Wardround 14x05

This week’s two minute tutorials were based on the theme of a normal ECG.

P wave and PR interval MJM
QRS Dr Mohan
ST/T Dr Kidder
QT and axis (and unsolicited infectious disease associations!) Dr Jones

You can listen to an extended version of the P wave tutorial on the midweek podcast. I will attach links to the summary sheets from my own and Dr Mohan’s talks.

The challenge for next week is to identify what we mean (or should mean) if we say an ECG is normal.

My initial thoughts would be:

Correct patient and date
Scan for lead misplacement (aVr being positive or II of much lower amplitude than other limb leads)
Normal rhythm and rate (Sinus rhythm between 60-100 bpm)
Normal axis (-30 to +90, t axis similar to QRS axis)
Normal P waves (present, not too tall, too wide or abnormally inverted)
Normal PR interval
Normal QRS ( not too wide, not too big, no pathological Qs, )
Normal QT (QTC = 0.35-0.43)
Normal ST (not deviated)
Normal T
Normal U
Unchanged from previous recordings

Have I missed anything important?

The reading for next week is:

Swots Corner: What is an odds ratio? Bandolier


Interesting cases this week:

A patient with syncope and significant injury, mixed aortic valve disease, paroxysmal AF, hypertension with postural hypotension, vertigo, tinnitus and hypokalaemia, to mention just some of her problems. Investigation of syncope.

Cerebral vasculitis

Acute polyarticular gout

Paracetamol poisoning

Korsakoff’s syndrome

Kluver-Bucy Syndrome

And have a look at Naveen's page for an ECG quiz and link to more ECG quizzes.

Don’t forget your two minute tutorials…make them concise and precise.
Next week’s theme is the Exercise ECG…what’s normal?

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If anyone out there would like to submit two minute tutorials for the podcast, just leave me a note in one of the comments.