ECG abnormalities- a collection of things to think about!

P wave

Inverted = retrograde conduction Will be negative in aVR

Peaked

P waves are a classic finding in severe right atrial enlargement if they are over 2.5mm high. Biphasic or M shaped P waves usually indicate atrial or biatrial enlargement
Remember to obtain an overall clinical picture. Do not make assumptions based on one aspect or lead on a ECG

Q waves

Main interpretations of a significant Q wave is that it represents dead myocardial tissue Insignificant Q waves are merely a representation of the first vector of ventricular depolaristion- these are referred to as septal Q waves and are usually found in leads I and aVL Significant Q waves (pathological): More than1/3 the total height of the QRS Wider than 0.03 seconds
(it is better to have both criteria but the second one is more significant) Remember to obtain an overall clinical picture. Do not make assumptions based on one aspect or lead on a ECG

QRS complex

Small amplitude may indicate:

Pericardial effusion Increased body fat Localised pleural effusion (may dampen certain leads)

Remember to obtain an overall clinical picture. Do not make assumptions based on one aspect or lead on a ECG

QRS complex

Large amplitude:

Men have a larger amplitude than woman Younger persons have amplitude QRS size usually caused by hypertrophy, abnormal pacer or abberantly conducted beat Pericardial effusion Increased body fat Localised pleural effusion (may dampen certain leads)
Remember to obtain an overall clinical picture. Do not make assumptions based on one aspect or lead on a ECG

Widened QRS complex

Hyperkalemia Ventricular Tachycardia Idioventricular rhythms including AVNB Drug effects and ODs especially tricyclics Wolff-Parkinson- White BBB and IVCD PVBs Aberrantly conducted beats
Remember to obtain an overall clinical picture. Do not make assumptions based on one aspect or lead on a ECG

ORS notching

May cause benign ST elevation but you can almost be sure that when you see the notching that the ST elevation afterward is benign. Do not confuse with a J or Osborne wave. Almost always associated with early reploarisation pattern or pericarditis.
Remember to obtain an overall clinical picture. Do not make assumptions based on one aspect or lead on a ECG

ST segment

In general, ST depression and T waves in the opposite direction from what is normal are a sign of ischemia ST elevation with or without T wave changes is a sign of myocardial injury

Remember to obtain an overall clinical picture. Do not make assumptions based on one aspect or lead on a ECG

T wave

All symmetrical T waves should be considered pathological until proven otherwise Biphasic T waves can occur in any lead but especially the leads transitioning between a positive and a negative lead If the first part of the T wave is negative the cause is more likely to be pathological

Remember to obtain an overall clinical picture. Do not make assumptions based on one aspect or lead on a ECG

T wave

If the T wave is more than 2/3 the height of the R wave it is definitely abnormal. Tall T waves are associated with ischemia and infarction, CNS events and potassium levels If the T waves is negative, where it should be positive, such as lead II, it is flipped. Flipped T waves are sometimes indicative of ischemia and severe ventricular hypertrophy etc

Remember to obtain an overall clinical picture. Do not make assumptions based on one aspect or lead on a ECG

T wave