Ecg Lecture

Marvin Allan S.
De la Cruz, RN,MAN
Electrocardiography (ECG)
graphically measures & records the electrical current traveling through the conduction system generated by the heart measured by electrodes placed on the skin & connected to an amplifier & strip chart recorder
Marvin Allan S. De la Cruz, RN,MAN
DIAGNOSTIC TESTS
EKG/ECG (electrocardiogram)- is a graphic recording of the electrical potentials produced by the cardiac tissue.
Screening tool for cardiac abnormalities Most commonly performed cardiac test.
Holter monitor- are set to monitor heart activity continuously for about 24 hours
Electrophysiologic Properties of the Heart

1. Automaticity
initiate an impulse spontaneously & repetitively
2. Excitability/Irritability (depolarization)
respond to a stimulus
3. Conductivity
Transmit electrical impulses
Contractility
Contract
Refractoriness
Inability to respond until repolarization
Rhythmicity
Ability to contract & relax @ reg rate & pattern
SA (60-100/min) AV (40-60/min) BUNDLE OF HIS (30-40/min) BUNDLE BRANCHES PURKINJE FIBERS (20-30/min)
ELECTRICAL CONDUCTION SYSTEM OF THE HEART
P WAVE
Atrial depolarization /systole (contraction) Indicates impulse comes from SA node If (-) or abN position, impulse originates outside the SA node
PR INTERVAL
Time impulse travels from SAAV BB PF Normal: 0.12-0.20 sec. Short: impulse comes from AV node Long: delayed conduction heart block
QRS COMPLEX
Ventricular Depolarization Impulse traveled through R & L Ventricle resulting to ventricular contraction Normal: <0.12 sec. Q 1st (-) deflection R 1st (+) deflection S 2nd (-) deflection
ST SEGMENT
Normal is in isoelectric line (ventricles at rest) Elevated: MI (myocardial injury) Depressed: myocardial ischemia
T WAVE
Rounded wave form, taller & wider than P wave Ventricular Repolarization (rest or recovery) Inverted & sharply pointed: ISCHEMIA
U WAVE
Small, rounded, low amplitude after P wave Usually not seen in a normal ecg (+) late polarization of ventricles; low K+ Opposite direction w/ T wave: cardiac dse, HPH
ANALYZING ECG
STEP 1: DETERMINE REGULARITY OF R WAVES After finding out the patient's medical history, begin by labeling the P wave, PR interval, QRS complex, QT interval and T wave. Determine if the rhythm is regular or irregular. This is done by accessing whether the RR intervals and PP intervals are regularly spaced.
REGULAR OR IRREGULAR?????
STEP 2. CALCULATE HEART RATE

FOR REGULAR RHYTHM
Big Block Method:
(300/# of R waves) in 3-sec strip. 1500/# small boxes bet R
Memory Method: (300,150,100,75,60,50,43,33,30)
FOR IRREGULAR RHYTHM:

For 6 sec strip(#of R x 10) For 3 sec strip (#of R x 20) If less than 3 sec, count # of Rs x 40
Calculate the atrial and ventricular heart rates. A rate of less than 60 beats per minute is slow, 60-100 beats per minute is normal and greater than 100 beats per minute is fast .
STEP 3. IDENTIFY & EXAMINE P WAVES

P waves should precede each QRS complex identical or near identical
STEP 4: MEASURE PR INTERVALS

Count # of boxes X 0.04sec
STEP 5:MEASURE QRS COMPLEX

# of boxes X 0.04
ECHOCARDIOGRAM (2D ECHO)

Echocardiogram
Uses sound waves to create pictures of the heart and its blood vessels. A moving image of the patients beating heart is played on a video screen, where a physician can study the hearts thickness, size and function.
SINUS RHYTHMS (SA NODE)
Normal Sinus Rhythm Sinus Bradycardia Sinus Tachycardia
INTERVENTION:
Usually does not warrant treatment Assess client for the tolerance of the rate If hypotension or decreasing LOC occurs, the rhythm is treated Administer Atropine
SINUS TACHYCARDIA
CAUSES:
Caffeine Alcohol Physiologic response to stimuli
INTERVENTION:
Monitor pts tolerance Administer digitalis, beta-blockers, diltiazem
NORMAL SINUS RHYTHM

