EKG (ECG)

Modern ECG Machine

Cardiac Conduction System

Sinoatrial (SA) node Atrioventricular (AV) node AV bundle (bundle of His) Purkinje fibers

Intrinsic Conduction System of the Heart

Extrinsic Control of the Heart

PNS acts through the vagus nerve, releasing ACh to decrease heart rate and force of cardiac contraction Hyperpolarization of the conduction cells Absence of vagal tone, HR = 100 beats/min Maximal vagal tone, HR = 20-30 beats/min SNS increases rate of impulse generation and conduction speed, increasing heart rate and force of cardiac contraction Maximal sympathetic stimulation, HR = 250 beats/min Epinephrine and norepinephrinereleased from the adrenal medulla as a result of sympathetic stimulation increase heart rate

10 electrode placement - 12 leads

Limb Leads I, II, III, aVR, aVL, and aVF
Electrodes placed on patients arms and legs

Chest leads (precordial) V1, V2, V3, V4, V5, V6

Electrodes placed on patients chest

Electrocardiogram (ECG)
An ECG provides a graphical record of the electrical activity of the heart and can be used to aid clinical diagnoses

12 lead EKG

12-Lead ECG + Rhythm Strip

Can be determined from EKG

Rate Rhythm Axis Hypertrophy Infarction

Heart Rate-6 sec strip

Normal Sinus Rhythm (NSR)

Sinus Bradycardia

Premature Atrial Contraction (PAC)

Atrial Fibrillation
350-450 bpm

Atrial Fibrillation

Atrial Flutter

Atrial Flutter
250-350 bpm, invert tracing to diagnose or vagal stimulation

Premature Ventricular Contraction (PVC)

Bigeminy PVC every other complex Trigeminy every third beat is a PVC Quadrigeminy every forth beat is a PVC (as seen below)

Ventricular Tachycardia (Rate 150-250 bpm)

Ventricular Flutter
250-350 bpm, single focus

Ventricular Fibrillation 350-450 bpm

Flutter-Fib

Ventricular Fibrillation (Fine and Course)

Pacemaker

Asystole

LVH with strain (R wave amplitude V5 + S wave amplitude V1 = 35mm)

MI-Acute vs. Old Injury

ST elevation = acute injury Significant Q wave = old injury (1mm wide or 1/3 amplitude of QRS)

ST Elevation

Significant Q waves = Old Infarction

Locating an MI
Posterior large R in V1-2; Q in V6; mirror test Inferior Q or ST elevation in II, II, AVF Anterior - Q or ST elevation in V1-4 Lateral Q or ST elevation in I, AVL, V5-6

Acute Anterior MI

Acute Inferior MI

Acute Lateral MI

Acute Posterior MI

Old Inferior MI