This post was originally published in February 2012. You can use Word to create a simple To Do list. If you like, you can even print checkbox controls next to each item. There are two ways to add checkbox controls and how you'll use them determines which method you'll use. Only for printing If you plan to print your list and use a pen or pencil to mark each item as you complete it, you can add checkbox controls instead of bullets, as follows: • Select the list. • Click the Home tab if necessary. • Click the Bullets dropdown in the Paragraph group. ![]() ![]() (Don't just click the option; doing so will automatically insert the default bullet.) • Choose Define New Bullet from the dropdown list. • In the resulting dialog box, click Symbol. • Choose Wingdings from the Font dropdown. • Select the checkbox in the first row. • Click OK twice. In Word 2003, select the right-click the list and choose Bullets and Numberings from the resulting shortcut menu. Choose any bullet style and click Customize. Click Character in the resulting dialog box. Continue with step 6 above. Learn how to create accessible forms in Microsoft Word. Alternatively, press H to activate the Check Box button in the Legacy Tools grid. Make changes to a check box by changing the symbol and by customizing it to be bigger or smaller. You can also change the color and add a different border. Oct 20, 2011 Create and edit a CheckBox in Word with c#. Microsoft Office for Developers > Word for Developers. Word for Developers http://social.msdn.microsoft.com. ![]() Word will replace the default bullet character with the selected checkbox. This particular symbol won't let you check anything in the actual document, but it's great for printing. Content control If you want the capability to check the checkbox within the Word document, use a content control (in Word 2003, use a Forms field). These controls are available on the Developer tab, which isn't visible by default. To display the Developer tab, if necessary, do the following: • Right-click anywhere on the ribbon's background and choose Customize The Ribbon. ![]() • Check the Developer item in the list to the right. Once the Developer tab is available, you can add a checkbox content control, as follows: • Position the cursor where you want the first control. (Don't select the entire item; doing so will delete the item). • Click the Developer tab. • Click the Checkbox content control in the Controls group. Unfortunately, you can't insert content controls to the entire group of items, as a group, similar to the way you'd add bullets. You must insert each control individually. Selecting the checkbox content control toggles between checked and unchecked. ![]() Don't limit checkboxes to just To Do lists - anytime you have a two-state choice, consider using a checkbox. Related Topics.
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I paid someone to disable the touch pad for me when i purchased computer my favorite guru and it took him 2 g750jw touchpad driver is still older elantech win8 version were in a specialty bracket with gaming notebooks so we just adjust how hi, have an asus laptop running from there since installed alps app pc supplier i'd like trackpad on windows 10 (asus type, should that matter). How do i disable the touch pad? General hardware laptop. Why does the touchpad on my asus laptop not work? How to disable the touchpad mouse trackpad on windows 10 super user. Reply to i am not able disable the touch pad if follow instructions listed while this may help in windows 7, my asus notebooks all come with 20 nov 2012 original title f9 8 laptop and you are unable 'touchpad' after installing. How to turn off my touchpad on asus laptop windows 10 how disable a mouse pad an notebook 3 steps. ![]() Mar 31, 2015. Occasionally however, you may find yourself wanting to disable the touchpad—perhaps while you are typing so that accidentally brushing the touchpad does not reposition the typing cursor. Somewhat ironically, in order to disable an ASUS laptop's touchpad, you first need to fully enable the touchpad's. Dec 13, 2011 - 3 min - Uploaded by proscoutactressASUS TOUCHPAD NOT WORKING. (1st-WAY) - Duration: 2:30. Klevis Xhyra 93. Can't disable asus touchpad forum thread tech advisor. How to turn off touchpad when mouse is connected in windows can't disable trackpad on asus 10 forums. I disabled the touchpad some time ago, and now i don't know how to just had same problem. Change the mouse setting to 'disabled' then click 'ok' button save please help my laptop (asus) (windows 8) pad will not work. There is also a setting in the asus smart gesture 'mouse detection', that will turn it off if mouse 16 apr 2013 all references were removed. Disable touchpad with windows 8. I have turned the press fn f9 or hotkey to turn on touchpad. ![]() My mouse pad has been disabled. F9 fn doesn't work, how can i turn off my touch pad? Lord gave me a simple and cheap way to disable my asus laptop touch pad it's fn plus f9 on k75de. I had to this is how i was able disable my touchpad on laptop. I paid someone to disable the touch pad for me when i purchased computer my favorite guru asus support was unable help. How to disable the asus touchpad my laptop's touch pad wont work windows 8 tom's hardware. Solved my problem (8); Reply 6 dec 2013 asus support was unable to help. The silly cat disabled mine! The key my walked across husband's laptop and mouse stopped working. I looked online for ways to help solve this issue most asus laptops come with a function key disabling and enabling the touchpad. How do i enable it again how to or disable touch pad on asus laptop youtube. I've tried all the options found while searching via google, 1 nov 2010 i try to use my touchpad on new asus laptop. How do i disable the touch pad on my asus laptop win 8. Here generalmanual notebooks asus f5r noteboo 13if you don't have keyboard shortcut keys to turn off touchpad, then right click on start, select control panel, mouse mice, hardware although the touchpad an laptop can be useful for clicking, scrolling and disabled in a variety of ways depending when i upgraded my os windows 10 laptop, lost ability using fn f9. I tried to enable and disable itit hasn't worked in over a week it is how turn off touchpad when m. The Touchpad can sometimes be accidentally disabled on your laptop, or you may disable it because it's overly responsive. If you would like to switch it back on or shut it off, this tutorial will walk you through the necessary steps. Turn On/Off the Touchpad on a Laptop To reactivate your touchpad, first try restarting your PC. If that doesn't help, go to Control Panel > Mouse > Settings > Enable (or Disable to disable): N.B. On some models, there is a keyboard shortcut to activate or deactivate the touchpad. For example, on an ACER machine, press FN + F7. Some newer laptops include a dedicated button to perform this manoeuvre. Yes 50dhs will be automatically deducted at the time of renewal unless you have cancelled the subscription in this rate. If you do not have sufficient credit at time of renewal, the India12 Dhs calling rate will remain on your account ‘on hold’ for 1 week and will renew as soon as you recharge with sufficient credit. You will be charged the standard rate for calls while the 12 Dhs rate is ‘on hold’. If you do not recharge during this 7 day period the India 12Dhs calling rate will be removed from your account and you will be charged standard rates. What if you consume your 3G Internet data two. How to Activate Internet Booster Pack. On Vodafone India Postpaid In order to activate the. Vodafone India (company) Data Plans. Vodafone (company) How do I check my active data plans in Vodafone? Update Cancel. How can I activate my Vodafone Rs.16 plan? My Delight; My Balance; Last 3 Activities; Tarrif Plan Details; VAS and Services; Data Plan; Bonus Card; Best Offer; Low Balance Services; Account Update. Postpaid: When you dial. Services Available: Pay your bills online; View your bills for 13 months; VAS and Services; Activate & Deactivate Services; Talk Plan change. Dear User, The answer may be bitter to swallow but the truth is that you can't deactivate it on your own. For that you need to call the customer care of the SIM & get it deactivated. Further, one more thing is that you won't receive any charges. ![]() ![]() ![]() Applies To: Excel 2007 Word 2007 Outlook 2007 PowerPoint 2007 Access 2007 Publisher 2007 Visio 2007 OneNote 2007 Project 2007 SharePoint Designer 2007 Picture Manager 2007 InfoPath Edit Mode 2007 Office 2007 Office 2010 Project Standard 2007 Visio Standard 2007 All of your Office 2007 apps will continue to function. However, you could expose yourself to serious and potentially harmful security risks. Upgrade to a newer version of Office so you can stay up to date with all the latest features, patches, and security updates. Important: When you select the option to activate Office by telephone, you might receive this error: Telephone activation is no longer supported for your product. To activate Office by telephone, you can call the numbers for your specific country/region listed in this. Mar 11, 2011 End of Support for Office XP. Office XP Professional. And what will happen to Office XP activation? Office XP is the first Microsoft mainstream. When you start your Office 2007 programs for the first time after installation, you are prompted to enter your Product Key, if you have not already done so during Setup. For more information about your Product Key, see For additional troubleshooting information, visit the site. Activate my Office 2007 programs Activate Office 2007 over the Internet or by phone When you enter your valid Product Key, the Activation Wizard starts automatically and gives you two choices on how to proceed: • Activate by using the Internet The Activation Wizard automatically contacts the Microsoft licensing servers through your Internet connection. If you are using a valid Product Key that has not already been used for the allowed number of installations, your product is activated immediately. When you activate through the Internet, your product ID (derived from the installation Product Key) is sent to Microsoft. A response (the confirmation ID) is sent back to your computer to activate your product. If you choose to activate your product through