1.

ECG interpretation
 NOTE PAD
  WAVES , INTERVALS , SEGMENTS UNDERSTANDING and REPORT

Report :

Standardization : Present /Absent

Rate : No.Of R waves * 10 in six second strip

Rhythm : If P wave present before QRS complex in II,III ,aVF ,V1, aVL  Sinus

Axis :

Lead I + + - -

Lead aVF + - - +

REPORT NORMAL Left Axis Extreme Right Right Axis

Axis
CONDITIONS Not Applicable Left Ventricular Right Atrial Right Atrial
ASSOCIATED Hypertrophy Dilation Dilation

Left Bundle Right Bundle Right Bundle

Branch Block Branch Block Branch Block

Mitral Valve or Tricuspid valve of Tricuspid valve of

Aortic valve Pulmonary valve Pulmonary valve

Dilated Dilated Dilated

Cardiomyopathy Cardiomyopathy Cardiomyopathy

Chambers :

Right Left Atrium : P WAVES : LEAD I , II , aVL , V1

Height shows the Right atrium , Width shows the Left atrium

Right Ventricle RS complex : if negative in V1  Normal Right Ventricle

Left Ventricle :

 S in V3 + R in aVL > 24 mm (men)

 S in V3 + R in aVL > 20 mm (women)

Intervals : QRS interval normal is 3 small squares

Q wave : If Present in absence of ST elevation , abnormal shows old MI

 REPORTING OF ECG
 RELEVANCE TO PROJECT (PRIMARY , SECONDARY /STAGED PTCA / Medical
Management of MI)
Acute ST segment elevation myocardial infarction (STEMI) is defined as the combination of
signs and symptoms compatible with acute myocardial ischemia - chest
pain/discomfort/pressure/ shortness of breath/ being clammy/nauseous/, which lasts for > 15
minutes, combined with specific ECG changes (comprising of 1 mm or more of ST segment
elevation in two or more contiguous limb leads or 2mm or more of ST segment elevation in two
or more consecutive chest leads. Patients presenting with new or assumed new left bundle
branch block, in combination with a clinical presentation consistent with acute myocardial
infarction should be considered for the same treatment pathway

NICE Clinical Guidelines (CG 167) state that thrombolysis should be given if primary PCI cannot
be delivered within 120 minutes of when thrombolysis could be given

6.4 Criteria for thrombolysis • Clinical diagnosis of myocardial infarction within 12 hours of
onset of symptoms • And ECG changes of: ST elevation of > 1 mm in two or more contiguous
limb leads or ST elevation of > 2 mm in two or more consecutive precordial leads or
Presumed new LBBB.No contraindications present (see checklist on page 10).

ST elevation was recorded in millimeters from the lead in which maximum elevation was
observed. ECG monitoring was done after administration of Streptokinase (SK). ST resolution
was observed in the lead with the maximum ST elevation. Complete resolution was defined as a
reduction of >70%, partial resolution as a reduction of 30% to 70%, and no resolution as
reduction of <30% in ST elevation 180 minutes post thrombolysis