RHYTHM
SINUS BRADY
SINUS TACHY
REGULAR 60-100 NORMAL PRECEDE EACH QRS COMPLEX NORMAL: 0.12-0.20 SEC NORMAL: <0.12 SEC
REGULAR <60 NORMAL PRECEDE EACH QRS COMPLEX NORMAL: 0.12-0.20 SEC
REGULAR 100-150 NORMAL PRECEDE EACH QRS COMPLEX NORMAL: 0.12-0.20 SEC NORMAL: <0.12 SEC
RATE
P WAVE
PR INTERVAL
QRS COMPLEX
NORMAL: <0.12 SEC
ATRIAL RHYTHMS (AV NODE)
ATRIAL FLUTTER ATRIAL FIBRILLATION
ATRIAL FLUTTER
P waves in sawtooth appearance (flutter waves) No isoelectric line between flutter waves CAUSES:
Cardiomyopathies, pulmonary embolism, valve dse, CHF
MGMT:
Cardioversion (<50 joules) Digoxin, Propanolol, Diltiazem, Verapamil
ATRIAL FIBRILLATION
Is the quivering, chaotic motion in the upper chambers of the heart P wave in wavy deflection Holiday Heart Syndrome It is not typically a medical emergency. CAUSES:
CAD, Valve dse, heart failure
MGMT:
IF STABLE: digitalis, beta-blocker (Inderal) or Ca antagonist (Diltiazem, Verapamil) DEFIBRILLATION
ATRIAL FIBRILLATION
ATRIAL FIBRILLATION
ATRIAL FLUTTER
ATRIAL FIBRILLATION
RHYTHM
RATE P WAVE
REG or IRR
A: 250-400 V: VARIABLE SAWTOOTH
IRREG
A: >400 V: 130 FIBRILLATORY WAVES
PR INTERVAL
QRS COMPLEX
NOT MEASURABLE
NOT MEASURABLE
NORMAL NORMAL Marvin Allan S. De la Cruz, < 0. 12 sec 0.06 0.08 sec RN,MAN
HEART BLOCK
Heart block is the delayed or complete lack of electrical communication between the upper chambers of the heart (atria) and the lower chambers of the heart (ventricles). S/SX:
Syncope (fainting) Dizziness Lightheadedness Chest pain Shortness of breath
CAUSES: cardiac ischemia, CAD, heart attack. Hyperkalemia OR hypokalemia Disease or normal aging Myocarditis. beta blockers, calcium-channel blockers or digitalis Heart surgery. Rheumatic fever. Congenital heart condition
HEART BLOCKS
FIRST DEGREE AV BLOCK SECOND DEGREE AV BLOCK
MOBITZ 1 WENKEBACH MOBITZ 2
THIRD DEGREE AV BLOCK (COMPLETE HEART BLOCK
FIRST DEGREE HEARTBLOCK

Sinus impulses are delayed in the AV node but all are conducted to the ventricles Prolonged PR interval ( >0.20 sec) Heart rate and rhythm are normal, and there may be nothing wrong with the heart. CAUSES: Ischemia, digitalis, B-blockers, CaAntagonists TREATMENT:
observe, monitor for progression, d/c cardiac depressants
1st DEGREE AV BLOCK

PR Interval Constant PR Interval Long One P waves to each QRS complex Regular Ventricular Rhythm
FIRST DEGREE AV BLOCK
2ND DEGREE HEART BLOCK Type I second-degree heart block, or Mobitz Type I, or Wenckebach's AV block.
Some sinus impulses are not conducted to the ventricles Skipped beats Not too serious but sometimes causes dizziness and/or other symptoms.
Type II second-degree heart block, or Mobitz Type II.

Failure of some sinus impulses to conduct to Ventricles Sinus impulses blocked at a regular interval
BUNDLE OF HIS: QRS normal BUNDLE BRANCH: QRS widened
Fainting, dizziness & syncope May progress to complete heart block Marvin Allan S. De la Cruz, In some cases a pacemakerRN,MAN is needed.
SECOND DEGREE HEART BLOCK

some signals from the atria don't reach the ventricles. This causes "dropped beats." P wave isn't followed by the QRS wave, because the ventricles weren't activated.
SECOND DEGREE AV BLOCK MOBITZ II WENKEBACH
THIRD DEGREE HEART BLOCK

Complete heart block (complete AV block) means that the heart's electrical signal doesn't pass from the upper to the lower chambers. When this occurs, an independent pacemaker in the lower chambers takes over. The ventricles can contract and pump blood, but at a slower rate than that of the atrial pacemaker. No correlation between atrial impulses (P waves) & ventricular response (QRS complex) Medical emergency with potentially severe symptoms and a serious risk of cardiac arrest If a pacemaker can't be implanted immediately, a temporary pacemaker might be used to keep the heart pumping until surgery can be performed.
THIRD DEGREE AV BLOCK
VENTRICULAR RHYTHMS (BUNDLE OF HIS)
PREMATURE VENTRICULAR CONTRACTION (PVC) VENTRICULAR TACHYCARDIA VENTRICULAR FIBRILLATION
PVC
Premature ectopic beats Occur within a basic rhythm Are of ventricular in origin No P waves Wide, bizarre QRS complex T waves are directly opposite QRS complex
INTERVENTIONS/IMPLICATIONS:
Indicative of ventricular irritability, & considered significant if:
1. occur frequently >6/min 2. occur in a consecutive manner or in pairs 3. occur on a T wave of a preceding complex
PVC
PVC
PVC (BIGEMINY)
PVC
VENTRICULAR TACHYCARDIA
Looks like a row of PVCs in configuration Wide & bizarre Very rapid rate of 125-200 bpm May cause severe decrease in CO Potentially life-threatening TREATMENT: lidocaine, procainamide, bretylium, cardioversion
VENTRICULAR TACHYCARDIA
VENTRICULAR FIBRILLATION
it is always a medical emergency. If left untreated, lead to death within minutes. When a heart goes into V-fib, effective pumping of the blood stops. V-fib is considered a form of cardiac arrest, and an individual suffering from it will not survive unless CPR and defibrillation are provided immediately.
Electrocardiogram
CARDIAC ARREST
CARDIAC ARREST
Sudden, unexpected cessation of breathing & adequate heart circulation ASSESSMENT FINDINGS:
Unresponsive (-) respiration Pallor, cyanosis (-) heart sound /BP/ Pulse Dilated pupils V-fib
Defibrillator Monitor
Automated emergency device
AED
Defibrillator placement
CARDIOVERSION
synchronized electrical cardioversion is the process by which an abnormally fast heart rate or cardiac arrhythmia is terminated by the delivery of a therapeutic dose of electrical current to the heart at a specific moment in the cardiac cycle. Pharmacologic cardioversion uses medication instead of an electrical shock to convert the cardiac arrhythmia.

