1. ECG diagnosis

3. NSR

5. QRS waveform nomenclature R r qR qRs Qrs QS Qr Rs rS qs rSr’ rSR’

6. The 10 rules for a normal ECG .2 I II III aVR aVL aVF V1 V2 V3 V4 V5 V6

7. Rule 1 Millivolts Milliseconds 0 200 400 600 -0.5 0 0.5 1.0 P R T Q S PR interval should be 120 to 200 milliseconds or 3 to 5 little squares PR interval

8. Rule 2 Millivolts Milliseconds 0 200 400 600 -0.5 0 0.5 1.0 QRS The width of the QRS complex should not exceed 110 ms, less than 3 little squares P R T Q S

9. Rule 3 The QRS complex should be dominantly upright in leads I and II I II III aVR aVL aVF

10. Rule 4 QRS and T waves tend to have the same general direction in the limb leads I II III aVR aVL aVF

11. Rule 5 All waves are negative in lead aVR P Q T S

12. Rule 6 V 1 V 2 V 3 V 4 V 5 V 6 The R wave in the precordial leads must grow from V1 to at least V4

13. Rule 7 The ST segment should start isoelectric except in V1 and V2 where it may be elevated I II III aVR aVL aVF V1 V2 V3 V4 V5 V6

14. Rule 8 The P waves should be upright in I, II, and V2 to V6 I II III aVR aVL aVF V1 V2 V3 V4 V5 V6

15. Rule 9 There should be no Q wave or only a small q less than 0.04 seconds in width in I, II, V2 to V6 I II III aVR aVL aVF V1 V2 V3 V4 V5 V6

16. Rule 10 The T wave must be upright in I, II, V2 to V6 I II III aVR aVL aVF V1 V2 V3 V4 V5 V6

26. Bundle branch block I II III aVR aVL aVF V1 V2 V3 V4 V5 V6 I II III aVR aVL aVF V1 V2 V3 V4 V5 V6 Anterior wall MI Left bundle branch block

27. Sequence of changes in evolving AMI 1 minute after onset 1 hour or so after onset A few hours after onset A day or so after onset Later changes A few months after AMI Q R P Q T ST R P Q ST P Q T ST R P S T P Q T ST R P Q T

28. Anterior infarction Anterior infarction Left anterior descending artery (LAD) I II III aVR aVL aVF V1 V2 V3 V4 V5 V6

29. Inferior infarction Inferior infarction Right coronary Artery( RCA) OR Circumflex (LCX) I II III aVR aVL aVF V1 V2 V3 V4 V5 V6

30. Lateral infarction Lateral infarction Left circumflex coronary Artery OR DAIAGONAL branch of LAD I II III aVR aVL aVF V1 V2 V3 V4 V5 V6

31. Location of infarct combinations aVR V1 V4 I II III LATERAL OR HIGH LATERAL INFERIOR SEPTAL ANT ANT LAT aVL aVF V2 V3 V5 V6

33. Hay….. wake up we are done