Wave Forms, Segments, and Intervals in Electrocardiogram

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© Springer Nature Singapore Pte Ltd. 2020
J. VarshneyElectrocardiography in Veterinary Medicinehttps://doi.org/10.1007/978-981-15-3699-1_6


6. Abnormal Wave Forms, Segments, and Intervals in Electrocardiogram



J. P. Varshney1 


(1)
Veterinary Medicine, Shri Surat Panjarapole Prerit Nandini Veterinary Hospital, Surat, Gujarat, India

 



When the measurements of different wave forms, their intervals, and/or duration of segments are not in line with the values detailed for normal electrocardiogram, it is said to be an abnormal electrocardiogram. Changes in the measurements of the waves, intervals, or segments are indicative of specific cardiac abnormalities. The details are illustrated below:
























































































































































































































Abnormal wave forms


Indications


“P” wave (Fig. 6.1)


Broad (duration >0.04 s and/or notched)


Left atrium enlargement (P-mitrale)


Tall (amplitude >0.4 mV)


Right atrium enlargement (P-pulmonale)


Tall and broad (>0.4 mV and >0.04 s)


Biatrial enlargement


Variable amplitude of P wave


Wandering pace maker


Absence of P wave


Atrial standstill or silent atrium


Ta wave (increased height of descending arm of “P”)


Right atrium enlargement


“QRS” complex (Fig. 6.2)


Tall “R” (amplitude >2.5 mV in small breeds >3.0 mV in large breeds)


Left ventricular enlargement (LVE) or left bundle branch block (LBBB)


Wide “QRS” (duration >0.05 s small breeds, >0.06 s large breeds)


LVE or LBBB


Deep “S” (amplitude >0.35 mV in leads II, III, aVF; >0.8 mV in lead CV5RL)


Right ventricular enlargement (RVE) or right bundle branch block (RBBB)


Deep “Q” wave (amplitude >0.5 mV in leads II, aVF)


RVE


Low-voltage “QRS” complexes (amplitude <0.5 mV in leads I, II, III, aVF)


Pericardial effusions


Pleural effusions


Pneumothorax


Obesity


Cardiomyopathy


Hypothyroidism


Loose lead contact with skin


Notched “QRS” with normal duration


Normal or minor atrioventricular defect


“R”-alternans (varying amplitude)


Pericardial effusion


Alternating bundle branch block


Supraventricular tachycardia


“J” wave (Fig. 6.3)


Deflection at “R” ST junction


Hypothermic dogs


Normal dogs


S-T segment/J point (Fig. 6.4)


Elevation (>0.15 mV), i.e., above the baseline


Hypoxia


Pericarditis


Infarction


Secondary change (ventricular hypertrophy, VCPs, conduction disturbance)


Left ventricular epicardial injury.


Transmural myocardial infarction


Digoxin toxicity


Depression (>0.2 mV), i.e., below the baseline


Infarction, ischemia


Conduction disturbance


Cardiac trauma


Hyper- or hypokalemia


Secondary change (VCPs, ventricular hypertrophy, conduction disturbance)


Digitalization


Myocardial infarction/injury


False depression


Slurring or coving


Left ventricular hypertrophy


P-R interval (Fig. 6.5)


P-R interval is inversely proportional to heart rate


Increase (>0.13 s)


First-degree heart block


Q-T interval (Fig. 6.6)


Increased (>0.25 s)


Hypocalcemia


Hypothermia


Hypokalemia


CNS disorders


Ventricular hypertrophy


Conduction disorders


Strenuous exercise


Quinidine toxicity


Ethylene glycol poisoning


Secondary to prolonged QRS duration


Short (<0.15 s)


Hypercalcemia


Hyperkalemia


Digitalis toxicity


“T” wave (Fig. 6.7)


“T” wave changes are mostly nonspecific


Sudden change in polarity


Hypoxia


Abnormal conduction


Ventricular enlargement


Metabolic disorders


Height >25% of “R”


Hyperkalemia


Small biphasic


Hypokalaemia


Large T wave


Myocardial hypoxia


Ventricular enlargement


Intraventricular conduction abnormalities


Hyperkalemia


Metabolic diseases


Respiratory diseases


Normal variation


Tented T wave


Hyperkalemia


T-alternans (amplitude varying)


Pericardial effusion


Alternating bundle branch block


Supraventricular tachycardia


“U” wave (Fig. 6.8)


Small rounded deflection after T wave.


It was first described by Einthoven (1906).


Represents last phase of ventricular repolarization.


Usually monophasic, positive, or negative.


Characteristic of hypokalemia in dogs (Tai Fu et al. 1984).


U wave with same polarity of T has also been seen in normal human beings (Goesing et al. 2009).


“R-R” interval (Figs. 6.9, 6.10, and 6.11)


Variable


Arrhythmia


Pause between R-R <twice of normal R-R interval


Sinus block


Pause between R-R >twice of normal R-R interval


Sinus arrest

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Jul 17, 2021 | Posted by in INTERNAL MEDICINE | Comments Off on Wave Forms, Segments, and Intervals in Electrocardiogram

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