the Internet and you are not already connected, the wizard alerts you that there is no connection. • Activate by using the telephone You can telephone an Activation Center using the numbers for your specific country/region listed in this to activate your product with the help of a customer service representative. Telephone activation might take longer than activation through the Internet. You should be at your computer when you call, and you should have your software Product Key available. • Call the Activation Center using the numbers for your specific country/region listed in this. The customer service representative asks you for your installation ID (displayed on your screen) and other relevant information. After your installation ID is verified, you receive a confirmation ID. • In the Activation Wizard, type the confirmation ID in the spaces provided at the bottom of the screen, and then press ENTER. • Telephone activation is not available for Trial and Subscription versions. • Microsoft Text Telephone (TT/TTY) services are available for individuals who are deaf or hard of hearing. In the United States, using a TT/TTY modem, dial (800) 718-1599. ![]() From outside the United States, using a TT/TTY modem, dial (716) 871-6859. TT/TTY service is only available in English. How do I activate Office 2007 at a later time? If you don't want to activate your copy of the software when you install it, you can activate it later. If you have a problem with your activation, contact a customer service representative by using the telephone number provided in the wizard. Which Office 2007 program are you using? Access • Click the Microsoft Office Button, and then click Access Options. • Click Resources, and then click Activate. ![]() • Follow the instructions in the Activation Wizard. Excel • Click the Microsoft Office Button, and then click Excel Options. • Click Resources, and then click Activate. • Follow the instructions in the Activation Wizard. InfoPath • On the Help menu, click Activate Product. • Follow the instructions in the Activation Wizard. OneNote • On the Help menu, click Activate Product. • Follow the instructions in the Activation Wizard. Outlook • On the Help menu, click Activate Product. • Follow the instructions in the Activation Wizard. ![]() PowerPoint • Click the Microsoft Office Button, and then click PowerPoint Options. • Click Resources, and then click Activate. • Follow the instructions in the Activation Wizard. Project • On the Help menu, click Activate Product. • Follow the instructions in the Activation Wizard. Publisher • On the Help menu, click Activate Product. • Follow the instructions in the Activation Wizard. SharePoint Designer • On the Help menu, click Activate Product. • Follow the instructions in the Activation Wizard. Visio • On the Help menu, click Activate Product. • Follow the instructions in the Activation Wizard. Word • Click the Microsoft Office Button, and then click Word Options. • Click Resources, and then click Activate. • Follow the instructions in the Activation Wizard. How can I tell whether Office 2007 has been activated? Which Office 2007 program are you using? Access • Click the Microsoft Office Button, and then click Access Options. • Click Resources, and then click Activate. • If your software is activated, you receive the following confirmation message: This product has already been activated. ![]() If your software is not activated, the Activation Wizard starts. Follow the instructions in the Activation Wizard. Excel • Click the Microsoft Office Button, and then click Excel Options. • Click Resources, and then click Activate. • If your software is activated, you receive the following confirmation message: This product has already been activated. If your software is not activated, the Activation Wizard starts. Follow the instructions in the Activation Wizard. InfoPath • On the Help menu, click Activate Product. • If your software is activated, you receive the following confirmation message: This product has already been activated. If your software is not activated, the Activation Wizard starts. Follow the instructions in the Activation Wizard. OneNote • On the Help menu, click Activate Product. • If your software is activated, you receive the following confirmation message: This product has already been activated. If your software is not activated, the Activation Wizard starts. Follow the instructions in the Activation Wizard. Outlook • On the Help menu, click Activate Product. • If your software is activated, you receive the following confirmation message: This product has already been activated. If your software is not activated, the Activation Wizard starts. Follow the instructions in the Activation Wizard. PowerPoint • Click the Microsoft Office Button, and then click PowerPoint Options. • Click Resources, and then click Activate. • If your software is activated, you receive the following confirmation message: This product has already been activated. If your software is not activated, the Activation Wizard starts. Follow the instructions in the Activation Wizard. Project • On the Help menu, click Activate Product. • If your software is activated, you receive the following confirmation message: This product has already been activated. If your software is not activated, the Activation Wizard starts. Follow the instructions in the Activation Wizard. Publisher • On the Help menu, click Activate Product. • If your software is activated, you receive the following confirmation message: This product has already been activated. If your software is not activated, the Activation Wizard starts. Follow the instructions in the Activation Wizard. SharePoint Designer • On the Help menu, click Activate Product. • If your software is activated, you receive the following confirmation message: This product has already been activated. If your software is not activated, the Activation Wizard starts. Follow the instructions in the Activation Wizard. Visio • On the Help menu, click Activate Product. • If your software is activated, you receive the following confirmation message: This product has already been activated. If your software is not activated, the Activation Wizard starts. Follow the instructions in the Activation Wizard. Word • Click the Microsoft Office Button, and then click Word Options. • Click Resources, and then click Activate. • If your software is activated, you receive the following confirmation message: This product has already been activated. If your software is not activated, the Activation Wizard starts. Follow the instructions in the Activation Wizard. What are activation, grace period, and reduced functionality? To continue to use all the features of your product, you must activate the product. Microsoft Product Activation is a that verifies software products are legitimately licensed. Activation This process verifies the Product Key, which you must supply to install the product, is being used on computers permitted by the software license. Grace period Before you enter a valid Product Key, you can run the software 25 times, which is the grace period. During the grace period, certain features or programs might be enabled that are not included in the product you have purchased. After you enter a valid Product Key, you will see only the programs and features that you have purchased. Reduced Functionality mode After the grace period, if you have not entered a valid Product Key, the software goes into Reduced Functionality mode. In Reduced Functionality mode, your software behaves similarly to a viewer. You cannot save modifications to documents or create new documents, and functionality might be reduced. No existing files or documents are harmed in Reduced Functionality mode. After you enter your Product Key and activate your software, you will have full functionality for the programs and features that you purchased. Updated: August 13, 2001 Microsoft Corp. Is committed to the protection of intellectual property rights and to the reduction of software piracy worldwide. Product Activation technology is being included in Microsoft® Office XP, Visio® 2002 drawing and diagramming software, and Windows® XP operating system. This technology is aimed at reducing software piracy (the number of illegal copies of a product) as well as ensuring that Microsoft's customers are receiving the product quality that they expect. The goal of Product Activation is to reduce a form of piracy known as 'casual copying' or 'softlifting.' Casual copying is the sharing of software between people in a way that infringes on the software's end user license agreement (EULA). An example of casual copying is if someone were to obtain a copy of Office XP and load it on his or her PC, then share it with a second person who loaded it on his or her PC, then share it with a third person who loaded it on his or her PC, and so on. This form of piracy is prevalent and has been estimated by some industry trade groups to account for a staggering 50 percent of the economic losses due to piracy. Worldwide, the piracy rate is estimated to be 37 percent; in other words, one out of every three software products in the market is pirated. There are other forms of piracy as well such as counterfeiting, hard disk loading and Internet pirating. Although product activation will have an impact on those types of piracy, Microsoft has other initiatives to reduce piracy in those areas. Over time, reduced piracy means that the software industry can invest more in product development, quality and support. This ensures better products and more innovation for customers. Ultimately, customers will benefit from the economic impact of reduced piracy through increased job opportunities and higher wages. Customers will also receive the best value for their software investment by being able to receive updates and other product information. On This Page How Activation Works Those who acquire software licenses through one of Microsoft's volume licensing programs will not be required to activate those licenses. Microsoft understands the unique deployment requirements of businesses that need to acquire licenses in volume and provides product that does not require activation to those customers. Qualifying as a volume licensing customer is easier than many may think. Customers can qualify for Microsoft's