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ECG reading systematic approach Hindi explained
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Bahut achha content mil gaya - Harrison's, Ganong's, aur Braunwald's se ECG ka complete material hai. Ab main ek comprehensive ECG guide Hindi mein likhta hoon:
⚡ ECG Puri Padhna - Systematic Guide
(Source: Harrison's Principles of Internal Medicine 22E, Ganong's Medical Physiology, Braunwald's Heart Disease)
ECG Kya Hai?
ECG (Electrocardiogram) dil ki electrical activity ko body surface par electrodes se record karta hai. Standard 12-lead ECG mein:
- 6 Limb leads: I, II, III, aVR, aVL, aVF (frontal plane)
- 6 Chest (Precordial) leads: V1, V2, V3, V4, V5, V6 (horizontal plane)
Yeh diagram dekho - har lead body ke alag angle se dil ko "dekhti" hai:
ECG Paper Samjho - Sabse Pehle
ECG paper par:
- Horizontal axis = Time (1 small box = 0.04 sec, 1 large box = 0.2 sec)
- Vertical axis = Voltage/Amplitude (1 small box = 0.1 mV, 1 large box = 0.5 mV)
- Standard speed = 25 mm/sec
- Standard calibration = 10 mm = 1 mV
SYSTEMATIC APPROACH - 14 Steps (Harrison's)
Harrison's ke mutabik har ECG mein yeh 14 cheezein systematic taur par check karo:
- Standardization & Technical features
- Rhythm
- Heart Rate
- PR Interval / AV Conduction
- QRS Interval
- QT/QTc Interval
- Mean QRS Electrical Axis
- P Waves
- QRS Voltages
- Precordial R-wave Progression
- Abnormal Q Waves
- ST Segments
- T Waves
- U Waves
STEP-BY-STEP BREAKDOWN
1. Standardization Check (Calibration)
- Har ECG ke shuru mein ek calibration pulse honi chahiye: 10 mm tall, 0.2 sec wide
- Agar yeh missing hai ya galat hai → ECG unreliable hai
2. RHYTHM
Sinus Rhythm ki Pehchan:
- Har QRS se pehle ek P wave honi chahiye
- P wave Lead II mein positive (upright), aVR mein negative honi chahiye
- P-P interval regular hona chahiye
- HR: 60-100 bpm
| Rhythm | Feature |
|---|---|
| Normal Sinus | P wave → QRS, regular, 60-100 bpm |
| Sinus Brady | Wohi par rate <60 |
| Sinus Tachy | Wohi par rate >100 |
| AF | P waves absent, irregular irregular |
| Atrial Flutter | Sawtooth P waves, 300/min |
3. HEART RATE Calculate Karo
Method 1 - Regular Rhythm:
- 300 ÷ number of large boxes between two R waves
- Example: 2 large boxes = 300/2 = 150 bpm
- Shortcut: 300 → 150 → 100 → 75 → 60 → 50 (yaad karo!)
Method 2 - Irregular Rhythm:
- Count karein kitne QRS complexes hain 10-second strip mein
- Multiply by 6 = HR per minute
4. P WAVE
Normal P wave:
- Duration: <120 ms (3 small boxes)
- Amplitude: <2.5 mm (2.5 small boxes)
- Lead II mein positive (upright)
- aVR mein negative
- V1 mein biphasic (positive + small negative component) ho sakta hai
Abnormalities:
- P tall (>2.5mm) aur pointed → Right Atrial Enlargement (P-pulmonale)
- P broad (>120ms), notched → Left Atrial Enlargement (P-mitrale)
5. PR INTERVAL
- Measure: P wave ke shuru se QRS ke shuru tak
- Normal: 120-200 ms (3-5 small boxes)
| PR | Matlab |
|---|---|
| <120 ms | Pre-excitation (WPW) ya junctional rhythm |
| >200 ms | 1st Degree AV Block |
| Progressive lengthening | 2nd Degree AV Block (Wenckebach/Mobitz I) |
| Fixed PR + dropped QRS | 2nd Degree AV Block (Mobitz II) |
| No relation P to QRS | Complete (3rd Degree) AV Block |
6. QRS COMPLEX
Normal QRS:
- Duration: <120 ms (3 small boxes)
- V1 mein: Small r + large S (rS pattern)
- V6 mein: Small q + large R + small s (qRs pattern)
R-wave Progression:
- V1 se V6 tak R wave progressively barhti hai
- Transition zone (jahan R=S): usually V3 ya V4
- Agar V1-V4 mein R nahi badh raha → Poor R-wave progression (anterior MI ka sign)
QRS Width:
-
120 ms → Bundle Branch Block (BBB)
