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EKG

Referance : Wagner GS. Marriott's Practical Electrocardiography-9th ed. Williams & Wilkins. 1994.

  1. Rate and regularity
  2. P wave morphology (≤0.12sec, ≤2.5mm) II,V1
  3. PR interval (0.14-0.22sec)
  4. QRS complex morphology (0.07-0.10sec)
  5. ST segment morphology
  6. T wave morphology
  7. U wave morphology
  8. QTc interval = QT+1.75(ventricular rate-60) ≒ 0.41sec
  9. Rhythm

LAE

  • I,II : notched P > 0.12sec, duration between peaks of notch > 0.04sec
  • V1 : terminal negative P deflection > 0.04sec

RAE

  • II,III,aVF : Amplitude of peaked P > 2.5mm
  • V1 : peaked P

LVH

  • SV1-2 + RV5-6 > 35mm or RV5-6 > 26mm

RVH

  • RV1-2 + SV5-6 ≥ 11mm

RBBB

  • V1-2 : M-shaped QRS (RSR' variant); sometimes wide R or qR
  • I,V5-6 : wide S

LAFB

  1. LAD (usually -60°)
  2. I,aVL : small Q , II,III,aVF : small R
  3. normal QRS duration
  4. late intrinsicoid deflection aVL (>0.045)
  5. increased QRS voltage in limb leads

LPFB

  1. RAD (usually +120°)
  2. I,aVL : small R , II,III,aVF : small Q
  3. normal QRS duration
  4. late intrinsicoid deflection aVF (>0.045)
  5. increased QRS voltage in limb leads
  6. no evidence for RVH

LBBB

  • V1-2 : QS or rS
  • I,V5-6 : no Q , monophasic R

WPW syndrome

  • PR interval < 0.12sec
  • QRS complex with δ wave > 0.10sec

Ischemia due to increased myocardial demand (SEI;subendocardial ischemia)

  1. ≥ 1.0mm depression at J point
  2. horizontal or downsloping depression of ST segment

Ischemia due to insufficient blood supply (TMI;transmural ischemia)

  • elevation of ST segment at J point
    • ≥ 1.0mm in two or more limb leads or
    • ≥ 2.0mm in two or more chest leads or
  • ≥ 2.0mm depression of ST segment at J point (V1-3에서 2개 이상)

Pathologic Process

Waveforms Involved

Direction Deviated

Ischemia of increased demand

ST, T

Away from ventricular area

Ischemia of decreased supply

ST, T, QRS

Toward ventricular area

Infarction

QRS, T

Away from ventricular area

Myocardial Infarction

Abnormal Q waves

Lead

Upper Limit

Lead

Upper Limit

I

<0.03 sec>

V1

Any

II

<0.03 sec>

V2

Any

III

 

V3

Any

aVR

 

V4

<0.02 sec>

aVL

<0.03 sec>

V5

<0.03 sec>

aVF

<0.03 sec>

V6

<0.03 sec>

Abnormal R waves (Posterior-lateral infarction)

Lead

Criteria for Abnormal

V1

R dur ≥ 0.04 sec, R amp ≥ 0.60 mV, R amp ≥ S amp

V2

R dur ≥ 0.05 sec, R amp ≥ 1.50 mV, R amp ≥ 1.5 × S amp

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