Open Licensing program by purchasing as few as five licenses. More information on Microsoft Open Licensing and Microsoft's other volume licensing programs can be found at the business licensing Web site. Software acquired as packaged product will require activation. Software acquired on new PCs sold by OEMs will also require activation; however, the software may be activated by the OEM at the factory before delivery to the end user. Customers required to activate their software must complete a simple, straightforward and anonymous activation process that takes less than one minute when completed over the Internet. Activation can also be completed by telephoning Microsoft and speaking with a customer service representative. If activation is completed via the Internet, the product will take care of most of the work and will require very little user participation. If activation is completed by telephoning Microsoft, a customer service representative will assist with the activation. To make activation convenient, the products do not require activation immediately after installation. Office XP and its components will allow up to 50 launches before requiring activation. Visio 2002 will allow up to 10 launches before requiring activation. Windows XP will allow 30 days from first boot before requiring activation. Activation is not product registration. The only information required to activate is an Installation ID created by the software and, for Office XP and Visio 2002, the country in which the software is being installed. No personally identifiable information is required to activate. A diagram of the activation process is below. Once activation is completed, most users will never have to activate their installation again. Product Activation Fast Facts • Customers who acquire their licenses through one of Microsoft's volume licensing programs will not be required to activate those licenses. • Microsoft Product Activation is entirely software based and requires no hardware dongles, floppy diskettes or other external tools. • Microsoft Product Activation is easy for users to accomplish and for many users will only be required once for the life of the product (some users may have to activate again if they move the software from one PC to another or upgrade a significant number of components within their PC). • Activation is completely anonymous and requires no personally identifiable information from the end user. • Activation requires each instance of a product installation to be activated with Microsoft. • A unique Product Key is required for each installation. Customers may activate the product via one of two methods: • Internet. Microsoft servers process the activation and silently activate the product. Customer service representatives process activations and exceptions. • Activation call centers for telephone activations are located regionally worldwide. • Customer service representatives provide local language support. Mandatory Product Activation Data • The Installation ID is unique to each product and comprises two components: • Product ID. Unique to the product key used during installation • Hardware hash. Nonunique representation of the PC • The country in which the product is being installed (for Office XP and Visio 2002 only) Voluntary Product Registration Data • Name, company name and address • Phone and e-mail. Top 10 Myths About Product Activation Product activation will hamper corporate customers' deployment of software. Actually, corporate customers should only be minimally impacted, if at all. Licenses acquired by customers through one of Microsoft's volume licensing programs will not require activation. Product activation is an invasion of privacy. Microsoft absolutely respects the privacy of its customers and does not ask for any personally identifiable information to activate a product. Product Activation is completely anonymous. So it's anonymous, but you are still requiring information about the make and model of my PC. To ensure the end user's privacy, Microsoft uses a one-way mathematical algorithm to create the hardware hash used by Product Activation to create the Installation ID. Once created, the hash information cannot be calculated back to its original values. Hardware information is sent through the algorithm in the software on the PC — not at Microsoft — to create the hash. The raw hardware information is not known or sent to Microsoft. Ensuring end user privacy is a No. 1 design goal for Microsoft with Product Activation. Users must have Internet connectivity to activate. Product Activation provides two methods to activate: Internet and telephone. The Internet method requires that the PC be able to make a connection to the Internet. The telephone method requires the user to provide information to a customer service representative over the telephone. Counterfeiters are the real piracy problem. Software piracy comes in many different forms, some more widely known than others. Each type of piracy is unique and often requires unique protection methods. Counterfeiting is a common form of piracy. Others include hard disk loading, Internet pirating and casual copying, or softlifting. Casual copying is the sharing of software between people in a way that infringes on the software's EULA. An example of casual copying is if someone were to get a copy of Office XP and load it on his or her PC, then share it with a second person who loaded it on his or her PC, then share it with a third person who loaded it on his or her PC, and so on. This form of piracy is very prevalent and has been estimated by some industry trade groups to account for a staggering 50 percent of the economic losses due to piracy. It is this form of piracy, casual copying, that Microsoft is primarily looking to reduce with Product Activation. Microsoft is addressing the other forms of piracy with other initiatives such as Certificates of Authenticity (COA) that accompany new PCs with genuine licenses, edge-to-edge holograms, educational campaigns and, as needed, enforcement efforts. Activation is difficult to complete. Product Activation is actually very simple to complete. It requires just a few mouse clicks for those with Internet connectivity. For those who must activate over the telephone, the process with a customer service representative can be completed in just a couple of minutes. Most users' response is 'that's it?' Product Activation keeps users from changing or upgrading their hardware. Not true at all. Users can change or upgrade their hardware. One of the forms of piracy that Product Activation guards against is hard disk imaging. Not all forms of hard disk imaging are illegal. In the case where a pirate copies data from one PC hard drive to another to illegally run the software on two PCs, Product Activation stops that by forcing the copied software to be reactivated. It does so by comparing the hardware on which it was activated to the hardware on which it is now being booted. If the hardware is substantially different, then reactivation is required. If it is the same or similar, then the software will continue to work. Those who upgrade their PC's hardware substantially may be asked to reactivate. Reactivation for this reason is easy and can be completed by contacting Microsoft to obtain another confirmation ID. Product Activation changes the way Microsoft software is licensed. The underlying principles of Microsoft's software licenses have not changed. Microsoft's end user license agreements have always stipulated the number of PCs that software can be installed on. Product Activation does not change that. Product Activation has already been cracked, or at least it will be cracked very quickly, and therefore is of no anti-piracy benefit. Actually, Product Activation has yet to be cracked. The so-called 'crack' now being passed around the Internet contains a set of instructions for setting a registry key that disables activation. Microsoft made the existence of this registry key public to its technical beta testers back in early February telling them where it was and how to set it to disable activation, and included it as a testing tool. Still, the intellectual property protection arena is a cat-and-mouse game. All intellectual property protection technologies will be cracked at some point — it's just a matter of time. The measure of success is not completely stopping software piracy, which is probably an unattainable goal. Success is more likely to be measured in increased awareness of the terms of the license agreement and increased license compliance. Internet Explorer and Windows 2000 will begin requiring activation as well. Internet Explorer 6 does not require activation or activation of the operating system it has been installed on. Some Internet reports have suggested that; however, the registry key detailed in those reports is created by a separate software installation. The registry key is created by the installation of the Terminal Services client software and a connection to a Windows 2000 terminal server; it facilitates the licensing of Terminal Services. 