Here is what magically happens to a fairly inconspicuous ECG when it is handed to me by a consultant and I am asked "what do you see here?"
As far as I can tell, this happens for a few reasons. Firstly, I have a nasty habit of choking under acute pressure, forgetting everything I know about everything, including when my birthday is, and how to keep my bowels closed. Secondly, it is because, after six or seven identical lectures entitled "How to understand an ECG", I still cannot understand an ECG. Thirdly, it is because the little elves in my head who turn the cogs are extremely easy to distract and would prefer to think about sarcasm, boobs, Bristol City and Jack Daniels, in no preferential order.
So, I have devised a foolproof algorithm for answering the question "what is wrong on this ECG?"
- Pick a letter from P, Q, R, S and T. These, I am told, correspond to specific squiggly bits.
- Pick a word from "inversion", "elongation", "elevation" and "absence". These are a few of the things that can go wrong with the aforementioned squiggly bits.
- Pick a number from 1 to 6, or if you're feeling smug, pick aVF, aVR or aVL. These are the different lines with the squiggly bits on.
- Report our answer, for example- "Q wave elongation in lead aVF".
- Sit back and soak up the glory or, in the rare case of a wrong answer, say "oops, did I say aVF? I meant lead 3...".
Don't go spreading my technique around though guys, or everyone will end up being great at cardiology and I'll never get a job.
60 comments:
ur right u shoulda done law mate
ok
very basically
(i find them horrid too):
1. check name, date etc
2. rate (brady/tachy?), and rhythm (sinus? This means is there a P wave (atrial depolarisation) before every QRS complex? If there's not, there's some sort of heart block
3. Axis - look at the 3 top left leads. Leads I and III should have QRS complexes tht are vaguely the same. If the Q wave is giant in I, and the R wave is giant in III, there's L axis deviation (Left, the complexes are Leaving). If vice versa, Right Reaching = Right axis deviation. There are lots of causes of axis deviation as you prob know. http://www.ecglibrary.com/axis.html
4. Now look for ST elevation or depression (acute/old MI etc)
5. Check that the complexes are of normal height. You prob just have to learn this. Is also handy to learn which leads look at which part of the heart.
6. Try to compare w an old ECG so u can go 'no acute changes'. Hmm if u get this far the person askin will prob be bored by now. Good luck!
Where would I be without you mate, endless list of good suggestions. I found ECG made Easy to be v useful too, but I take it you know of it?
Thanks again x
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