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7/29/2019 ECG Booklet.pdf
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Basic Principles ofElectrocardiography
Nursing Program, Medicine Faculty
Brawijaya University 2004
References
Atwood,Stanton, Storey (1996). Pengenalan DasarDisritmia Jantung. Yogyakarta : Gajah MadaUniversity Press.
Emergency Nurses Chapter (2001). Basic ECGCourse. 3rd edition. Singapore : Singapore NursesAssociation
Ginger & Melvin Ochs (1997). Recognition &Interpretation : ECG RHYTHMS. 3rd edition.USA: Appleton & Lange.
Thaler (2000). Satu-satunya BUKU EKG yangAnda Perlukan. Edisi 2. Jakarta : Hipokrates.
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Learning Objectives
General Objectives
After studying this subject in about
2 x 3 x 50 menit, the students expected
to be able to use ECG machine
and interpret the ECG result.
Composition :
15 Pre test90 Presentation & Discussion
15 Post test
Specific Objectives1. Fundamentals of EKG (20)
a. Introduction
b. Hearts conducting system
c. EKG Machine
d. EKG Waveform Analysis
2. Obtaining 12 leads EKG (20)
a. About 12-Lead EKG
b. Recording 12-Lead EKG
c. Troubleshooting (problems&solutions)
d. Care & Cleaning
3. Interpreting Basic EKG (50)
a. 5 Steps of Arrhythmia Interpretation
b. Classification of Arrythmias
c. Recognition & Treatment
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Fundamentals of EKG
Introduction
Hearts conducting system
EKG Machine
EKG Waveform Analysis
During the late 1800's and early 1900's, Dutchphysiologist Willem Einthoven developed the earlyelectrocardiogram. He won the Nobel prize for itsinvention in 1924.
Hubert Mann first uses the electrocardiogram todescribe electrocardiographic changes associatedwith a heart attack in 1920.
Electrocardiography- graphic recording of theelectrical activity (potentials) produced by theconduction system and the myocardium of theheart during it depolarization / repolarizationcycle.
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Hearts Conducting System(Ginger & Melvin Och, 1997)
Normally electrical impulses that causesrythmic contraction of heart muscles arises inthe SA Node as the intrinsic pacemakerof theheart. From the SA Node, impulse spreads overthe atrial muscles causing atrial contraction.The impulse is also conducted to the AV Node& it takes 0.03 sec to travel from SA to AVNode. From AV Node the electrical impulse is
conducted to ventricular muscles via thebundle of his, the bundle branches & thepurkinje fibres. The bundle branches & thepurkinje fibres are collectively calledtheventricular conduction system
Fundamentals of ECG
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A heart controlled by the SA Node is said to be
in normal sinus rhythm. The SA Node underinfluence of the autonomic nervous system
(Sympathetic which increases the heart rate via
B1 adrenergic receptors; Parasympathetic which
slows the heart rate via vagus nerve)
The rhythm originates from SA Node because
the SA Node depolarizes more frequently (60-
100 beats/min) than AV Node (40-60 b/m) &
ventricular conducting system (30-40 b/m), sothe AV Node & ventricular conducting system
are captured by the sinus impulse and driven
at 60-100 b/m
Fundamentals of ECG
The electrical impulse from the SA node isconducted through the AV node because theatria & ventricles are separated by a fibrousconnective tissue ring that has poorconductivity. The AV node provides a pathfor the impulse to proceed from the atria toventricles.
The AV node together with bundle of Hismake up theAV junctional tissue. The AVJunc Tissue has its own intrinsic pacemakeractivity at 40-60 b/m. if SA node are injured,the AV Junc Tissue can take over control ofthe heart rate & rhythm
Fundamentals of ECG
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EKG Machine(Ginger & Melvin Och, 1997)
An EKG machine is a highly sensitivevoltmeter that measures voltage differencebetween two points on the body surface
The voltage difference comes fromdepolarization and repolarization of cardiacmuscle cells
An EKG machine has a positive and anegative terminal
Single, Multi Channel
Fundamentals of ECG
Electrophysiology(Ginger & Melvin Och, 1997)
Normal electrical activity of the heart
Polarization the phase of readiness. The muscles is relaxedand the cardiac cells are ready to receive an electrical impulse
Depolarization the phase of contraction. The cardiac cells havetransmitted an electrical impulse, causing the cardiac muscle to
contract. Repolarization the recovery phase. The muscles are returning
to a relaxed state.
