Documenti di Didattica
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Terry White, RN
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Discussion Topics
ECG Monitoring Basics
Standardized Methods & Devices
Components & Measurements of
the ECG Complex
ECG Analysis
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ECG Monitoring
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ECG Monitoring
Recording of Electrical Activity
Uses Bipolar or Unipolar leads
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ECG Monitoring
Bipolar Leads
1 positive and 1
negative electrode
RA always negative
LL always positive
Lead III
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ECG Monitoring
Einthoven’s Triangle
Each lead “looks” from a
different perspective
Can determine the
direction of electrical
impulses
Upright electrical
recording indicates
electricity flowing towards
the + electrode
positive deflection
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Standardized Methods
& Devices
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Standardized Methods &
Devices
ECG Paper
Device Paper Speed
Device Calibration
Electrode Placement
Variations Do Exist!
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Standardized Methods &
Devices
ECG Graph Paper
Vertical axis- voltage
1 small box = 1 mm = 0.1 mV
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Standardized Methods &
Devices
ECG Paper Examples
Vertical Axis
No. of mm in 10 small boxes?
No. of small boxes in 2 mm?
Horizontal Axis
No. of seconds in 5 small boxes?
No. of small boxes in 0.2 second?
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Standardized Methods &
Devices
Paper Speed & Calibration
Paper Speed - 25 mm/sec standard
Calibration of Voltage is Automatic
Both Speed and voltage calibration
can be changed on most devices
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Standardized Methods &
Devices
Electrode Placement
Standardization improves accuracy of
comparison ECGs
3 Lead and 12 Lead Placement are most
common
Assure good conduction gel
Prep area with alcohol prep
Avoid
Bone
Large muscles or hairy areas
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Components of the
ECG
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Components of the ECG
Complex
Components & Their
Representation
P, Q , R, S, T Waves
PR Interval
QRS Interval
ST Segment
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Components of the ECG
Complex
P Wave
first upward
deflection
represents atrial
depolarization
usually 0.10 seconds
or less
usually followed by
QRS complex
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Components of the ECG
Complex
QRS Complex
Composition of 3
Waves
Q, R & S
represents ventricular
depolarization
much variability
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Components of the ECG
Complex
Q Wave
first negative
deflection after P
wave
depolarization of
septum
not always seen
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Components of the ECG
Complex
R Wave
first positive
deflection following P
or Q waves
subsequent positive
deflections are R’,
R”, etc
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Components of the ECG
Complex
S Wave
Negative deflection
following R wave
subsequent negative
deflections are S’,
S”, etc
may be part of QS
complex
absent R wave in
aberrant conduction
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Components of the ECG
Complex
PR Interval
time impulse takes to
move through atria and
AV node
from beginning of P
wave to next deflection
on baseline (beginning
of QRS complex)
normally 0.12 - 0.2 sec
may be shorter with
faster rates
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Components of the ECG
Complex
QRS Interval
time impulse takes to
depolarize ventricles
from beginning of Q
wave to beginning of
ST segment
usually < 0.12 sec
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Components of the ECG
Complex
J Point
point where QRS
complex returns to
isoelectric line
beginning of ST
segment
critical in measuring
ST segment elevation
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Components of the ECG
Complex
ST Segment
early repolarization of
ventricles
measured from J point
to onset of T wave
elevation or
depression may
indicate abnormality
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Components of the ECG
Complex
T Wave
repolarization of
ventricles
concurrent with end of
ventricular systole
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ECG Analysis
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ECG Analysis
Rate
Rhythm/Regularity
QRS Complex
P Waves
Relationships & Measurements
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ECG Analysis
Ventricular Rate
Triplicate method
300-150-100-75-60-50
R-R method
divide
300 by # of large squares
between consecutive R waves
6 Second method
multiply # of R waves in a 6 second
strip by 10
Rate meter unreliable!!!
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ECG Analysis
Rhythm
Measure R-R intervals across strip
Should find regular distance
between R waves
Classification
Regular
Irregular
• Regularly irregular
• Irregularly irregular
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ECG Analysis
QRS Complex
Narrow
< 0.12 seconds (3 small boxes) is
normal
indicates supraventricular origin (AV
node or above) of pacemaker
Wide
> 0.12 seconds is wide
indicates ventricular or
supraventricular w/aberrant
conduction
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ECG Analysis
P Waves
Present?
Do they all look alike?
Regular interval
Upright or inverted in Lead II?
Upright = atria depolarized from top
to bottom
Inverted = atria depolarized from
bottom to top
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ECG Analysis
Relationships/Measurements
PR Interval
Constant?
Regular relationship?
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ECG Analysis
A monitoring lead can tell you:
How often the myocardium is
depolarizing
How regular the depolarization is
How long conduction takes in
various areas of the heart
The origin of the impulses that are
depolarizing the myocardium
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ECG Analysis
A monitoring lead can not tell you:
Presence or absence of a
myocardial infarction
Axis deviation
Chamber enlargement
Right vs. Left bundle branch blocks
Quality of pumping action
Whether the heart is beating!!!
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ECG Analysis
An ECG is a diagnostic tool, NOT a
treatment
No one was ever cured by an ECG!!
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