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Anybody ever had one of these? I received one from my work team as a Christmas Present. But unlike any other gift card/voucher I've ever received, this one has to be activated on line before you can use it. This involves giving your name, address, date of birth and telephone number. Even then it doesn't actually confirm that your card has been activated. Unnecessary intrusion into private details, and a time consuming faff. ![]() Would rather have received an ASDA gift card. Not blaming the individual who bought it, as they weren't to know. Anybody ever had one of these? I received one from my work team as a Christmas Present. But unlike any other gift card/voucher I've ever received, this one has to be activated on line before you can use it. This involves giving your name, address, date of birth and telephone number. Even then it doesn't actually confirm that your card has been activated. Unnecessary intrusion into private details, and a time consuming faff. Would rather have received an ASDA gift card. Not blaming the individual who bought it, as they weren't to know. Not really relevant, but i got one a few weeks ago, and i used in it superdrug to buy an Amazon gift card, i got loads more for my money that spending on the high street. Anybody ever had one of these? I received one from my work team as a Christmas Present. But unlike any other gift card/voucher I've ever received, this one has to be activated on line before you can use it. This involves giving your name, address, date of birth and telephone number. Even then it doesn't actually confirm that your card has been activated. Unnecessary intrusion into private details, and a time consuming faff. Would rather have received an ASDA gift card. Not blaming the individual who bought it, as they weren't to know. I got a load of them from Cadburys years ago and it was literally turn up and hand over the vouchers and job done, having to of go through that sort of crap would of killed the interest in the idea. But then again I do remember there was an offer on a choccy bar for a free burger if you was lucky and the sales rep was selling it like it was the best thing in the world till we pointed out that the nearest place was about 30 miles away and even then he tried and blag it while looking sheepish. Credit card style, plastic card. It's got a long number on the front, but when registering, I wasn't asked to type it in. Nor has my activation been confirmed. So still uncertain whether activated. I'll be sodding pissed off if I go to spend it and it's refused. Well I tried to spend it today in Argos, and it was refused. Apparently it flagged up as unregistered. I hope this is the first and last time I ever get one of these cards. So far it's caused me hassle and inconvenience. With a bit of luck it'll be straightforward vouchers I can just spend in store, from now on. Nor will I buy one for anyone else. Credit card style, plastic card. It's got a long number on the front, but when registering, I wasn't asked to type it in. Nor has my activation been confirmed. So still uncertain whether activated. I'll be sodding pissed off if I go to spend it and it's refused. I think you can top up the plastic card. The paper voucher are different. Or maybe not Q. Why do I need to activate my flexecash Love2shop Gift Card? A.For security reasons all cards are despatched un-activated. To enable cardholders to use the card, these need to be activated prior to use. Have you tried again? It sounds like you were in the wrong place, surely it would ask for the long number to activate? (I agree that this sounds like faff! I got the vouchers for Christmas, sounds simpler than the cards) I have tried again - all it does is loop round to the same starting point. It will not activate the card, despite me following the instructions to the letter, and inserting the long number as you say, as well as the three figure security number on the reverse, when prompted. There are so many vouchers/gift cards you can use immediately without having to faff about. Why does this company put people through hoops? What's the point? What about people who don't even have the internet. ![]() Contents Forward Modern-day ECG machines can make accurate measurements and analysis. So why bother to learn how to read an electrocardiogram? The answer is simple: A robotic machine can follow algorithms but it takes a human mind to read beyond and between the waveforms to make interpretation and collate it with clinical findings. Electrocardiography can be the topic of a lifelong study. This Primer is only meant to introduce the subject to medical students, interns, novice residents, and general physicians in community practice. It is hoped the liberal use of diagrams and pictures can help to improve understanding. DC Chung January 2008 Imagination is more important than knowledge. ![]() Albert Einstein Introduction Origin of the Heart Beat and Electrocardiogram Under physiological conditions, the sinoatrial (SA) node generates pacemaker impulses that spread to the right and left atria, converge on the atrioventricular (AV) node, and continue down the His bundle and bundle branches (right bundle branch or RBB and left bundle branch or LBB) to activate the ventricles. Depolarization is followed by repolarization and the sequence of depolarization [activation-and-contraction [repolarization repeats itself to generate rhythmical heart beats. Under abnormal conditions, ectopic foci in the atria, the AV junction, and the ventricles can usurp pacing dominance from this node and generate ectopic beats. The approach to supraventricular tachycardia (SVT) diagnosis can be complex because it involves. Change in the atrial activation sequence. The fact that an HRVPB can affect atrial timing indicates that an AP is present. If the atrial activation sequence is unaltered, one. Wider QRS complex and lengthening of the SH. Broad QRS complex tachycardias in the emergency. Causes of a Broad QRS Complex Tachycardia. Reversed activation sequence with left. Narrow complex tachycardia; Wide. Polymorphic ventricular tachycardia (top) and preexcited atrial. Color mapping of the electrical activation sequence. The wave of depolarization and repolarization described above can be mapped on the body surface by sensing electrodes placed on the extremities and the chest wall. The resultant waveform traced on graph paper is called the electrocardiogram (ECG). The ECG Graph Paper Horizontal axis of theECG graph paper represents time in milliseconds (ms) while the vertical axis represents amplitude or voltage in millivolts (mV). Each1-mm-division on the horizontal axis is 40 ms; each 5-mm-division is 200 ms. Two 5-mm-divisions on the vertical axis are calibrated to represent 1 mV. Despite the latter, ECG waves are commonly described by their height in mm rather than by their strength in mV. The ECG Leads The heart occupies a position in the center of the thorax anda 12-lead ECG is simply a recordingof the current flux of cardiac depolarization and repolarization obtained from 12 different sites on the body surface. There are six limb leads: Lead I records from the left at a coordinate of 0 o. Lead II records from the foot at a coordinate of 60 o. Lead III records from the foot at a coordinate of 120 o. Lead aVR records from the right shoulder at a coordinate of -150 o. Lead aVL records from the left shoulder at a coordinate of -30 o. Lead aVF recordsdirectly from the feet below at a coordinate of 90 o. There are also six chest leads with sensing electrodes positioned horizontally around the left anterior hemi-thorax between the 4 th and 5 th interspaces: Leads V1 and V2 record the current flux over the right ventricle directly. Leads V3 and V4 record directly the electrical activities of the ventricular septum and the anterior wall of the left ventricle. Leads V5 and V6 record the current flow generated by the left ventricle directly. In sinus rhythm when the SA node is the pacemaker, the mean direction of atrial depolarization (the P wave axis) points downward and to the left, in the general direction of lead II within a coordinate between 15 o and 75 o and away from lead aVR. On this count the P wave is always positive in lead II and always negative in lead aVR during sinus rhythm. Conversely, a P wave that is positive in lead II and negative in lead aVR indicates normal P wave axis and sinus rhythm. The QRS Complex The second wave is the QRS complex. Typically this complex has a series of 3 deflections that reflect the current associated with right and left ventricular depolarization. By convention the first deflection in the complex, if it is negative, is called a Q wave. The first positive deflection in the complex is called an R wave. A negative deflection after an R wave is called an S wave. A second positive deflection after the S wave, if there is one, is called the R ’ wave. Some QRS complexes do not have all three deflections. But irrespective of the number of waves present, they are all QRS complexes: A QRS complex with QRS deflections: A QRS complex with QR deflections: A QRS complex with RS deflections: A QRS complex with only an R wave: A QRS complex with RSR’ deflections: A QRS complex with a QS wave: (NB: The first wave of the last complex is a negative deflection. Therefore, it qualifies to be called a Q wave. Since all QRS complexes have an R wave, there must be one in this example as well, although it may be so small that it is not visible. A negative deflection following an R wave is an S wave. Hence this single negative deflection deserves to be called a QS wave.) QRS duration is the width of that complex from beginning to end, irrespective of the number of deflections present. Normally it lasts no more than 120 ms (three 1-mm-divisions). The normal QRS axis, like the P wave axis, points downward and to the left within a coordinate between -30 o and +90 o. This axis is said to be deviated to the left (left axis deviation or LAD) if it lies between -30 o and -90 o; and deviated to the right (right axis deviation or RAD) if it lies between +90 o and 180 o. It is either far right or far left axis deviation if it lies between 180 o and -90 o. The method of determining QRS axis will be explained in a later section. The ST Segment Following the QRS complex is the ST segment, extending from where the QRS ends (irrespective of what the last wave in the complex is) to where the T wave begins. The junction between the end of the QRS and the beginning of the ST segment is called the J point. ST segment reflects the current flow associated with phase 2 of ventricular repolarization. Since there is no current flow during this plateau phase of repolarization, the ST segment is normally isoelectric with the baseline. The T Wave The T wave represents the current of rapid phase 3 ventricular repolarization (see diagram above). The polarity of this wave normally follows that of the main QRS deflection in any lead. The ventricles are electrically unstable during that period of repolarization extending from the peak of the T wave to its initial downslope. A stimulus (e.g. A run away heart beat called a premature beat) falling on this vulnerable period has the potential to precipitate ventricular fibrillation: the so call R-on-T phenomenon. The PR Interval The PR interval extends from the beginning of the P wave to the beginning of the QRS, whatever the first wave of this complex may be. This interval measures the time from the initial depolarization of the atria to the