Main Electrocardiographic Anomalies

Main Electrocardiographic AnomaliesPACE:

* normal: regular, each QRS is preceded by a P wave (sinus rhythm).

* anomalies: irregular, no P wave before QRS.

FREQUENCY:

* normal: between 50 and 100 / min.

* anomalies:

– f> 100 / min: tachycardia.

F <50 / min: bradycardia.

P WAVE:

* normal: duration in D1 <0.12 s, amplitude in D2 <2 mm, positive in D1, D2, D3.

* anomalies:

– absence: sinoatrial block, BAV III, fibrillation, flutter, average nodal rhythm.

– amplitude> 2 mm in D2, D3, VF and diphasic in V1: right atrial hypertrophy.

– duration> 0.12 s: left atrial hypertrophy or interauricular conduction disorder.

– double hump aspect: HAG or intra-auricular conduction disorder.

– retrograde D2-D3-VF: lower nodal junctional rhythm.

SPACE PR:

* normal: duration = 0.12-0.20 s, isoelectric.

* anomalies:

– duration <0.12 s: Wolff Parkinson White, superior nodal rhythm.

– duration> 0.20 s: atrioventricular block I or II (Mobitz I).

Q WAVE:

* normal: duration <0.04 s, amplitude <25% of R, q in DIII disappearing in deep inspiration.

* anomalies:

– duration> 0.04 s and amplitude> 25% of R: old IDM.

Absence q in V5-V6: BBIG or BBGC.

– Q in D1: HBAG.

QRS COMPLEX:

* normal: duration <0.10 s, axis = [-30 ° to + 120 °].

* anomalies:

– duration> 0,10-0,12 s: BBID, BBIG

– duration> 0.12 s: BBCD, BBCG, ESV, ESA with functional block (aberration), TPSV + pre-existing or functional block, WPW, TV, hyperkalemia.

– delay intrasecoid deflection of +0.05 s in left precordial: BBG.

– intrasecoid deflection delay of +0.03 s in precordial straight lines: BBD.

– axis> -30 °: HBAG, axis> + 120 °: HBPG.

– R in V1-V2 and S in V5-V6 and right axial deviation: right ventricular hypertrophy.

 R at V6 and S at V1 and left axial deviation: left ventricular hypertrophy (Sokolow index: SV1 + RV5> 35 mm).

– Wide R in V6 and QS in V1: BBCG.

– RSR ‘: BBCD.

– S in D3: HBAG.

– aspect S1-Q3: sign of gravity of the pulmonary embolism.

ST SEGMENT:

* normal: isoelectric.

* anomalies:

– its offset encompassing the T wave (Pardee wave): IDM.

– overdose> 2 mm: subepicardial lesion, pericarditis.

– under offset> 2 mm: endocardial lesion.

Concave cupula upwards: digitalis, quinidine, hypokalemia.

– descending, sub-shifted: BBGC.

– ascending, over-shifted: BBCD.

– Osborn J wave in case of hypothermia.

QT SEGMENT:

* normal: time proportional to the frequency (use the ECG rule), between 0.35 and 0.45 s for a normal frequency.

* anomalies:

– pseudo-prolongation of QT (U-wave): hypokalemia.

– lengthening: hypocalcemia, alkalosis, hypothermia, Cordium, quinidines, other antiarrhythmics.

– shortening: hypercalcemia, hyperkalemia, acidosis, digitalis.

T WAVE:

* normal: asymmetric, not pointed, axis = [-10 to + 70 °], negative in VR +/- V1.

* anomalies:

– giant, pointed, symmetrical: subendocardial ischemia, hyperkalemia, pulmonary embolism.

– negative, deep, symmetrical: subepicardial ischemia.

– negative, asymmetric left precordial (V5, V6, VL): left ventricular systolic hypertrophy.

– negative, asymmetrical: repolarization disorders after ESV, BBDC if V1, V2, BBGC if V5, V6.

U WAVE:

* normal: absent.

* anomalies:

– U wave presence with flat or negative T wave: hypokalemia.

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Editor-in-chief of the Medical Actu website; general practitioner graduated from the Faculty of Medicine of Algiers in 2005 currently practicing as a liberal.

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