The ECG Made Easy, 9e

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In some cases there can be a notched (or bifid) p-wave known as “p mitrale”, indicative of left atrial hypertrophy which may be caused by mitral stenosis. There may be tall peaked p-waves. This is called “p-pulmonale” and is indicative of right atrial hypertrophy often secondary to tricuspid stenosis or pulmonary hypertension. The presence of a delta wave does NOT diagnose Wolff-Parkinson-White syndrome. This requires evidence of tachyarrhythmias AND a delta wave. Delta wave Q-waves It represents the time for electrical activity to move between the atria and the ventricles. QRS complex The paper used to record ECGs is standardised across most hospitals and has the following characteristics:

RAD is commonly associated with conditions such as pulmonary hypertension, as they cause right ventricular hypertrophy. RAD can, however, be a normal finding in very tall individuals. Right Axis Deviation Left axis deviationAn ECG lead is a graphical representation of the heart’s electrical activity calculated by analysing data from several ECG electrodes. Chest leads Left axis deviation occurs if lead I is positive and II is negative. Right axis deviation is negative in I and positive in II. Left axis deviation may occur in left ventricular hypertrophy (LVH), along with ST depression in lateral leads. Right axis deviation occurs in situations where there is right heart strain, such as pulmonary embolisms and atrial septal defect. When a normal P wave is present, it’s called paroxysmal atrial tachycardia; when a normal P wave isn’t present, it’s called paroxysmal junctional tachycardia. Leftward (left axis deviation, or LAD) - QRS is upright in lead I (positive) and downward in lead aVF (negative) Ever wonder how nurses and doctors can read ECG papers with ease?How do they differentiate atrial tachycardia from atrial fibrillation, or how even to know what atrial fibrillation or tachycardia is?

For over fifty years The ECG Made Easy book has been regarded as the best fundamental guide to ECG learning, with sales of over a million prints as well as being translated into more than one language. Recognized by the British Medical Journal as a “medical classic”, it has remained a favorite of ages of medical and health care workers who want fair, basic information about the ECG.

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Sinus rhythm should have clear P waves. The commonest tachycardia is poorly controlled AF - look for the variable RR interval with the loss of clear P waves. The T waves are also raised (in contrast to a STEMI, where the T wave remains the same size and the ST segment is raised).