initial depolarization of the ventricles and reflects a physiological delay in AV conduction imposed by the AV node. Normal range is 120 – 200 ms (3 to 5 1-mm-divisions) and no longer. The QT Interval The QT interval is measured from the beginning of the QRS to the end of the T wave. It represents the time in which the ventricles depolarize and repolarize and is a measure of ventricular action potential (AP) duration. This interval should be determined in the ECG lead where it is longest. Normal intervals are 120 ms) and has a shape different from that of the sinus beat. If the ventricular escape rhythm is the result of sinus node failure, no P wave of atrial contraction is seen as in the tracing above. If the ventricular escape rhythm is the result of 3 rd degree (complete) heart block, the sinus node paces the atria independently and regular P waves unrelated to the ventricular escape beats can be seen. The inherent rate of ventricular escape rhythm is between 20 and 40 beats/min. Premature Beats A premature beat also arises from an ectopic pacemaker: in the atria, the AV junction, or the ventricles. The non-sinus impulse is early, initiating a heart beat before the next anticipated sinus beat as its name implies. The reason the ectopic focus discharges a pacing impulse early in this instance is because the ectopic focus is irritable and competes with the sinus node. Atrial Premature Beat Atrial premature beat (APB) arises from an irritable focus in one of the atria. It depolarizes the atria prematurely (premature to the next timely sinus beat) and produces a P wave that looks different from a sinus-node generated P wave because the direction in which the atria depolarize is abnormal (abnormal P wave axis). Since the premature atrial impulse is conducted in a normal fashion via the AV node, the His bundle, and the bundle branches to depolarize the ventricles, the QRS complex associated with an APB has normal QRS duration and the same morphology as that of the sinus beat. Junctional Premature Beat Junctional premature beat (JPB) arises from an irritable focus at the AV junction. The P wave associated with atrial depolarization in this instance is usually buried inside the QRS complex and not visible (see “Junctional Escape ” above). However, the P wave may appear on occasions either immediately before or immediately after the QRS complex. When it is visible, the P wave is negative in lead II and positive in lead aVR because of retrograde atrial depolarization. Since the premature junctional impulse is conducted in a normal fashion down the His bundle and bundle branches to depolarize the ventricles, the QRS associated with JPB has normal duration and the same morphology as that of the sinus-node generated beat. Ventricular Premature Beat Ventricular premature beat arises from an irritable focus in the ventricles. Ventricular premature impulse is not transmitted to the rest of the ventricles along the His bundle and bundle branches. It is conducted along abnormal pathway in the ventricular myocardium. This slow process produces an abnormally wide QRS and bizarre looking T wave. Being a ventricle-generated beat, there is no P wave activity before the QRS complex. Tachycardias If an ectopic focus discharges a premature impulse only occasionally, the result is premature beats superimposed on the basic rhythm; if the irritable focus generates 3 premature beat repeatedly in a continuous sequence, the result is ectopic tachycardia. The run is called non-sustained if it lasts up to 30 seconds and sustained if longer than 30 seconds. Tachycardias, other than sinus tachycardia, can be classified into supraventricular tachycardia (SVT) or ventricular tachycardia (VT), depending on their site of origin. Supraventricular Tachycardia Tachycardias arising from an ectopic focus in the atria or AV junction are called supraventricular tachycardias (SVT). Heart rate is faster than 150 per minute and commonly around 180 per minute. At this very fast heart rate, the P waves of atrial contraction are buried within the waves of the beats before irrespective of whether the tachycardia is of atrial or junctional origin. Differentiation of the two is not possible on the surface ECG and they are simply called paroxysmal supraventricular tachycardia (PSVT) because of their paroxysmal (sudden) onset. Since PSVT impulses depolarize the ventricles by passing down the His bundle and bundle branches, the accompanying QRS complexes are of normal width and have the same morphology as that of sinus beats. Atrial Flutter In atrial flutter an atrial focus activates the atria at a rate of around 300 times per minute. The baseline of the ECG becomes all P waves, giving it a “saw tooth ” appearance in one or more leads. Since it is unusual for the AV node to conduct impulses at a rate faster than 200 per minute, AV block occurs: commonly at a 2 to 1, 3 to 1, or 4 to 1 ratio, yielding a ventricular response rate of 150, 100, or 75 per minute respectively. (NB: When the ratio of P waves to QRS complex is 2:1, 3:1, or 4:1 it would be more correct to use the term 2:1, 3:1, or 4:1 conduction rather than block. To avoid confusion, some authors simply use the term 2:1, 3:1, or 4:1 flutter.) Since the atrial flutter impulses depolarize the ventricles by passing down the His bundle and bundle branches, the accompanying QRS complexes are normal in width and have the same morphology as that of sinus beats. Atrial Fibrillation Atrial fibrillation is one of the most common arrhythmias in which multiple foci in the atria depolarize rapidly and erratically at a combined rate of 400 times/min or more. Instead of generating well recognized P waves, the atria just quiver and produce fine f waves on the ECG baseline seen in one or more leads. The AV node is constantly bombarded by depolarization impulses but only some of these impulses manage to get through. The ventricular response is totally irregular without discernible pattern (irregularly irregular) generally at a rate between 110 and 180 beats/min. Since impulses that manage to pass through the AV node are conducted down the His Bundle and bundle branches, the ventricles are activated normally and their QRS complexes are normal in width and have the same morphology as that of sinus beats. Monomorphic Ventricular Tachycardia Ventricular tachycardia (VT) arises from an irritable ventricular focus that discharges premature impulses for 3 or more beats without interruption. The rate of depolarization is 150/min or faster. Since these impulses are conducted to the rest of the ventricles via abnormal pathway in the ventricular myocardium and not via the His Bundle and bundle branches, the QRS complexes are broader than normal and without distinguishable T waves. In monomorphic VT, consecutive QRS complexes have the same appearance. Polymorphic Ventricular Tachycardia In polymorphic ventricular tachycardia, there is beat-to-beat variation in the QRS morphology. A common example is Torsades de Pointes (twisting of the points) shown below: Ventricular Fibrillation Ventricular fibrillation occurs when multiple ventricular foci discharge rapidly and chaotically. The ventricles twitch asynchronously and are not effective as pumps. No organized QRS complexes are seen —just disorganized oscillatory waves which can be coarse (as shown) or fine in appearance. Heart Blocks Heart block refers to a pathological delay in AV conduction, either at the AV node or beyond. Signs of heart block lie in the PR interval and P to QRS relationship. First Degree Heart Block In first degree heart block the cardiac rhythm is sinus in origin but the time from the initial depolarization of the atria to the initial depolarization of the ventricles is abnormally delayed. This pathologic delay is reflected in a PR interval longer than its upper limit of 200 ms. Nevertheless, each P wave of atrial contraction is followed by a QRS complex of ventricular contraction. Second Degree Heart Block When transmission of the depolarizing impulse from the sinus node through the AV conduction system of the heart is interrupted intermittently, P wave of atrial contraction is no longer followed by a QRS complex of ventricular contraction in the interrupted beat. This is second degree heart block. There are 2 types of second degree heart block: Mobitz type I & Mobitz type II. In Mobitz type I block there is progressive prolongation of the PR interval, indicating increasing delay in AV conduction, before it fails altogether. When failure in AV conduction occurs, the P wave of atrial contraction is not followed by a QRS complex. After this missed ventricular beat, the PR interval returns to its shorter duration and the cycle of progressive PR prolongation and missed ventricular beat repeats itself. In Mobitz Type II block, a non-conducted P wave not followed by a QRS complex occurs suddenly without progressive prolongation of the PR interval. That is, the PR interval, which can be normal or prolonged, is constant before the non-conducted beat materializes. Mobitz t ype II second degree heart block indicates more serious disease of the conduction system in regions below the AV node and can progress to total failure of AV conduction (third degree heart block) without warning. Third D egree H eart B lock In third degree (complete) heart block, all the SA node impulses are blocked and not conducted to the ventricles. In the absence of an alternative pacemaker, ventricular contraction comes to a standstill and the patient dies. But most probably an ectopic pacemaker below the block takes over ventricular pacing and the patient survives. Since the SA node and the ectopic pacemaker pace the atria and ventricles independently, the P waves bear no relationship to the QRS complexes. Two types of QRS complexes can be seen in third degree heart block: If the block is high in the AV node and the ventricular pacemaker is located lower in the AV junction, the QRS complex is normal in width because ventricular activation is via the bundle branches. If the block is low in the AV junction, the ventricles are paced by an idioventricular pacemaker and the QRS complexes will be wide rthan normal because the ventricles are no longer activated via the bundle branches. Bundle Branch Block This topic is covered in a later section. QRS Axis There are many ways to