- RBBB: V1 mein RSR' (rabbit ears), V6 mein wide S wave
- LBBB: V6 mein broad R, V1 mein QS/rS pattern
Abnormal Q waves:
-
40 ms wide (1 small box) ya >25% of QRS height → Pathological Q wave (old MI ka sign)
7. QRS AXIS (Electrical Axis)
Einthoven triangle ke principle par based:
Normal Axis: -30° to +100°
Quick Method - Lead I + Lead aVF dekho:
| Lead I | aVF | Axis |
|---|---|---|
| Positive | Positive | Normal (-30° to +90°) |
| Positive | Negative | Left Axis Deviation (LAD) |
| Negative | Positive | Right Axis Deviation (RAD) |
| Negative | Negative | Extreme / Northwest Axis |
Causes:
- LAD (<-30°): LVH, Left anterior fascicular block (LAFB), Inferior MI
- RAD (>+100°): RVH, Left posterior fascicular block, Lateral MI, WPW, Dextrocardia
8. ST SEGMENT
- Baseline (isoelectric) pe honi chahiye - J point ke baad se T wave tak
- Normal: Isoelectric ± 0.5 mm
ST Elevation (STEMI signs):
- ≥1 mm in limb leads, ≥2 mm in precordial leads
- Convex (dome shape) - suggests acute infarction
- Concave (saddle shape) - suggests pericarditis
ST Depression:
- Subendocardial ischemia
- Digoxin effect (scooping)
- Reciprocal changes in STEMI
9. T WAVE
Normal T wave:
- Same direction as QRS (concordant)
- Slightly asymmetric - slow rise, fast fall
- V1 mein negative ya flat
- aVR mein negative
Abnormalities:
- Tall peaked T waves → Hyperkalemia, hyperacute STEMI
- Inverted T waves → Ischemia, RVH (V1-V3), LVH (V5-V6)
- Wellens' pattern (deep T inversion V1-V4) → Critical LAD stenosis - Emergency!
10. QT INTERVAL
- QRS ke shuru se T wave ke end tak
- Normal QTc (corrected): ≤440 ms men, ≤460 ms women
- Bazett's formula: QTc = QT / √(RR interval in seconds)
- Prolonged QT → Torsades de Pointes ka risk (hypokalemia, drugs, congenital)
- Short QT → Hypercalcemia, digoxin toxicity
11. U WAVE
- T wave ke baad ek chhoti si wave
- Normally <1 mm, same direction as T wave
- Prominent U wave → Hypokalemia (most common cause), amiodarone, sotalol
NORMAL INTERVALS - Quick Reference Table
| Parameter | Normal Value |
|---|---|
| Heart Rate | 60-100 bpm |
| PR Interval | 120-200 ms (3-5 small boxes) |
| QRS Duration | <120 ms (<3 small boxes) |
| QT Interval (QTc) | <440 ms (men), <460 ms (women) |
| QRS Axis | -30° to +100° |
| P wave amplitude | <2.5 mm |
| P wave duration | <120 ms |
LEADS KA LOCATION - Kaunsa Lead Kya Dekh Raha Hai
| Leads | Dil Ka Hissa |
|---|---|
| II, III, aVF | Inferior wall (RCA territory) |
| I, aVL, V5-V6 | Lateral wall (LCx territory) |
| V1-V4 | Anterior wall (LAD territory) |
| V1-V2 | Septal |
| aVR | Right atrium / aortic root |
| V4R | Right ventricle (special lead) |
ECG PADHNE KA MEMORY TRICK
"Rate Rhythm Axis P-wave PR-QRS-ST-T-U"
Ya phir: "Real Radiologists Are Pretty Poor At Studying, Till U nag"
- Rate
- Rhythm
- Axis
- P wave
- PR interval
- QRS
- ST segment
- T wave
- U wave
COMMON PATTERNS - Quick Diagnosis
| Pattern | Kya Socho |
|---|---|
| Diffuse ST elevation + PR depression | Acute Pericarditis |
| STEMI + reciprocal changes | Acute MI |
| Delta wave + short PR | WPW Syndrome |
| Tall R in V1 + RAD | RVH / RBBB / Posterior MI |
| Peaked P in II + RAD | Cor Pulmonale |
| Electrical alternans | Cardiac Tamponade |
| Sine wave pattern | Severe Hyperkalemia |
| Osborne (J) wave | Hypothermia |
| "S1Q3T3" | Pulmonary Embolism |
Sources: Harrison's Principles of Internal Medicine 22E (2025) - Ch. 247 | Ganong's Review of Medical Physiology 26E | Braunwald's Heart Disease
ECG ek skill hai - jitni practice karoge utna better hoga. ECG Wave-Maven (Harvard) par free practice cases milte hain.
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