ECG (Electrocardiogram) is a non-invasive diagnostic tool that records the electrical activity of the heart and helps correlate pulse characteristics with underlying cardiac conditions. It is crucial for assessing rate, rhythm, conduction defects, ischemic changes, and pulse abnormalities.

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A. Key Parameters in ECG for Pulse Assessment

ECG Parameter	Clinical Importance	Pulse Correlation
Heart Rate (HR)	Detects bradycardia, tachycardia	Slow or rapid pulse
Rhythm	Differentiates normal vs. irregular rhythms	Regular or irregular pulse
PR Interval	Assesses AV conduction	Heart block (irregular pulse)
QRS Complex	Identifies ventricular depolarization	Wide QRS = abnormal ventricular contraction
QT Interval	Prolonged QT can cause arrhythmias	Torsades de Pointes (irregular pulse)
ST Segment & T Wave	Identifies ischemia or infarction	Weak pulse in cardiogenic shock

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B. ECG Patterns and Their Pulse Correlation

1. Rate Abnormalities

ECG Finding	Heart Rate	Pulse Characteristics	Clinical Condition
Sinus Bradycardia	< 60 bpm	Slow, regular	Athletes, hypothyroidism, sick sinus syndrome
Sinus Tachycardia	> 100 bpm	Rapid, strong	Fever, anemia, shock, hyperthyroidism
Ventricular Tachycardia (VT)	> 120 bpm	Weak or absent pulse	Life-threatening arrhythmia

2. Rhythm Abnormalities

ECG Finding	Pulse Type	Clinical Condition
Atrial Fibrillation (AFib)	Irregularly irregular pulse	Seen in stroke, hypertension, heart failure
Atrial Flutter	Regular or irregular	May present as fast pulse with palpitations
Ventricular Fibrillation (VFib)	No palpable pulse	Cardiac arrest, requires CPR
Complete Heart Block	Slow, regular	Pulse dissociation with atria and ventricles

3. Pulse Abnormalities in Ischemia & Shock

ECG Finding	Pulse Changes	Clinical Condition
ST Elevation	Weak, thready pulse	Myocardial infarction
ST Depression	Irregular pulse	Myocardial ischemia
Electrical Alternans	Pulsus paradoxus	Seen in pericardial tamponade

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C. Advanced ECG Interpretation in Pulse Abnormalities

1. Pulse Deficit and ECG Correlation

• Pulse Deficit = ECG HR – Palpable Pulse Rate
• If ECG HR is higher than the pulse rate, it indicates:
  • Atrial fibrillation (ineffective cardiac output)
  • Frequent premature ventricular contractions (PVCs)
  • Heart failure with reduced ejection fraction

2. QT Prolongation and Sudden Cardiac Death Risk

• QTc > 450 ms in men, > 460 ms in women = Increased arrhythmia risk
• Seen in:
  • Hypokalemia, hypocalcemia, hypomagnesemia
  • Long QT syndrome (Torsades de Pointes risk)

3. Pulsus Paradoxus on ECG

• Characterized by:
  • Electrical Alternans (QRS amplitude variation with respiration)
  • Drop in systolic BP > 10 mmHg during inspiration
  • Seen in cardiac tamponade, severe asthma, pericardial effusion

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D. ECG Case-Based Clinical Applications

Case 1: A 65-Year-Old with Syncope and Slow Pulse

• ECG Findings: Complete heart block (dissociated P waves & QRS)
• Pulse Findings: Bradycardia (40 bpm), irregular pulse
• Diagnosis: AV block → Pacemaker required

Case 2: A 50-Year-Old with Chest Pain & Weak Pulse

• ECG Findings: ST elevation in anterior leads (V1–V4)
• Pulse Findings: Weak, thready pulse
• Diagnosis: Acute MI with cardiogenic shock

Case 3: A 40-Year-Old with Palpitations & Irregular Pulse

• ECG Findings: Absent P waves, irregular R-R intervals (AFib)
• Pulse Findings: Irregularly irregular pulse
• Diagnosis: Atrial fibrillation with thromboembolic risk

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