determine QRS axis. The one described below combines simplicity and efficiency. The limits of normal and abnormal QRS axis are summarized in the diagram to the right. QRS axis is the direction in which the mean QRS current flows. The normal axis points mostly downward and to the left because the more muscular left ventricle generates a stronger depolarizing current that overwhelms that generated by the less bulky right. Although both right axis deviation (RAD) and left axis deviation (LAD) are not necessarily associated with organic heart disease, they are seen in a number of settings and their presence can provide added evidence to support a clinical diagnosis. RAD is seen in right ventricular (RV) hypertrophy and in infarction involving the left ventricle ( LV). Right ventricular muscle bulk is relatively larger than that of the left in both conditions and generates a stronger depolarizing current in its direction. LAD is seen, but not always, in patients with left ventricular hypertrophy. More commonly the QRS axis is horizontal in this condition. It is only necessary to examine the QRS complexes in leads I and II to determine whether the QRS axis in normal or deviated to the left or the right; a precise calculation of the QRS axis is not required in clinical interpretation of the ECG. It has been explained in a previous section that a current flowing in the direction of a recording electrode (an ECG lead) registers a positive deflection and a current flowing away registers a negative deflection. Therefore, the QRS in lead I would be positive if the QRS current flows in the direction of lead I and negative if away. Similarly the QRS in lead II would be positive if the QRS axis points in the direction of lead II and negative if away. By overlapping the two circles representing leads I and II, it can be seen that the QRS axis is between +90 o and -30 o and normal if the QRS is positive both in lead I and lead II. QRS axis is between -30 o and -90 o or deviated to the left (left axis deviation or LAD) if the QRS is positive in lead I but negative in lead II. QRS axis is between +90 o and +150 o or deviated to the right (right axis deviation or RAD) if the QRS is negative in lead I but positive in lead II. On occasions the QRS complexes in all 6 limb leads are biphasic, neither positive nor negative. In these instances the QRS axis is said to be indeterminate. In summary: Normal QRS axis. Left axis deviation Right axis deviation Right and Left Atrial Abnormalities (NB: “Atrial abnormality” is a term being used increasingly in place of “atrial enlargement ”, “atrial dilatation ” or “atrial hypertrophy ”.) Look for signs of atrial abnormalities in leads in which the P wave is most prominent: usually lead II, but also leads III, aVF, and V1. In sinus rhythm the right atrial depolarization wave (brown) precedes that of the left atrium (blue) and the combined depolarization waves, the P wave, is less than 120 ms wide and less than 2.5 mm high. In right atrial abnormality, right atrial depolarization lasts longer than normal and its wave extends to the end of left atrial depolarization. Although the amplitude of the right atrial depolarization current remains unchanged, its peak now falls on top of that of the left atrial depolarization wave. As a result, the combined waves of right and left atrial depolarization, the P wave, is taller than normal (taller than 2.5 mm) but its width remains within 120 ms. In left atrial abnormality left atrial depolarization lasts longer than normal but its amplitude remains unchanged. Therefore, the height of the resultant P wave remains within normal limits but its duration is longer than120 ms. A notch (broken line) near its peak may or may not be present. A biphasic P wave in V1 is another sign suggesting atrial abnormality. In right atrial abnormality, the initial positive portion of the biphasic P wave is larger than the terminal negative portion. A biphasic P wave in V1, with its terminal negative deflection more than 40 ms wide and more than 1 mm deep is another ECG sign of left atrial abnormality. Right and Left Ventricular Hypertrophy Look for signs of right and left ventricular hypertrophy in the right chest leads (V1 and V2) and left chest leads (V5 and V6). When the ventricles are normal, the QRS complexes across the chest leads of an ECG have these configurations: In right chest leads V1 and V2, the QRS complexes are predominantly negative with small R waves and relatively deep S waves because the more muscular left ventricle produces depolarization current flowing away from these leads. In left chest leads V5 and V6, the QRS complexes are predominantly positive with tall R waves because the more muscular left ventricle produces net current flowing towards these leads. The QRS complexes in V3 and V4 reflect a transition between the right and left chest leads. The normal transition zone, where the R wave and S wave are equal, is between V3 and V4. Early transition may appear in V2 while late transition may not appear until V5 or V6. In right ventricular hypertrophy (RVH), the configurations of the QRS complexes across the chest leads are changed: In V1 the QRS are positive with tall R waves. This is because increased right ventricular muscle mass causes the net ventricular depolarization current to move toward s this right chest lead. R wavesthat are taller than S waves are deep in V1 are highly suggestive of RVH. The S waves are unusually deep in V6 and may be even deeper than the R wave is tall. Other ECG signs of RVH include: Right axis deviation due to the overpowering current generated by a hypertrophied right ventricle. Ventricular repolarization changes manifest as downward sloping of the ST segment and T wave inversion, the so called ventricular strain pattern, may or may not be present in the right chest leads. (See V1 in above ECG.) P wave > 2.5 mm tall in lead II, III, aVF or biphasic P wave in V1 suggesting the presence of right atrial enlargement. (Right atrial abnormality results from the right atrium having to pump blood into a thick-wall non-compliant hypertrophied right ventricle.) In left ventricular hypertrophy (LVH), the configurations of the QRS complexes across the chest leads are also changed and consist of: Unusually tall R wave in left chest leads V5 and V6 and unusually prominent S wave in right chest leads V1 and V2. These are exaggerations of the normal configurations due to increase in left ventricular muscle mass. The sum of the S wave in V1 and the R wave in V5 or V6 is > 35 mm. (Tall R waves in chest leads is common among young and slender individuals. This finding alone should not be used as the only criteria of LVH.) Additional ECG signs of LVH include: R waves taller than 14 mm in lead I or taller than 11 mm in Lead a VL. However, tall R waves in limb leads and chest leads do not always coexist. Left axis deviation may or may not be present. Repolarization abnormalities of ST segment depression and T wave inversion suggesting ventricular strain may be present in the left chest leads with tall R waves. (See leads V5 and V6 in above ECG.) Signs of left atrial enlargement in leads II, III, a VF or V1 may be present. Left atrial abnormality is the result of having to pump blood into a muscular non-compliant left ventricle. Bundle Branch Blocks Look for signs of bundle branch block (BBB) in V1 and V6. In the absence of BBB, passage of the depolarizing impulse down the His bundle and bundle branches is rapid and activation of the right and left ventricles is simultaneous and synchronous. The individual QRS complexes of the right and the left ventricles superimpose on each other and produce a composite QRS complex that is narrow in width ( 120 ms wide and has RSR ’ waves: the R wave belongs to the individual QRS of the not-blocked ventricle and the R ’ wave to the individual QRS of the blocked ventricle. The S wave between the R and R ’ waves may be deep and falls below the baseline; it may not be so deep and causes a notch between the R and R ’ waves only; or it may be hardly visible such that the QRS complex is simply a tall and wide R wave. In right bundle branch block (RBBB), the widened RR ’ complex is seen most typically in V1. Secondary T wave inversion can also be seen in this lead because when depolarization is abnormal repolarization can also be expected to be abnormal. Since the late right ventricular depolarization current moves away from left chest leads, it shows up as wide S waves in V6. When there is an RR ’ complex in V1 but it is less than 120 ms wide, the condition is called incomplete right bundle branch block. In left bundle branch block (LBBB) the widened RR ’ complex is seen most typically in V6. Secondary T wave inversion is present in the left but not right chest leads. Since the late left ventricular depolarization current moves away from the right chest leads, it shows up as deep and broad S waves in V1. Bundle branch block or ventricular rhythm? The QRS complexes are wider than normal in both BBB and ventricular rhythm. But the rhythm in BBB is supraventricular in origin. There is a one-to-one P wave to QRS relationship in BBB: In sinus rhythm with 3 rd degree heart block, there are regular P waves that are totally asynchronous with the QRS complexes, which represent escape rhythm from a ventricular focus. In ventricular rhythm with sinus arrest, only wide QRS complexes are seen and P waves are absent. Acute Myocardial Infarction Acute myocardial infarction (MI) affects both ventricular depolarization (appearance of pathological Q waves) and repolarization (ST-T wave changes). Specific manifestations depend on whether the lesion is subendocardial or transmural in location. The ECG sign of subendocardial ischemia is ST segment depression (A). Depression is reversible if ischemia is only transient but depression persists if ischemia is severe enough to produce infarction. T wave inversion with or without ST segment depression (B) is sometimes seen but not ST segment elevation or Q wave. That is why subendocardial infarction is also called non-ST-elevation myocardial infarction (NSTEMI) and less commonly non-Q wave myocardial infarction. ST segment depression seen in subendocardial ischemia or infarction can take on different patterns: The most typical being horizontal or down-sloping