 0.04 s 0.2 s
25 mm / s
1 mV
1 s
R
P T
SQ
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Figure 3: Sinus tachycardia with the R-R interval approximately 2 seconds (>120 BPM). Approximately 2.2 large squares indicates that the heart rate is 136 BPM (300/2.2).
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Figure 5: Rhythm strip demonstrating second degree AV block with progressively lengthening of the PR interval demonstrated here with 2 P waves per R-R interval (arrows).
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Figure 6: Rhythm strip demonstrating third degree AV block. AV dissociation results in no QRS but a prominent P wave. The absence of the Q wave allows visualisation of the repolarisation of atria (arrow).
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Figure 12: ECG appearance of myocardial ischaemia spectrum clockwise from normal (P QRS T), up-sloping ST depression (>1.5mm), horizontal ST depression (>1mm), down-sloping ST depression (>1mm) and ST elevation.
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Figure 13: ECG appearance of myocardial infarction spectrum clockwise from normal, hyperacute MI (T wave), transmural (ST elevation), necrosis (ST elevation, Q waves and T wave inversion), necrosis / fibrosis (Q waves and T wave inversion) and fibrosis (Q wave and upright T wave).
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