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However, the U wave is not typically seen and its absence is generally ignored. Changes in the structure of the heart and its surroundings including blood composition change the patterns of these four entities. ECGs are normally printed on a grid. The horizontal axis represents time and the vertical axis represents voltage.

The standard values on this grid are shown in the adjacent image:. The "large" box is represented by a heavier line weight than the small boxes. Not all aspects of an ECG rely on precise recordings or having a known scaling of amplitude or time. For example, determining if the tracing is a sinus rhythm only requires feature recognition and matching, and not measurement of amplitudes or times i.

An example to the contrary, the voltage requirements of left ventricular hypertrophy require knowing the grid scale. In a normal heart, the heart rate is the rate in which the sinoatrial node depolarizes since it is the source of depolarization of the heart. Heart rate, like other vital signs such as blood pressure and respiratory rate, change with age.

In adults, a normal heart rate is between 60 and bpm normocardic , whereas it is higher in children. A complication of this is when the atria and ventricles are not in synchrony and the "heart rate" must be specified as atrial or ventricular e. In normal resting hearts, the physiologic rhythm of the heart is normal sinus rhythm NSR. Generally, deviation from normal sinus rhythm is considered a cardiac arrhythmia.

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Thus, the first question in interpreting an ECG is whether or not there is a sinus rhythm. Once sinus rhythm is established, or not, the second question is the rate. For a sinus rhythm, this is either the rate of P waves or QRS complexes since they are 1-to If the rate is too fast, then it is sinus tachycardia , and if it is too slow, then it is sinus bradycardia.

If it is not a sinus rhythm, then determining the rhythm is necessary before proceeding with further interpretation. Some arrhythmias with characteristic findings:. The heart has several axes, but the most common by far is the axis of the QRS complex references to "the axis" imply the QRS axis.

Each axis can be computationally determined to result in a number representing degrees of deviation from zero, or it can be categorized into a few types. The QRS axis is the general direction of the ventricular depolarization wavefront or mean electrical vector in the frontal plane.

Role of the electrocardiogram in determining electrophysiologic end points of drug therapy.

It is often sufficient to classify the axis as one of three types: normal, left deviated, or right deviated. The normal QRS axis is generally down and to the left , following the anatomical orientation of the heart within the chest. An abnormal axis suggests a change in the physical shape and orientation of the heart or a defect in its conduction system that causes the ventricles to depolarize in an abnormal way. All of the waves on an ECG tracing and the intervals between them have a predictable time duration, a range of acceptable amplitudes voltages , and a typical morphology.

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Any deviation from the normal tracing is potentially pathological and therefore of clinical significance. It may also affect the high frequency band of the QRS. The earliest sign is hyperacute T waves, peaked T waves due to local hyperkalemia in ischemic myocardium. Over a period of hours, a pathologic Q wave may appear and the T wave will invert.

What is an electrocardiogram?

Over a period of days the ST elevation will resolve. Pathologic Q waves generally will remain permanently. The left anterior descending LAD artery supplies the anterior wall of the heart, and therefore causes ST elevations in anterior leads V 1 and V 2. An ECG tracing is affected by patient motion. Some rhythmic motions such as shivering or tremors can create the illusion of cardiac arrhythmia. Distortion poses significant challenges to healthcare providers, [37] who employ various techniques [39] and strategies to safely recognize [40] these false signals.

Improper lead placement for example, reversing two of the limb leads has been estimated to occur in 0. Numerous diagnoses and findings can be made based upon electrocardiography, and many are discussed above.

Overall, the diagnoses are made based on the patterns. For example, an "irregularly irregular" QRS complex without P waves is the hallmark of atrial fibrillation ; however, other findings can be present as well, such as a bundle branch block that alters the shape of the QRS complexes. ECGs can be interpreted in isolation but should be applied — like all diagnostic tests — in the context of the patient.

Antiarrhythmic drugs

For example, an observation of peaked T waves is not sufficient to diagnose hyperkalemia; such a diagnosis should be verified by measuring the blood potassium level. Conversely, a discovery of hyperkalemia should be followed by an ECG for manifestations such as peaked T waves, widened QRS complexes, and loss of P waves. The following is an organized list of possible ECG-based diagnoses. The word is derived from the Greek electro , meaning related to electrical activity; kardia , meaning heart; and graph , meaning "to write".

Role of the electrocardiogram in determining electrophysiologic end points of drug therapy.

From Wikipedia, the free encyclopedia. Not to be confused with other types electrography or with echocardiography. Main article: Cardiac electrophysiology. Main article: Electrocardiography in myocardial infarction.


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Spodick reviews our present day physiologic and pathophysiologic understanding of systolic time intervals, and how they are affected by a variety of cardiac disease states and pharmacologic agents. Ellestad examines problems and provides pragmatic tips on exercise testing in the diagnosis of coronary artery disease, and advances in exercise scores and computer analysis. Graboys reviews the value of exercise testing in the diagnosis and management of patients with serious ventricular arrhythmias. Kellermann presents the complimentary role that exercise testing plays in com- prehensive follow-up therapy of the cardiac patient, and the use of exercise for work and physical training.

Detailed information concerning the interaction of cardiac rehabilitation and ventricular arrhythmias are examined. Read more Read less. Product details Paperback: pages Publisher: Springer; Softcover reprint of the original 1st ed. This report of a case describes a man in his 70s with type 2 diabetes, hypertension, and hyperlipidemia who presented to the emergency department with 4 days of progressive dizziness, shortness of breath, and chest pain on exertion.

This case report describes a diagnostically challenging electrocardiography finding after apparent chemotherapy infusion reaction. This case report describes a wide complex tachycardia in a woman with type 2 diabetes, hypertension, dyslipidemia, and obseity. This case report describes the occurrence of atrial flutter presenting on an electrocardiogram as electrical alternans.

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