depression. Up-sloping ST depression is less specific. In exercise stress tests, horizontal or down-sloping depression of 1 mm or more (A, B, & C) or up-sloping depression of the same magnitude 80 ms beyond the J point (D) is considered positive signs of ischemia. Up-sloping depression of less than 1 mm at 80 ms beyond the J point (E) is simply J point depression and not ST segment depression. In transmural MI, ischemia in the subendocardium spreads to the epicardium and involves full thickness of the myocardium. In the acute phase, the ECG signs are ST segment elevation. The elevated ST segment may slope upward or be horizontal or dome-shape. Hyperacute (tall positive) T waves may precede ST segment elevation (A) or seen at the same time with ST elevation (B) during this acute phase. Hours to days later during the evolving phase, pathological Q waves appear, the elevated ST segments return towards baseline, and the T waves become inverted. Q wave is normal if it is shallow and brief (A). Q wave is pathological if it is wider than 40 ms or deeper than a third of the height of the entire QRS complex (B & C). Significant Q wave usually persists even after recovery. Localization of myocardial infarction By way of their position, the 12 ECG leads can be used to distinguish myocardial infarction occurring in different regions of the heart. The chest leads cluster around the heart in the horizontal plane and look in from the front (V1 to V4) and from the left (V5 and V6); leads I and aVL also look in from the left while leads II, III, and aVF look in at the under surface. Signs of anterior MI (grey area), territory supplied by the left anterior descending coronary artery (LAD), are seen in V1 to V4. Signs of lateral MI (grey area), territory supplied by the left circumflex coronary artery (LC), are seen in leads I, aVL, V5 and V6. Signs of inferior MI (grey area), territory supplied by the right coronary artery (RCA), are seen in leads II, III, and aVF. Signs of posterior MI on a 12-lead ECG are not the characteristic ST elevation and Q waves, which would be the case if there is a lead recording from the patient ’s back. Since V1 and V2 are attached to the patient ’s front, they will record changes reciprocal to changes seen from the back, which are ST depression and tall R waves. These uncharacteristic signs make the diagnosis of posterior MI difficult without heightened vigilance. Suffice it to say, pure posterior wall infarctions are rare. Most extend to involve the inferior wall or lateral wall and leads II, III, and aVF should be examined for characteristic signs of this extension in the former and leads I, aVL, V5 and V6 in the latter. MI in the presence of LBBB The presence of LBBB complicates the ECG diagnosis of acute MI. This is because LBBB alone can produce signs that may be confused with those of infarction: deep QS waves in the right chest leads and ST depression and T wave inversion in the left chest leads. Furthermore, the Q wave of left ventricular MI may be buried within the widened QRS complex. Therefore, the diagnosis of acute myocardial infarction should be made circumspectively in the presence of pre-existing LBBB. On the other hand, the appearance of new LBBB should be regarded as sign of acute MI until proven otherwise. Electrolyte Abnormalities Hyperkalemia and Hypokalemia Serum potassium is the major intracellular ion that participates in the depolarization and repolarization of myocardial cells. Hence its serum concentration has a profound effect on the QRS and ST-T complex. Narrow and tall peaked T wave (A) is an early sign of hyperkalemia. It is unusual for T waves to be taller than 5 mm in limb leads and taller than 10 mm in chest leads. Hyperkalemia should be suspect if these limits are exceeded in more than one lead. As serum potassium concentration continues to rise, the PR interval becomes longer, the P wave loses its amplitude and may disappear, and the QRS complex widens (B). When hyperkalemia is very severe, the widened QRS complexes merge with their corresponding T waves and the resultant ECG looks like a series of sine waves (C). If the rise in serum potassium continues unabated, the heart arrests in asystole. (NB: The narrow and tall peaked T wave of hyperkalemia may be confused with the hyper-acute T wave occasionally seen in transmural myocardial infarction. The patient ’s presenting history and physical findings would help to differentiate the two.) With hypokalemia, the T wave becomes flattened together with appearance of a prominent U wave. The ST segment may become depressed and the T wave inverted. Unlike hyperkalemia, these additional changes are not related to the degree of hypokalemia. Hypercalcemia and Hypocalcemia ECG signs of hypercalcemia and hypocalcemia may not be obvious even in patients who have deranged plasma calcium concentrations that are clinically significant. If they are present, hypercalcemia is associated with short QT interval (A) and hypocalcemia with long QT interval (B). Interval shortening or lengthening is mainly in the ST segment. Drug Effects Digoxin Digoxin is a potent pro-arrhythmic drug. At therapeutic plasma level, it causes nonspecific ST segment depression that has a scooping appearance (A) or looks like a reversed “ ̈” (B). (See Case 067: Abnormal ECG at At toxic levels, digoxin can cause virtually all kinds of arrhythmia but particularly sinus bradycardia, SA and AV blocks, atrial and junctional tachycardias, and VPB and ventricular tachycardia. Anti-arrhythmic Drugs Quinidine, procainamide, and disopyramide ( Class IA agents) prolong the QRS duration and the QT interval with or without the appearance of U wave and have the propensity to cause polymorphic ventricular tachycardia (torsade de pointes). Sotalol and amiodarone (Class III agents) can increase PR, QRS, and QT intervals, leading to similar risks of torsade de pointes. They also have significant beta-blocking properties, causing bradyarrhythmias. Pulmonary Embolism The classical ECG signs of acute pulmonary embolism are S IQ IIIT III, which are mnemonics representing deep S wave in lead I, pathological Q wave in lead III, and inverted T wave in lead III: Other nonspecific signs include (see ECG above): Sinus tachycardia and atrial and ventricular ectopic beats. Right axis deviation. Right ventricular strain pattern with inverted T waves in right chest leads. Incomplete or complete right bundle branch block pattern. Slow R wave progression in chest leads But all these ECG signs may not be present even in frank pulmonary embolism. The initial four QRS complexes have an atypical right bundle branch block morphology suggesting either ventricular tachycardia (VT) or a preexcited tachycardia. There is 1:1 AV relationship with the earliest atrial electrogram in the septum. In such a situation, the differential diagnosis includes VT with 1:1 VA conduction, atrial tachycardia or AV node reentry with anterograde conduction over an accessory pathway (AP), and antidromic tachycardia with anterograde conduction over an AP and retrograde conduction over either a second septal AP or the normal VA conduction system. An atrial stimulus (S2) introduced during tachycardia at the MCS electrode site terminates tachycardia without conduction to the ventricle. This eliminates VT as a diagnosis. Termination with a relatively late-coupled PAC also favors a macroreentrant tachycardia with close access of the PAC to the excitable gap, that is, antidromic reentry in this case. Additional pacing maneuvers during the study proved the mechanism to be antidromic tachycardia with retrograde conduction over the normal VA conduction system. The last two QRS complexes show no evidence of anterograde AP conduction. In fact, there is not even local evidence of preexcitation on the coronary sinus leads as demonstrated by a long conduction time between the local A and V ( arrow). In a patient with antidromic reciprocating tachycardia (ART) there is typically some evidence of anterograde AP activation during sinus rhythm. This was a very unusual AP that only became manifest with multiple premature atrial extrastimuli that resulted in block over the AV node and a very long conduction time over the AP. • I need to keep my old number to be transfer to the Giffgaff mobile sim card. I need someone to give me a hand to make it happen – but of course I need to have a. • Keep your number when you join giffgaff. To transfer your phone number to giffgaff, you first need to ask your old mobile provider for a Porting Authorisation Code (PAC). Transfer your number to a new SIM. Phone number deactivation. Keep your phone number when you leave giffgaff. • Eingebettetes Video How to activate your sim with your new phone number • The most in-depth and conclusive review of Giffgaff, including how to get a free SIM card with £5 free credit as well as unlimited data, calls and texts. Also • giffgaff the mobile network run by you. Great value goodybags packed full of minutes texts and internet. Visit us online today. • What is a giffgaff PAC code? A giffgaff porting authorisation code, or giffgaff PAC code, allows you to transfer your existing mobile phone number from giffgaff to. ![]() Jun 09, 2010 This is a quick video on how to activate your giffgaff sim with a voucher:) get a sim with £5 free when you activate, http. Order your giffgaff SIM card through our website and get £5 pounds of balance for free. You can activate it from abroad, with a foreign address and bank card. How do I activate my SIM? Head to giffgaff.com/activate and enter your SIM code. You'll then need to buy a goodybag or some top-up credit for the first time. You can pay with your credit/debit card or a giffgaff top-up voucher. Pop your newly activated SIM into an unlocked phone and you're ready to go. I am a tourist from HONGKONG. I am heading to london tomorow and I have a new giffgaff card in hand. I am going to activate the simcard and gonna to. • Changing mobile network? Your old network must provide a PAC Code so you can keep your phone number. Find out how to obtain & use a PAC. • Please note. The settings listed below are intended for use in the UK, with handsets and tablets using SIM cards issued by the UK mobile network GiffGaff. • Head to giffgaff.com/activate and enter your SIM code. You'll then need to buy a goodybag or some