Welch Allyn Physician’s Guide - Hill-Rom

Welch Allyn? Physician's Guide

VERITASTM WITH ADULT AND PEDIATRIC RESTING ECG INTERPRETATION

Manufactured by Welch Allyn, Inc. Skaneateles Falls, NY U.S.A.

CAUTION: Federal law restricts this device to sale by or on the order of a physician.

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9515-001-52-ENG Rev E Revision date: 2019-08

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TABLE OF CONTENTS

PREFACE ......................................................................................................................................................................4

RHYTHM STATEMENTS ................................................................................................................................................6

RHYTHM STATEMENTS AND MODIFIERS................................................................................................................................... 6

MEDIAN BEAT FORMATION AND MEASUREMENTS...................................................................................................10

SIMULTANEOUS ACQUISITION.............................................................................................................................................. 10 MEDIAN BEAT FORMATION................................................................................................................................................. 10 GLOBAL MEASUREMENTS ................................................................................................................................................... 11

ADULT CRITERIA..........................................................................................................................................................................12 ARM LEAD REVERSAL AND DEXTROCARDIA............................................................................................................................. 12 VENTRICULAR PRE-EXCITATION ............................................................................................................................................ 13 ATRIAL ENLARGEMENT....................................................................................................................................................... 14 AXIS DEVIATION ............................................................................................................................................................... 14 LOW VOLTAGE ................................................................................................................................................................. 15 S1-S2-S3 PATTERN .......................................................................................................................................................... 15 PULMONARY DISEASE ........................................................................................................................................................ 16

ADULT CONDUCTION ABNORMALITIES .....................................................................................................................17

RIGHT BUNDLE CONDUCTION .............................................................................................................................................. 17 LEFT BUNDLE CONDUCTION ................................................................................................................................................ 19 NON SPECIFIC CONDUCTION ABNORMALITY ........................................................................................................................... 21

ADULT HYPERTROPHY ...............................................................................................................................................22

RIGHT VENTRICULAR HYPERTROPHY ..................................................................................................................................... 22 LEFT VENTRICULAR HYPERTROPHY........................................................................................................................................ 23 VOLTAGE CRITERIA ............................................................................................................................................................ 24 LEFT VENTRICULAR HYPERTROPHY CRITERIA (CONTINUED) ....................................................................................................... 25

ADULT MYOCARDIAL INFARCT ..................................................................................................................................26

MYOCARDIAL INFARCT DISCUSSION ...................................................................................................................................... 26 ANTERIOR INFARCT............................................................................................................................................................ 27 ANTERIOR INFARCT CRITERIA (CONTINUED) ........................................................................................................................... 28 SEPTAL INFARCT................................................................................................................................................................ 29 ANTEROSEPTAL INFARCT..................................................................................................................................................... 30 LATERAL INFARCT.............................................................................................................................................................. 31 LATERAL INFARCT CRITERIA (CONTINUED).............................................................................................................................. 32 ANTEROLATERAL INFARCT ................................................................................................................................................... 32 INFERIOR INFARCT ............................................................................................................................................................. 33 INFERIOR INFARCT CRITERIA (CONTINUED)............................................................................................................................. 34 INFERIOR INFARCT WITH POSTERIOR EXTENSION ..................................................................................................................... 34 INFARCT SUPPRESSIONS...................................................................................................................................................... 34

ADULT ST ELEVATION ................................................................................................................................................35

ST SEGMENT ELEVATION .................................................................................................................................................... 35 EARLY REPOLARIZATION ..................................................................................................................................................... 35 PERICARDITIS ................................................................................................................................................................... 36 ANTERIOR AND SEPTAL EPICARDIAL INJURY ............................................................................................................................ 37

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TABLE OF CONTENTS

ANTERIOR AND SEPTAL EPICARDIAL INJURY CRITERIA (CONTINUED) ............................................................................................ 38 LATERAL EPICARDIAL INJURY ............................................................................................................................................... 39 LATERAL EPICARDIAL INJURY CRITERIA (CONTINUED) ............................................................................................................... 40 INFERIOR EPICARDIAL INJURY............................................................................................................................................... 41 INFERIOR EPICARDIAL INJURY CRITERIA (CONTINUED) .............................................................................................................. 42 MINIMAL AND MODERATE ST DEPRESSION ........................................................................................................................... 43 ADULT ST DEPRESSION ..............................................................................................................................................44 SUB ENDOCARDIAL INJURY .................................................................................................................................................. 44 T WAVE ABNORMALITY, ISCHEMIA....................................................................................................................................... 45 ADULT T WAVE ABNORMALITIES...............................................................................................................................46 T WAVE ABNORMALITY ISCHEMIA CRITERIA (CONTINUED)........................................................................................................ 46 T WAVE ABNORMALITY, NONSPECIFIC .................................................................................................................................. 47