**The cardiac muscle cells have K inside and Na outside the cells.When polarized cell is stimulated by an electrical impulse, Kmoves outside the cell and Na moves inside.
Fundamentals of ECG
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Voltage
Time
.1 mv
.5 mv
.04 seconds .20 seconds
Paper speed =
25mm / second
paper
Fundamentals of ECG
1 mm = 1mV
1 small box = 0.040 sec
5 small boxes = 0.20 sec
15 small boxes = 3 sec
30 small boxes = 6 sec
300 small boxes = 1 min
ECG Waveform Analysis
Consist of :
1. Isoelectric Line Picture 12. ECG Waves * P Picture 1 & 2
* QRS
* T* U
3. ECG Intervals * P-R Picture 1 & 2
* QRS4. ST Segment Picture 25. J Point Picture 2
Fundamentals of ECG
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Picture1 Picture 2
Fundamentals of ECG
EKG Intervals
P wave
QRS Complex
T wave P wave
P-R
Interval
Q-T
Interval
P-R Interval = A-V Conduction Time
Q-T Interval = Ventricular Contraction
Time
R-R Interval = Cardiac Cycle Time
Heart Rate = 1/R-R Interval
Fundamentals of ECG
One Cardiac Cycle
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P Wave represents the electrical activity of the original
impulse from the SA node and its subsequent spread tothe atria. If the P wave is absent or abnormal in shape, itmeans the impulse originates from outside of the SA node.Normal duration is 0.04 to 0.11 second (maximum about 3small squares)
PR Intervals is measured from the beginning of the Pwave to the beginning of the QRS complex. It representsthe time taken for the impulse to travel from the SA node
to the AV node and the ventricles. Normal duration is 0.12to 0.20 second (3 to 5 small squares)
Fundamentals of ECG
Emergency Nursing Chapter, 2001
QRS Complex represents the time taken for the impulse to travel
from the Bundle of His to the Purkinje fibres, wich results in the
contraction of the ventricles. Duration is less than 0.12 second (3
small squares). The complex consists of an initial downward
deflection Q wave, an upward deflection R wave and second
downward deflection S wave. The configuration of the QRS
complex varies from lead to lead and there are several patterns.
ST Segment begins at the end of the S wave and terminates at the
upstroke of the T wave. The J point (junction point) marks where the
S wave ends the ST segment begins. The segment is elevated in
acute injury of AMI and depressed in ischemic states
Fundamentals of ECG
Emergency Nursing Chapter, 2001
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T Wave represents the recovery phase after ventricular
contraction. Tall, peaked or tented T waves indicate myocardialinjury or hyperkalemia. Inverted T waves may mean myocardial
ischemia.
QT Interval represents the depolarization& repolarization of the
ventricles. Abnormal duration indicates myocardial problems
U Wave represents the recovery period of the Purkinje fibres. It
is not present on all ECG waveforms. A prominent u wave may
indicated hypercalemia, hypokalemia or digoxin overdose.
Emergency Nurses Chapter, 2001
Fundamentals of ECG
Characteristics of a Normal Sinus Rhythm
Regular rhythm
Heart rate 60 to 100 per minute
P wave precedes every QRS complex. All P waves are similar inshape and size
All QRS complexes are similar in shape and size
Normal PR interval
T waves are after the QRS complexes All waves and interval are normal in duration and position
An Arrhytmia is an abnormal rhythm I.e. either the rate or thecontour/position of any individual wave is abnormal
Fundamentals of ECG
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Obtaining 12 Lead EKG
About 12-Lead EKG
Recording 12-Lead EKG
Troubleshooting (Problems& Solution)
Care & Cleaning
12-Lead ECG
The 12 EKG leads measure theelectrical activity of the heart from 12different directions
Bipolar Leads (augmented vector):Lead I, Lead II, Lead III
Unipolar Leads: aVR, aVL, aVF
Precordial Leads: V1, V2, V3, V4, V5, V6
Obtaining 12-lead ECG
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Obtaining 12-lead ECG
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Recording the 12-Leads ECG(Emergency Nurses Chapter, 2001)
Explanation Tell the patient that the doctor has ordered an
ECG and explain the procedure Emphasize that the test takes about a few
minutes and that its a safe and painless way toevaluate cardiac function Answer the patients question, and offer
reassurance. Preparing him well helps alleviateand promote co-operation
Obtaining 12-lead ECG
Prepping the Patient Ask the patient to lie supine in the center of the bed
with his arms at his sides
If he cant tolerate lying flat, raise the head of thebed to semi-Fowlers position
Ensure privacy, and expose the patients arms, legs,and chest
Selection of the Electrode Sites Choose spots that are flat and fleshy, not muscular
or bony
Clean excess oil or ather substances from the skin toenhance electrode contact. Rememberthe betterthe electrode contact, the better the recording
Obtaining 12-lead ECG
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Steps in recording the ECG
Know your machine
Set the ECG paper speed selector to 25mm/second.If necessary, enter the patients identification data.Then calibrate or standardize the machine accordingto the manufacturers instructions.
