Take the Test |
This "method" is recommended when reading all 12-lead ECG's. Like the physical examination, it is desirable to follow a standardized sequence of steps in order to avoid missing subtle abnormalities in the ECG tracing, some of which may have clinical importance. The 6 major sections in the "method" should be considered in the following order:
Click to view
Click to viewThe diagram illustrates the normal cardiac conduction system.
SA block (lesson VI): 2nd degree (type I vs. type II)
AV block (lesson VI): 1st, 2nd (type I vs. type II), and 3rd degree
IV blocks (lesson VI): bundle branch, fascicular, and nonspecific blocks
Exit blocks: blocks just distal to ectopic pacemaker site
(Go to ECG Cond uction Abnormalities (Lesson VI) for a description of conduction abnormalities)
P waves (lesson VII): are they too wide, too tall, look funny (i.e., are they ectopic), etc.?
QRS complexes: look for pathologic Q waves (lesson IX), abno rmal voltage (lesson VIII), etc.
ST segments (lesson X): look for abnormal ST elevation and/or depression.
T waves (lesson XI): look for abnormally inverted T waves.
U waves (lesson XII): look for prominent or inverted U waves.
This is the conclusion of the above analyses. Interpret the ECG as "Normal", or "Abnormal". Occasionally the term "borderline" is used if unsure about the significance of certain findings. List all abnormalities. Examples of "abnormal" statements are:
Inferior MI, probably acute
Old anteroseptal MI
Left anterior fascicular block (LAFB)
Left ventricular hypertrophy (LVH)
Nonspecific ST-T wave abnormalities
Any rhythm abnormalities
Click to view