PREFACE This book is primarily intended for Medicos, General practitioners and nursing staffs. I have specially designed this book for medicos who find difficulties in reading ECG in day to day clinical practices. Once I went to a doctor who was MD but he could not diagnose correct ECG of my relative and we got in severe trouble because the patient died. Being a medico I talked him about mis-interpretation. He told me that ECG is always tough, confusing and forgettable. He later added that most of students understand the concepts of ECG but they feel difficulties in applying those concepts when they got ECG strips in their hand and this problem is not only with graduate doctors also for many residents doctors who do not belongs to Medicine or Cardiology branch. This incident gave me a purpose of writing the book that will help medicos to not just learning concepts but also to apply it on ECG strips. This book contai ns various ECGs, Diagrams and Charts which will help you to learning ECG in better way. This book is helpful for everyone from a nursing staffs to a doctor who is practicing in day to day life and also for competitive exams like INICET, NEXT and NEET pg. This book is written in very simple language so that medicos at any level and low English literature can also understand the ECG. Now a day we have lots of other investigation which we do to finalise our diagnosis of ECG but in village area we still have lack of those investigation facilities. So, ECG is universal and cost effective way to diagnose heart diseases. I guess after reading this book today you will be able to save lives tomorrow.

Feedback The ECG is the gold standard in the diagnosis of heart disease, and every doctor, not only a cardiologist, should know the basics of an ECG. And when you need to quickly understand the ECG, this book comes to the rescue. This book is written in detail and at the same time is very easy to read. The author in this book does not just talk about the ECG, but speaks with the readers, feeling where it can be difficult for the reader to understand and reassuring him! This book is dedicated to all categories of doctors, whether he is a pediatrician, an ophthalmologist or a cardiologist with many years of experience. This book will be easy for everyone to learn.

PhD, MD Kalysov K.A

AKNOWLEDGEMENT

First of all I would like to thank all the Gods, Covid19 heroes and Vaccine scientists for saving us in this pandemic. I want to thank my Uppchar team and the dreams which keep me motivated for making betterment in healthcare every day. Especially I would like to thank my Professor Kalysov K.A for helping me to correct my mistakes and writing review. I want to thank my cardiology teacher Dr. Rajesh Gubba, Umid Zakirov and Dr. Mukesh Bhatia sir for helping me to learn and understand cardiology. I want to thank my family, Friends (Aryan, Ayush, and Iffah) and my all time artist Ashutosh who helped me in writing the book. I want to thank all free images sources [IT] to help me to complete this book. At last but most important I want to thank my readers who gave me confidence to write the book again.

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ISBN: 9781639977864

I dedicate my book to the Doctors, Nursing staffs and all the Frontline workers who gave off their lives during serving Covid19.

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CONTENTS 1. 2. 3. 4. 5.

INTRODUCTION ECG MACHINE ECG PAPER GENERAL ECG INTERPRETATION WAVES ANOMALIES A. P WAVE ANOMALIES B. Q WAVE ANOMALIES C. R WAVE ANOMALIES D. S WAVE ANOMALIES E. T WAVE ANOMALIES F. U WAVE G. EPSILON WAVE H. Osborn wave I. QRS COMPLEX 6. INTERVAL AND SEGMENTS ANOMALIES A. PR INTERVAL B. QT INTERVAL C. ST SEGMENT 7. ARRYTHMIA ECGS 8. HEART BLOCK(PR interval) 9. BBB 10. ECGS OF SOME MISLLENEOUS DISEASE A. MYOCARDIAL INFRACTION B. PERICARDIAL DISORDERS (PERICARDITIS AND PERICARDIAL EFFUSION AND CARDIAC TAMPONADES) C. ELECTROLYTE IMBALANCE D. WPW SYNDROME

E. DEXTROCARDIA 11. THE CONCLUSION

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INTRODUCTION Electrocardiography is one of the bases of modern cardiac diagnostic tool by which we get the electrical activity of heart to explore the functions and wellbeing of our heart. ECG tells us the electrical events during a cardiac cycle. Why ECG? As you already know our heart muscle is myogenic which mean heart is able to contract and produce electrical signals by its own but its rate and rhythm can be variable in various pathologic and neurologic situations of our body. And these change the electrical activities of heart which are one of the biggest diagnostic tools for various cardiac pathologies. Even if you go to any cardiology OPD in the world the first investigations will be ECG.