Plug the cord of the ECG machine into a groundedoutlet. If the machine operates on a charged battery,it may not need to be plugged in.
Place one or all of the electrodes on the patientschest, based on the type of machine youre using.
Make sure all the leads are securely attached, andthen turn on the machine.
Obtaining 12-lead ECG
Instruct the patient to relax, lie still, and breathenormally. Ask him not to talk during the recording toprevent distortion of the ECG tracing.
Press the AUTO button and record the ECG. Ifyoure performing a right chest lead ECG, select theapproriate button for recording.
Observe the quality of the tracing. When themachine finishes the recording, turn it off.
Remove the electrodes and clean the patients skin.
Obtaining 12-lead ECG
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Documentation
Date Time
Doctors name
Nurses name
Special circumstances : vital sign, clientscondition
Obtaining 12-lead ECG
Troubleshooting
Problem Cause Solution
Power line AC
interference
Poor electrode contact.
Dry or dirty electrodes
Abrade skin. Use new electrodes.
Reapply electrodes.
Power line ACinterference Lead wires may be pickingup interference from
poorly grounded
equipment near the patient
Route lead wires along limbs and awayfrom other equipment. Fix or move poorly
grounded equipment
Power line AC
interference
Patient cable is too
close to the cardiograph
or other power cords
Move cardiograph away from the
patient. Unplug the cardiograph and
operate on battery only. Move other
equipment away from the patient
Obtaining 12-lead ECG
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Problem Cause Solution
Wanderingbaseline
Electrodemovement. Poor
electrode contact
and skin
preparation
Be sure that the leadwires are not pulling on
the electrodes. Reapply
electrodes. Press the
filterkey
Patient movement Reassure and relax the
patient
Respiratoryinterference Move lead wires awayfrom areas with the
greatest respiratory
motion
Obtaining 12-lead ECG
Problem Cause Solution
Tremor or muscle
artifact
Poor electrode
placement. Poor
electrode contact.
Patient is cold
Clean the electrode
site. Be sure the
limb electrodes are
placed on flat, non-
muscular areas.
Warm the patient
Tense,uncomfortable
patient
Reassure and relaxthe patient. Press
the filterkey
Tremors Attach the limb
electrodes near the
trunk. Pressthe
filterkey
Obtaining 12-lead ECG
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Emergency Nurses Chapter, 2001
Problem Cause Solution
Intermittent or
jittery waveform
Poor electrode
contact. Dry
electrodes
Clean the electrode
site. Reapply
electrodes
Faulty lead wires Replace faulty
patient cable
Poor print quality Dirty printhead or
ink has finished
Clean printhead or
change the ECG
stylus
Obtaining 12-lead ECG
Interpreting Basic ECG
5 Steps of Arrhythmia Interpretation
Classification of Arrythmias Recognition & Treatment
Acute Myocard Infarct
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5 Steps of Arrhythmia
InterpretationStep 1 : Calculate the Heart
Rate
Using the two simplest methods : 10-times / 20-times
method
= Number of R-waves in a 6second strip multiply by 10
= Number of R waves in 3
second strip multiply by 20= 1500 divided by the number ofsmall boxes between consecutiveR-waves
Interpreting Basic ECG
Dividing Methods
Use only if the rhythm is regular.Divide 300 with the big boxesbetween 2 R waves.
If there are also small boxes, addthe small boxes to the big boxes.Divide 300 with the combination
Step 2 : Measure the regularity of
the R wavesUsing methods :
Pen/pencil and paper method
Caliper method
Step 3 : Examine the P waves Present before all QRS
Normal configuration
Similar size & shape
Interpreting Basic ECG
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Step 4 : Measure the PR interval Number of small squares between the start of P
wave and the beginning of QRS complex not morethan 5.
Step 5 : Evaluate the QRS complex Number of small squares from the beginning to
the end of the complex not more than 3.
