Gail Walraven, Basic Arrhythmias, Sixth Edition ©2006 by Pearson Education, Inc., Upper Saddle River, NJ Appendix D Basic 12-Lead Interpretation
Gail Walraven, Basic Arrhythmias, Sixth Edition ©2006 by Pearson Education, Inc., Upper Saddle River, NJ Appendix D Basic 12-Lead Interpretation.
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Gail Walraven, Basic Arrhythmias, Sixth Edition©2006 by Pearson Education, Inc., Upper Saddle River, NJ
Appendix DBasic 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
Inferior
Lateral
Anterior
Surface
II, III, aVF
I, aVL, V5, V6
V1, V2, V3, V4
Facing Leads
Gail Walraven, Basic Arrhythmias, Sixth Edition©2006 by Pearson Education, Inc., Upper Saddle River, NJ
Infarction Location
V3 & V4
V2 & V3
V1
These leads…
Anterior wall of the left ventricle
Anterior wall over the septum
Anterior wall of the right ventricle
Are directly over these surfaces
Gail Walraven, Basic Arrhythmias, Sixth Edition©2006 by Pearson Education, Inc., Upper Saddle River, NJ
Grades of Myocardial Damage
Gail Walraven, Basic Arrhythmias, Sixth Edition©2006 by Pearson Education, Inc., Upper Saddle River, NJ
Extent of Infarction
Gail Walraven, Basic Arrhythmias, Sixth Edition©2006 by Pearson Education, Inc., Upper Saddle River, NJ
Ischemic Changes
Gail Walraven, Basic Arrhythmias, Sixth Edition©2006 by Pearson Education, Inc., Upper Saddle River, NJ
Age of Infarction (Transmural MI)
Gail Walraven, Basic Arrhythmias, Sixth Edition©2006 by Pearson Education, Inc., Upper Saddle River, NJ
Infarction Location
Gail Walraven, Basic Arrhythmias, Sixth Edition©2006 by Pearson Education, Inc., Upper Saddle River, NJ
Anterior Wall Infarction (EKG)
Gail Walraven, Basic Arrhythmias, Sixth Edition©2006 by Pearson Education, Inc., Upper Saddle River, NJ
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)
Gail Walraven, Basic Arrhythmias, Sixth Edition©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)
Gail Walraven, Basic Arrhythmias, Sixth Edition©2006 by Pearson Education, Inc., Upper Saddle River, NJ
Atrial Enlargement
Gail Walraven, Basic Arrhythmias, Sixth Edition©2006 by Pearson Education, Inc., Upper Saddle River, NJ
Ventricular Enlargement
Gail Walraven, Basic Arrhythmias, Sixth Edition©2006 by Pearson Education, Inc., Upper Saddle River, NJ
Rule of 35
Gail Walraven, Basic Arrhythmias, Sixth Edition©2006 by Pearson Education, Inc., Upper Saddle River, NJ
Right Bundle Branch Block
Gail Walraven, Basic Arrhythmias, Sixth Edition©2006 by Pearson Education, Inc., Upper Saddle River, NJ
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
• Wide, flat P waves• No P waves
Abnormality
Hyperkalemia
Suggestive of
Gail Walraven, Basic Arrhythmias, Sixth Edition©2006 by Pearson Education, Inc., Upper Saddle River, NJ
EKG Abnormalities –QRS ComplexesAbnormality
Widening of QRS Merging QRS and T
Hyperkalemia
Suggestive of
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
Disappearing ST segments Hyperkalemia
Suggestive of
ST depression Hypokalemia
Sloping ST segments Depressed, “scooped” ST segments
Digitalis Toxicity
Elevated, concave ST segments Pericarditis
Gail Walraven, Basic Arrhythmias, Sixth Edition©2006 by Pearson Education, Inc., Upper Saddle River, NJ
EKG Abnormalities – T Waves
Abnormality
Tall, peaked T waves Hyperkalemia
Suggestive of
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 Hyperkalemia
Suggestive of
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)
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