History of ECG In late 1800s there were lots of experiments were going on electrical activity of heart. Dutch physiologist Willem Einthoven in early 1900’s developed the early electrocardiogram. He got the novel prize for it in 1924. In 1920 Hubert Mann first used the electrocardiogram to describe the electrographic changes associated with heart attack.

Principle of ECG

Basically ECG machine acts as a galvanometer or you can say it a voltmeter which collect electrical potentials across positive and negative electrodes. And different electrodes help us to get images from different angle or area.

Types of ECG There are mainly 3 types of ECG: 1. Resting ECG - This type of ECG is carried out while patient is in lying down in a comfortable position. 2. Stress ECG – This type of ECG is carried out while patient is doing exercise on trade-mill, often termed as TMT trade-mill stress test. Mostly indicated for detecting Ischemia. 3. Ambulatory ECG – This type of ECG used to monitor the heart for 24 hours and more while doing normal day to day activities. A small machine worn at the patient waist and its electrodes are connected to the chest. This is also said to be Holter monitoring or 24 hour EKG.

HOW TO DO ECG? We have a machine called as electrocardiography device or commonly as ECG machine. It consists of sets of electrodes which are connected to a central unit.

What are indications of ECG? There are thousands of indications and It is nearly impossible to write all of them here but I am writing some of them 9

1. Chest pain [Angina] 2. Dyspnoea 3. Cyanosis 4. PAC [PRE ANESTHETIC CHECKUPS] 5. Cardiac arrhythmias 6. Seizures and syncope 7. Shock 8. Electrolyte disturbance specially [Hypokalemia and Hyperkalemia] 9. Oedema 10. Suspecting Cardiac disorders 11. In abnormal chest radiograph [Mediastanum] 12. Various other disorders where we can have cardiac manifestations

LIMITATIONS OF ECG 1. We need to evaluate ECG with other clinical findings for a specific conclusion or you can say it as unable to come to an accurate diagnosis. 2. A normal ECG cannot say that your heart is perfectly okay. In very least proportion of people patients with normal ECG had unhealthy heart 3. ECG records the electrical activity for a few seconds so it could not obtain electrical activity of the heart when we have Arrhythmia with irregular frequency or you can say it as different interval. And for this we need ambulatory monitoring [Holter]. 4. It is unable to measure directly the cardiac electrical generation sources.

5. ECG tells us the electrical behaviours of our heart muscles not the specialised conductive tissue which is responsible for most of the arrhythmias.

And if we will talk about advantage of ECG then it will be its disrespect because we cannot imagine modern clinical medicine without ECG. This is the primary, high yielding and universal diagnostic tools in modern medicine.

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HOW TO DO ECG? We have a machine called as electrocardiography device or commonly as ECG machine. It consists of sets of electrodes which are connected to a central unit. We have different generation machines like earlier we used to have the device which was working on the electrical analogue but now we use digital analogue system.

contec The components of ECG machines are 1. Leads or electrodes [ I generally call it as a camera which take photo of the electrical activity of the particular area from the surface over the skin] 2. Cable wires 3. Monitor 4. Central digital processing unit

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ECG PAPER

ZOOM [wiki] THIS IS THE GRAPH BETWEEN POSTENTIAL WHICH IS ON Y AXIS WHICH IS CHANGING WITH RESPECT TIME WHICH IS ON X AXIS. 1. A small box have 40 ms on x axis and 0.1 milivolts on Y axis as amplitude [Actually 25 small box is equal to 1 sec that is why one box is 0.04 sec] 2. Five small box will make one big box which by simple multiplication we can get the value as 200 ms on x axis and 0.5 milivolts on Y axis as amplitude.[10 small box is equal 1mv].

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