ð ç« æ«éèš
Systematic ECG Approach
- Standardization
- Rate (300 / large boxes)
- Rhythm (sinus vs other)
- Axis (-30° to +90° normal)
- Intervals (PR 120-200, QRS < 100, QTc < 440 M / 460 F)
- Waves
- Chambers
- Ischemia
- Special
Major Findings
- STEMI: ⥠1 mm in 2 contiguous leads (⥠2 mm V2-V3 men); regional + reciprocal
- NSTEMI / Ischemia: ST depression + T inversion
- Q waves: prior MI
- MI Localization: V1-V4 (anterior LAD), V5-V6/I/aVL (lateral), II/III/aVF (inferior RCA/LCx)
Hypertrophy + BBB
- LVH: Sokolow-Lyon S(V1) + R(V5/V6) ⥠35 mm
- RBBB: QRS > 120, rSRâ V1
- LBBB: QRS > 120, notched R V6, QS V1 (almost always underlying disease)
AV Blocks
- 1°: PR > 200; Mobitz I: progressive PR; Mobitz II: dropped beats; 3°: AV dissociation
WPW
- Short PR + delta wave + wide QRS; avoid AV nodal blockers in AF + WPW
Hyperkalemia
- Peaked T â flat P â wide QRS â sine wave â asystole
Pericarditis vs STEMI
- Pericarditis: diffuse STâ + PR depression; STEMI: regional STâ + reciprocal
Pulmonary Embolism
- S1Q3T3 + sinus tachycardia + RBBB + RAD
Long QT
- Drugs (macrolides, FQ, antifungals, antipsychotics, methadone, ondansetron)
- HypoK + HypoMg + HypoCa
- Treatment: Mg IV for torsades + correct electrolytes + stop offending drug
Sgarbossa (LBBB + MI)
- Concordant STâ ⥠1 mm: 5 pts
- Concordant STâ V1-V3 ⥠1 mm: 3 pts
- Discordant STâ ⥠5 mm: 2 pts
- ⥠3 = likely STEMI
Modern Era
- AI-ECG: LVEF estimation + AF prediction + hyperkalemia detection (Mayo + others)
- Wearables + implantable loop recorders for rhythm
- AI integration + remote monitoring expanding
ç§é«åž« hint
- ECG = first-line diagnostic; systematic approach essential
- STEMI: emergent reperfusion (PCI within 90 min, fibrinolysis if no PCI)
- Inferior MI: always V4R for RV infarct
- Long QT: stop offending drug + correct electrolytes
- Hyperkalemia ECG: peaked T â wide QRS â sine wave (treatment urgent)
- WPW + AF: avoid AV nodal blockers (use procainamide or cardioversion)