Conclusion
Interpreting Basic ECG
Classification of ArrhythmiaEmergency Nursing Chapter, 2001
According to :
Site of arrhythmia Mechanism of disorder
Seriousness of the arrhythmia
Interpreting Basic ECG
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Major Sites Sinus arrhythmia Atrial arrhythmia AV node arrhythmia Ventricular arrhythmia
Major Mechanisms Tachycardia (HR > 100 beats per minute) Bradycardia (HR < 60 beats per minute) Premature beats Flutter
Fibrilation Defects in conduction e.g. heart block
Interpreting Basic ECG
Recognition & TreatmentGinger & Melvin Och, 1997
Thaler, 2000
Normal Sinus Rhythm
Sinus Arrhythmias
Atrial Arrhythmias Heart Blocks
Ventricular Arrhythmias
Interpreting Basic ECG
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Normal Sinus Rhythm (NSR)
Description
This is the normal heart rhythm. It originates in the SA node and follows the appropriate
conduction pathways. The rate is normal, and the rhythm is regular. Every beat has a P wave,
and every P wave is followed by a ventricular response.
EKG Criteria
Rate: 60-100 bpm.
Rhythm: Regular. A normal variant called Sinus Arrythmia changes rhythm in response to
respiration. This is seen most often in young healthy people.Pacemaker: Each beat originates in the SA node.
P wave: look the same, all originate from the same locus (SA node)
PRI: 120-200 msec
QRS: 80-120 msec, narrow unless effected by underlying anomoly
Interpreting Basic ECG
SINUS BRADYCARDIA
Description
Sinus bradycardia originates in the SA node. It has reduced rate generally from a reduction in
sympathetic input, or excessive vagal (parasympathetic) tone. This rhythm may accompany
inferior MI's, hypoxia, hypothermia, or drug reactions. At moderately slow rates, the patient may
be asymptomatic. At slower rates, they may become hypotensive and present with symptoms
consistant with decreased perfusion: dizziness, syncope, shock like signs and symptoms.
Treatment is aimed at increasing the heart rate. Therapies include atropine, transcutaneous and
transvenous pacing, epinephrine, dopamine, isoproterenol .
EKG Criteria
Rate:
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SINUS TACHYCARDIA
Description
This arrythmia originates from the SA node. It is defined as a sinus rhythm exceeding 100 bpm.
Sinus tach is a normal rhythm which occurs in response to increased oxygen demand. This
occurs with exercise, infection, hypovolemia, hypoxia, myocardial infarct, and in response to
stimulant drugs, The rate usually has a gradual onset and elimination. Treatment is not usually
needed, but is aimed at treating the underlying condition.
EKG Criteria
Rate: >100 bpm.
Rhythm: Regular, generally.
Pacemaker: SA node.
P wave: Present and normal, may be buried in T waves in rapid tracings.
PRI: 120-200 msec., generally closer to 120 msec.
QRS: Normal.
Interpreting Basic ECG
PREMATURE ATRIAL COMPLEXES(PAC)
Description
These complexes originate in the atria. They often originate from ectopic pacemaker sites within
the atria which results in an abnormal P wave. The complex occurs before the normal beat is
expected, hence the prematurity. It is followed by a pause. There are many causes including:
increased sympathetic input, exogenous stimulants, drug interactions, AMI, cardiac ischemia,
idiopathic. These complexes can indicate increased automaticity. They may lead to re-entry
rhythms.
EKG Criteria
Rate: Underlying rhythm.
Rhythm: Irregular with PACs.
Pacemaker: Ectopic atrial pacemaker outside SA node.
P wave: Ectopic P wave present, generally different than normal SA P wave.
PRI: Generall normal range 120-200 msec, but differ from underlying rhythm.
QRS: Same as underlying rhythm.
Interpreting Basic ECG
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SUPRAVENTRICULAR TACHYCARDIA (SVT)
Description
There are several different types of SVT depending on the site of reentry (accessory pathway,
atrioventricular node or atrium). This rapid rhythm starts and stops suddenly. Treatment includes
vagal maneuvers, antiarrhythmia medication, radio-frequency ablation or surgical modification of
site of reentry.