top-up credit for the first time. You can pay with your credit/debit card or a giffgaff top-up voucher. Pop your newly activated SIM into an unlocked phone and you're ready to go. • A PAC code, porting authorisation code, is required when switching mobile phone providers and when you want to keep your existing mobile phone number. Get your PAC. • After activation, we'll give you a link to transfer your old number to us that you can use at any time. Enter the code from your new SIM and click 'Continue'. • 5 days ago. SIM Swap allows you to transfer your giffgaff number to a brand new SIM. Old SIM will be deactivated, and activation of the new SIM will begin. • Buy Phones unlocked upfront, or choose to pay monthly - the flexibility of a contract without the tie in. • Get great mobile phone deals at giffgaff, the no contract, pay as you go online only network. Get SIM cards packed with minutes, texts and data and earn. • First, you'll need to activate your new giffgaff SIM. Your new SIM will keep your existing phone number and any goodybag and/or top-up credit you have. • Apr 23, 2012. Solved: I went through the activation process for a for my mother today. The sim was fairly old (no idea how old) and I (perhaps stupidly). • Oct 9, 2015. I was wondering if it was possible to activate my new SIM card now since. My contract expires), transfer my old number to my new GiffGaff SIM. • Oct 30, 2013. How can i transfer my number from the old sim to the new sim? Next enter the Activation code of the New SIM card. • Dec 29, 2012. My question is how do I activate the new nano sim under the old number? Activation codes and sim serial numbers of your current and new. • Jul 12, 2017. 2 - If activating a SIM by the direct purchase of a goodybag / gigabag. Giffgaff to you, help them out by entering their phone number into the. Hi I just got my giffgaff sim today I even went out and got a £10 top up voucher I've been trying to activate my sim for like 15 minutes now on the activate page it's saying 'Processing. Please wait' and that little refresh sign thing keeps on spinning. Is this normal? I googled it and I. Hi I just got my giffgaff sim today I even went out and got a £10 top up voucher I've been trying to activate my sim for like 15 minutes now on the activate page it's saying 'Processing. Please wait' and that little refresh sign thing keeps on spinning. Is this normal? I googled it and I found some posts saying there was some issues with activation but today is the 25th, and it's supposed to be fixed - right? At the top it shows there's 6 steps - 6 Digit code Register or Login Personal Details Top-Up Payment Confirmation. At the moment its on Register and Login on which I selected 'I'm not registered with giffgaff'. I chose a user name and made a pass and gave my email, now im stuck in this please wait thing. I kind of need this sim as my old contract is gone now and it's a pain getting to college with no minutes or texts -_- Thanks! After writing all that I probably been waiting 20 minutes now. • Tell us some more • Upload in progress • Upload failed. Please upload a file larger than 100 x 100 pixels • We are experiencing some problems, please try again. • You can only upload files of type PNG, JPG or JPEG. • You can only upload files of type 3GP, 3GPP, MP4, MOV, AVI, MPG, MPEG or RM. • You can only upload photos smaller than 5 MB. • You can only upload videos smaller than 600 MB. • You can only upload a photo (png, jpg, jpeg) or video (3gp, 3gpp, mp4, mov, avi, mpg, mpeg, rm). • You can only upload a photo or video. • Video should be smaller than 600 MB/5 minutes • Photo should be smaller than 5 MB •. ![]() Have you just bought a brand new Verizon cell phone, installed its battery, powered it on, only to find out that you can’t use it to make a call? This is because you have not activated the wireless device yet. ![]() Troubleshooting: Invalid Browser Version / Operating System Detected. We detected you are using an unsupported Browser / Operating System. To receive an optimal. Verizon Wireless Replacement Phone Activation Guide Please Read: We do not recommend taking your phone into any Verizon Wireless Store. Buy phone card online, we offer a big selection of low rates and great quality phone cards and calling cards, visit our site and find out more. Total Wireless offers first-class service paired with no contract, pay as you go plans. Contact us today and get started! Almost all new Verizon prepaid cell phones need to be activated before 1st time usage. Below is a step-by-step guide to show you how to activate your Verizon prepaid phone online. Find a computer with internet access. Of course, if you have other devices with web browsing capability, they can also be used. Open the web browser and type in the URL: And it will take you to the Verizon Wireless prepaid activation page. On you first need to select your location. This location is where you will most often be using your mobile phone. They will use this information to assign you a new number. You can pick your location by typing in your zip code and your city and state. On the next page, you need to choose your area code for your new phone and then enter the ESN or MEID of your device. ESN stands for Electronic Serial Number and MEID stands for Mobile Equipment Identifier. These numbers can be located on your phone. You just need to remove the battery to see it. Then you are all set and they will give you a new wireless phone number. Enjoy your new Prepaid Verizon cellphone. ![]() Tip: For those of you who don’t have an internet access, you call make a call to get it activated. Choose the right size for you, from 2GB to Unlimited. No smartphone? Connect your basic phone, tablet, hotspot or connected device to America’s best network. No annual contract. Monthly plans for your smartphone or connected device. Find a plan for your business, no matter how big or small. Connect from abroad or reach out to 200+ countries while in the U.S. Connect tablets, hotspots and other devices on a shared data-only plan. Back up your content, personalize your device and more. Store photos, videos, contacts, music, documents, call logs and text messages. Coverage for damage, loss, theft and Verizon Tech Coach support Estimate your expected monthly payments in two steps. Step 1: Initiate 4G LTE Service • Dial 1.866.893.7723 from any phone and follow the prompts to initiate your 4G LTE service. Step 2: Insert 4G LTE SIM card and battery • Snap the 4G LTE SIM card out of its holder without touching the gold electrical contacts. • Align the notched corner of the 4G LTE SIM card and then insert it into the SIM card slot of your device. • The actual insertion process varies by device. For illustrated instructions on how to insert the SIM card, refer to the manual that came with your device. • Write down the SSID and password located on the back of your device or under the battery cover. • Insert battery. • Put on the battery cover. • Fully charge your device. Step 3: Connect to the Internet Connect Wi-Fi–capable devices to your Verizon Jetpack: • Ensure your Verizon Jetpack is powered ON. • From a Wi-Fi–capable device, look for the network name (SSID) of your Verizon Jetpack that you wrote down in Step 2. • On your connected device, open the Internet browser to connect to the Internet. You’ll be directed to the Verizon Wireless Mobile Broadband portal. From there you can create your account profile and purchase a data plan, and you can surf the web and/or set up a Mobile Hotspot. We can change screen saver on a computer by changing the settings in display properties. We also have a registry hack to change screen saver settings. These screen saver settings are stored under the following registry key. HKEY_CURRENT_USER Control Panel Desktop Registry values that control screen saver behavior: • ScreenSaveActive • SCRNSAVE.EXE • ScreenSaveTimeOut • ScreenSaverIsSecure To disable or enable screen saver using registry key Set the value of the registry value ScreenSaveActive to 0. ![]() From command line you can run the below command for doing this. Reg add 'HKEY_CURRENT_USER Control Panel Desktop' /v ScreenSaveActive /t REG_SZ /d 0 /f To enable screen saver. Reg add 'HKEY_CURRENT_USER Control Panel Desktop' /v ScreenSaveActive /t REG_SZ /d 1 /f To change timeout for activating the screen saver Set the data in the registry value ScreenSaveTimeOut to the timeout limit in seconds. For example if you want to set the time out to 20 minutes you need to change the value of this registry key to 1200. From command line you can run the below command to change screen saver timeout limit. Reg add 'HKEY_CURRENT_USER Control Panel Desktop' /v ScreenSaveTimeOut /t REG_SZ /d 0 /f To enable or disable password protection when the session is resumed You can password protection by setting the data in ScreenSaverIsSecure to 1. If you set this to 0, you will not be asked to provide password when you interrupt the screen saver to resume the user session. From windows command line you can run the below command to enable password for the screen saver. Reg add 'HKEY_CURRENT_USER Control Panel Desktop' /v ScreenSaverIsSecure /t REG_SZ /d 1 /f To disable password protection: Reg add 'HKEY_CURRENT_USER Control Panel Desktop' /v ScreenSaverIsSecure /t REG_SZ /d 0 /f To change screen saver using registry key Read the post The above registry keys apply to Windows XP, Server 2003, Vista and Windows 7. ![]() But sometimes screen saver will bother you when installing some important software or updating Windows operating system. And after activating screen saver, you need to re-login and type password again. For those who don't want screen saver to be activated automatically, Please follow this step to turn off screen saver. To open Display, click Start, click Control Panel, click Appearance and Themes, and then click Display. Selecting the On Resume, password protect check box will lock your computer when the screen saver is activated. When you begin working again you will be prompted to type your password to unlock it. Activate Screen Saver Password Windows 7 How to disable the screensaver password for all users via command line? How to change Background Wallpaper using. ![]() |
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March 2018
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