Ecg Lecture

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Marvin Allan S.

Marvin Allan S. De la Cruz, RN,MAN

Marvin Allan S. De la Cruz, RN,MAN

Marvin Allan S. De la Cruz, RN,MAN

Marvin Allan S. De la Cruz, RN,MAN

Marvin Allan S. De la Cruz, RN,MAN

Marvin Allan S. De la Cruz, RN,MAN

Marvin Allan S. De la Cruz, RN,MAN

Marvin Allan S. De la Cruz, RN,MAN

Marvin Allan S. De la Cruz, RN,MAN

Electrophysiologic Properties of the Heart

Marvin Allan S. De la Cruz, RN,MAN

Marvin Allan S. De la Cruz, RN,MAN

Marvin Allan S. De la Cruz, RN,MAN

ELECTRICAL CONDUCTION SYSTEM OF THE HEART

Marvin Allan S. De la Cruz, RN,MAN

Marvin Allan S. De la Cruz, RN,MAN

Marvin Allan S. De la Cruz, RN,MAN

Marvin Allan S. De la Cruz, RN,MAN

Marvin Allan S. De la Cruz, RN,MAN

Marvin Allan S. De la Cruz, RN,MAN

Marvin Allan S. De la Cruz, RN,MAN

Marvin Allan S. De la Cruz, RN,MAN

Marvin Allan S. De la Cruz, RN,MAN

Marvin Allan S. De la Cruz, RN,MAN

STEP 2. CALCULATE HEART RATE

Memory Method: (300,150,100,75,60,50,43,33,30)

FOR IRREGULAR RHYTHM:

Marvin Allan S. De la Cruz, RN,MAN

Marvin Allan S. De la Cruz, RN,MAN

Marvin Allan S. De la Cruz, RN,MAN

STEP 3. IDENTIFY & EXAMINE P WAVES

STEP 4: MEASURE PR INTERVALS

STEP 5:MEASURE QRS COMPLEX

Marvin Allan S. De la Cruz, RN,MAN

Marvin Allan S. De la Cruz, RN,MAN

Marvin Allan S. De la Cruz, RN,MAN

Marvin Allan S. De la Cruz, RN,MAN

ECHOCARDIOGRAM (2D ECHO)

Marvin Allan S. De la Cruz, RN,MAN

Marvin Allan S. De la Cruz, RN,MAN

SINUS RHYTHMS (SA NODE)

Normal Sinus Rhythm Sinus Bradycardia Sinus Tachycardia

Marvin Allan S. De la Cruz, RN,MAN

Marvin Allan S. De la Cruz, RN,MAN

Marvin Allan S. De la Cruz, RN,MAN

Marvin Allan S. De la Cruz, RN,MAN

Marvin Allan S. De la Cruz, RN,MAN

Marvin Allan S. De la Cruz, RN,MAN

Marvin Allan S. De la Cruz, RN,MAN

Marvin Allan S. De la Cruz, RN,MAN

Marvin Allan S. De la Cruz, RN,MAN

NORMAL SINUS RHYTHM

NORMAL: <0.12 SEC

ATRIAL RHYTHMS (AV NODE)

ATRIAL FLUTTER ATRIAL FIBRILLATION

Marvin Allan S. De la Cruz, RN,MAN

Marvin Allan S. De la Cruz, RN,MAN

Marvin Allan S. De la Cruz, RN,MAN

Marvin Allan S. De la Cruz, RN,MAN

Marvin Allan S. De la Cruz, RN,MAN

Marvin Allan S. De la Cruz, RN,MAN

Marvin Allan S. De la Cruz, RN,MAN

Marvin Allan S. De la Cruz, RN,MAN