ADULT BRUGADA........................................................................................................................................................................48

QT-INTERVAL................................................................................................................................................................... 48 BRUGADA........................................................................................................................................................................ 49

PEDIATRIC CRITERIA...................................................................................................................................................................50

ARM LEAD REVERSAL AND DEXTROCARDIA............................................................................................................................. 50 WOLFF-PARKINSON-WHITE ................................................................................................................................................ 50 ATRIAL ENLARGEMENT....................................................................................................................................................... 51 AXIS DEVIATION ............................................................................................................................................................... 51

PEDIATRIC CONDUCTION ABNORMALITIES............................................................................................................................52

RIGHT BUNDLE CONDUCTION .............................................................................................................................................. 52 LEFT BUNDLE CONDUCTION ................................................................................................................................................ 52 VENTRICULAR CONDUCTION DELAY ...................................................................................................................................... 53

PEDIATRIC HYPERTROPHY.........................................................................................................................................................54

RIGHT VENTRICULAR HYPERTROPHY ..................................................................................................................................... 54 RIGHT VENTRICULAR HYPERTROPHY CRITERIA (CONTINUED) ..................................................................................................... 55 RIGHT VENTRICULAR HYPERTROPHY CRITERIA (CONTINUED) ..................................................................................................... 56 LEFT VENTRICULAR HYPERTROPHY........................................................................................................................................ 57

PEDIATRIC ST SEGMENT ABNORMALITIES..............................................................................................................................59

ST SEGMENT ELEVATION .................................................................................................................................................... 59 ST SEGMENT DEPRESSION .................................................................................................................................................. 60 T WAVE ABNORMALITY, ISCHEMIA....................................................................................................................................... 61

PEDIATRIC T WAVE ABNORMALITIES.......................................................................................................................................62 T WAVE ABNORMALITY ISCHEMIA CRITERIA (CONTINUED)........................................................................................................ 62 T WAVE ABNORMALITY ISCHEMIA CRITERIA (CONTINUED)........................................................................................................ 63 QT PROLONGATION .......................................................................................................................................................... 65 BRUGADA PATTERN........................................................................................................................................................... 65

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TABLE OF CONTENTS

PEDIATRIC TRICUSPID ARTESIA.................................................................................................................................................66 TRICUSPID ATRESIA ........................................................................................................................................................... 66

PEDIATRIC ENDOCARDIAL CUSHION DEFECT .............................................................................................................67 ENDOCARDIAL CUSHION DEFECT .......................................................................................................................................... 67 ATRIAL SEPTAL DEFECT ...................................................................................................................................................... 68

REFERENCE SUMMARY..............................................................................................................................................................69 AGE TABLES ..................................................................................................................................................................... 69 QRS AXIS FOR AGE ........................................................................................................................................................... 69 QRS DURATION FOR AGE ................................................................................................................................................... 69 V6 R/S AMPLITUDE RATIO FOR AGE..................................................................................................................................... 70 V1/V3R R/S AMPLITUDE RATIO FOR AGE............................................................................................................................. 70 CONDITIONS ? RHYTHM STATEMENTS................................................................................................................................... 70 CONDITIONS ? RHYTHM STATEMENTS (CONTINUED) ............................................................................................................... 71 CONDITIONS ? CONTOUR STATEMENTS, ADULT ...................................................................................................................... 71 CONDITIONS ? CONTOUR STATEMENTS, ADULT (CONTINUED)................................................................................................... 72 CONDITIONS ? CONTOUR STATEMENTS, ADULT (CONTINUED)................................................................................................... 73 CONDITIONS ? CONTOUR STATEMENTS, PEDIATRIC ................................................................................................................. 73 CONDITIONS ? CONTOUR STATEMENTS, PEDIATRIC (CONTINUED) .............................................................................................. 74

VERITAS RESTING ECG INTERPRETATION EVALUATION .............................................................................................75 METHOD....................................................................................................................................................................... 75 INTRODUCTION AND GENERAL METHODOLOGY....................................................................................................................... 75 PEDIATRIC VENTRICULAR HYPERTROPHY ................................................................................................................................ 75 PACEMAKER DETECTION..................................................................................................................................................... 76 INTERVAL MEASUREMENTS ................................................................................................................................................. 88

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