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راح نتكلم اليوم عن
ECG abnormalities
للمختصين في المجال الصحي
كوب القهوة معاك ☕️ واستمتع
راح نتكلم عن كل جزء من ECG وايش المشاكل الي تكون موجوده فيه

S-T segment abnormalities:

First (S-T segment elevation):
1mm S-T elevation in all leads except V2, V3 is considered S-T elevation.
2mm S-T elevation in V2,V3 is considered ➡️ S-T elevation.
DDx:
-STEMI
-Benign early repolarization
-pericarditis
-vassospasms
-PE
-left ventricle aneurysm
-LVH
-LBBB

Second (S-T depression):
<0.5 mm of S-T depression in any lead ➡️ S-T depression.
Types:
Down-sloping
Up-sloping
Horizontal (more considered as ischemia)
Note 📝 up-sloping in V1-V3 with peaked T wave ➡️ proximal left anterior descending artery occlusion (LAD).

DDx:
⁃NSTEMI
⁃Posterior MI
⁃LBBB
⁃Left ventricle hypertrophy with strain pattern
⁃Reciprocal changes
⁃Digoxin toxicity

Third (J wave present):
DDX:
⁃Benign early repolrization
⁃hypothermia
⁃hypercalcemia
⁃Brugada syndrome

T-wave abnormalities:

First (T wave inversion):
> or equal 1mm of T-wave depression.
T wave inversion is normal in V1, V2 and lead lll.
DDx:
⁃Left ventricle strain (hypertrophy)
⁃Increase ICP
⁃PE
⁃bundle branch block
⁃Wellen’s syndrome B in V2 and V3 (ischemia)
⁃Inferior MI

Note 📝 T wave inversion in aVL is only suspicion of Inferior MI.

Second (hyperacute T-wave):
Tall and asymmetrical peak can equal QRS complex.
DDx:
⁃vasospasm (prinzmetal angina) is spasm in coronary artery.
⁃Early STEMI

Third (Biphasic T-wave):
Initial positive deflection followed by negative deflection, It might be the other way around.
DDx:
⁃(Wellen’s A) ischemia
⁃Hyperkalemia

Fourth (flat T-wave):
Between -1 and 1 mm deflection
DDx:
⁃ischemia
⁃Hyperkalemia

Fifth (peaked T-wave):
Very tall, very narrow and symmetrical peak.
DDx:
⁃hyperkalemia
⁃Hypermagnesemia
⁃Ischemia (D-wniters Twave)
Note 📝 D winters with up-sloping S-T depression is considered as proximal LAD.

QRS abnormalities:

First (wide QRS):
> 0.12 sec is wide QRS
DDx:
⁃BBB
⁃Hyperkalemia
⁃V tach
⁃WPW
⁃Paced rhythm (pt on pacemaker)
⁃Medication (tricyclic, antidepressants overdose).

Second (Q wave):
If you see Q wave in V1 and V3 ➡️it’s not normal
Pathological Q wave:
⁃> 0.04 sec
⁃2mm in depth
⁃25% of QRS length
DDx:
⁃MI
⁃PE
⁃LBBB
⁃Left ventricle hypertrophy

Third (low voltage QRS):
How to detect low voltage QRS:
1- add up leads I, II, lll
If it’s < 15mm ➡️ low voltage
Or
2- add up V1, V2, V3
If it’s < 30mm ➡️ low voltage

DDx:
(Any reason that block conduction)
⁃pericardial effusion (fluid)
⁃Obesity (fat)
⁃COPD (air)
⁃HF
⁃Infiltrated diseases (rare) for example(amyloidosis and sarcoidosis)

Fourth (poor R wave progression)
R wave does not increase as expected from V1-V6.
DDx:
⁃anterior MI
⁃Right ventricle hypertrophy

Fifth (dominate R wave):
R wave greater than S wave in V1-V3
DDx:
⁃posterior MI (dominate R wave in V1-V3 with ST depression and upright T wave).
⁃RBBB
⁃Right ventricle hypertrophy

Note 📝 Right bundle branch block VS left bundle branch block

Q-T interval abnormalities:

First (prolonged Q-T):
> 460 ms in female
> 450 ms in male
Note 📝 prolonged QT is high risk of torsades de points (polymorphic vtach).
DDx:
⁃anti-arrhythmic
⁃Antibiotics
⁃Antipsychotic
⁃Antidepressants
⁃Antiemetic
⁃Hypokalemia
⁃Hypomagnesemia
⁃Hypocalcemia

Second (Short Q-T):
< 350 ms is short QT
DDx:
⁃hyperkalemia
⁃Hypermagnesemia
⁃Digoxin toxicity

P-wave abnormalities:

First (right atrial enlargement):
1- in lead ll if p wave > 2.5mm
2- in V1 if positive deflection of p wave > negative deflection of p wave.
DDx:
⁃tricuspid valve stenosis
⁃Pulmonary HTN
⁃Pulmonary valve stenosis

Second (left atrial enlargement):
1- in lead ll if you see p wave bifid (like camel hump 🐫).
2- in V1 if you see negative deflection is > positive deflection.
DDx:
⁃mitral stenosis
⁃Aortic stenosis
⁃HTN

P-R interval abnormalities:

First (short P-R interval):
<0.12s
DDx:
⁃WPW
⁃Premature atrial contraction PAC

Second (prolonged P-R interval):
>0.20s
DDx:
⁃first degree heart block
⁃Second degree heart block mobitz1
⁃Third degree heart block

Cardiac axis abnormalities:
Normal axis:
Lead l and aVF you see QRS ➡️ positive deflection.
Or
Lead l QRS positive deflection and aVF negative deflection so you gonna see lead ll if it’s positive deflection so it’s normal.

First (left axis deviation):
More electrical activity in lefts side
Lead l positive deflection and aVF negative so you gonna see Lead ll if it’s negative so it’s ➡️ left axis deviation.
DDx:
⁃LBBB
⁃Left ventricle hypertrophy
⁃Inferior MI
⁃Hyperkalemia

Second (right axis deviation):
Lead l negative deflection
And
aVF positive deflection
DDx:
⁃RBBB
⁃Right ventricle hypertrophy
⁃Anterior MI
⁃V tach

Third (extreme right axis deviation):
Lead l negative deflection
And
aVF negative deflection
DDx:
⁃extreme right ventricle hypertrophy
⁃V tach
⁃Sever obesity

ventricle hypertrophy:

Left ventricle hypertrophy:
If you add up the high of R wave in V5 or V6
To
S wave in V1 or V2 > 35mm ➡️ this left ventricle hypertrophy
Right ventricle hypertrophy:
If you add up R wave in V1 or V2
To
S wave in V5 or V6 > 10mm ➡️ this right ventricle hypertrophy

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