EKGsThe Basics for FP Residents

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EKGsThe Basics for FP Residents

• Jess Fogler, MD
• University of California, San Francisco

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Part I

• Basics
• Rate
• Rhythm
• Axis
• Intervals

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• Basics
• Rate
• Rhythm
• Axis
• Intervals

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General Tips

• Read your EKG in an orderly fashion
• Rate
• Rhythm
• Axis
• Intervals
• Hypertrophy
• Ischemia
• Go SLOWLY! 60-90 seconds
• Take notes as you go
• Attempt to unify the diagnosis

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Normal EKG

• Two basic QRS patterns
• I. Dominant R wave
• e.g. leads I, V6
• Small septal Q (lt30msec)
• ST segment slopes upward
• Upright T wave

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Normal EKG

• Two basic QRS patterns
• II. Dominant S wave
• e.g. leads V1-3
• Small R wave
• Large S wave
• J point slightly elevated
• Upsloping ST segment
• Upright T

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Normal EKG

• NOW.draw it from memory!

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• Basics
• Rate
• Rhythm
• Axis
• Intervals

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Rate

• Dont be a geekread the computer interpretation!
• If the QRSs are easy to find, trust the computer
• Otherwise
• 10-17 QRSs per sheet
• 300, 150, 100, 75, 60, 50.

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Train your eyes

• Train your eyes for Rate
• Check the computer

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• Basics
• Rate
• Rhythm
• Axis
• Intervals

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Rhythm

• Rhythm diagnosis is tricky
• Luckily its NSR most of the time
• Dont trust the computer for rhythm diagnosis
  unless it says normal EKG

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Rhythm

• An approach
• Start with the rhythm strip
• Regularity
• Measure RR interval carefully if rate fast
• Check for P wave before every QRS
• V1 most sensitive for P waves

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Rhythm

• An approach (cont.)
• Check leads I, II, aVF
• If P waves upright and consistent morphology
  originating from sinus node

I
II
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Rhythm

• An approach (cont.)
• If all of these conditions are met
• diagnose normal sinus rhythm

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Train your eyes

• Train your eyes for Rate
• Check the computer
• Train your eyes for Rhythm
• Check the rhythm strip
• Check I, II, avF

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• Basics
• Rate
• Rhythm
• Axis
• Intervals