EKG Criteria
Rate: 140 - 220 bpm
Rhythm: RegularPacemaker: Reentry circuit
Accessory pathway: Normal or short (if down accessory pathway)
A-V nodal reentry: Hidden in or at end of QRS
PRI: Depends on location of circuit
QRS: Normal if accessory pathway used - prolonged (>120 msec) with delta wave
Interpreting Basic ECG
ATRIAL FLUTTER
Description
Atrial flutter is characterized by "sawtooth" atrial activity and a conduction ratio to the ventricles of
2:1 to 8:1. It is caused by a reentrant circuit located in the right atrium. It may occur when the
atria are enlar ged in chronic obstructive lung disease, mitral or tricuspid disease, pericarditis orpost-operatively. Definitive treatment is direct-current cardioversion, surgical or catheter ablation.
EKG Criteria
Rate: 250 - 350 bpm (atrium)
Rhythm:Atrial rate regular, ventricular conduction 2:1 to 8:1
Pacemaker: Reentrant circuit rhythm located in the right atrium
P wave: Saw-tooth or picket fence
PRI: Constant onset
Interpreting Basic ECG
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ATRIAL FIBRILLATION
Description
This is the most common sustained cardiac arrhythmia. It is characterized by an undulating baseline
replacing P waves and an irregularly irregular ventricular response. This arrhythmia occurs with
hypertension, ischemic, mitral, myocardial and pericardi al disease, thyrotoxicosis, aging and sometimes
occurs in normals. Treatment includes anticoagulation, drugs to slow ventricular conduction and/or
cardioversion
EKG Criteria
Undulating baseline replaces P waves
Rhythm: Irregularly irregular
Interpreting Basic ECG
FIRST DEGREE AV BLOCK
Description
Conduction disturbances are characterized as first degree, second degree Mobitz 1, second
degree Mobitz II and complete heart block. The normal P-R interval is 120 - 200 msec. First
degree AV block is a constant and prolonged PR interval. Possible etiologies include insult to AV
node, hypoxemia, myocardial infarction, digitalis toxicity, ischemia of the conduction system and
increased vagal tone but is also seen in normals.
EKG Criteria
Rhythm: Regular
PRI: >200 msec
Interpreting Basic ECG
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SECOND DEGREE AV BLOCK
MOBITZ I (WENKEBACH)
Description
Wenkebach is characterized by progressive delay at the AV node until the impulse is completely
blocked. Etiologies are the same as cause first degree AV block and is also seen in normals. This
conduction abnormality does usually not progress to higher degree heart blocks.
EKG Criteria
Rhythm: Irregular
PRI: Progressive lengthening of PRI until dropped beat. A clue to Wenckebach is that the QRS's
appear to occur in groups.
Interpreting Basic ECG
SECOND DEGREE AV BLOCKMOBITZ II
DescriptionThis is a higher degree of conduction block then Mobitz I and may progress to complete AV
block. AV conduction appears normal until suddenly there is no AV conduction following one P
wave. This may occur in a pattern (every 2nd, 3rd or 4th complex) or may occur randomly. This is
intermittent block at the AV node and may progress to complete heart block.
EKG Criteria
PRI: Constant on conducted complexes until a sudden block of AV conduction. That is, a P wave
is abruptly not followed by a QRS
Interpreting Basic ECG
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PREMATURE VENTRICULAR CONTRACTIONS (PVC)
DescriptionA PVC is a depolarization that arises in either ventricle before the next expected sinus beat. The
normal sequence of depolarization is altered because the impulse originates in the ventricle. The two
ventricules depolarize sequentially insteat of simultaneously. Conduction moves more slowely than
through the specialized conduction pathways, this results in a widened QRS complex (greater than
0.12 sec). PVCs may occur as isolated complexes ormay occur in pairs, triplets, or in a repeating
sequence with normal QRS complexes. Three or more PVCs in a row is considered a run of
Ventricular Tachycardia. If it lasts for more than 30 seconds it is designated sustained VT. Treatment:
Rarely treated unless symptomatic. PVCs may indicate acute mycardial ischemia requiring rapid
intervention including oxygen, NTG, morphine, thrombolytic. Treating with lidocaine will cease the
PVC, but won't address the ischemic cause.
EKG CriteriaRhythm: Irregular
QRS: Is not normal looking. Broadened, greater than 0.12 seconds. P waves are usually obscured by
the QRS, ST segment, or T wave of the OVC. The P wave may sometimes be seen as notching during
the ST segment or T wave.
BIGEMINY PVCs
Description
PVC's may occur in patterns. When each normal complex is followed by a PVC forming groupsof 2, the term "ventricular bigeminy" is used.
EKG Criteria
QRS: Normal QRS complex followed by premature wide bizarre complex (PVC) in patterns of 2
Interpreting Basic ECG
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VENTRICULAR TACHYCARDIA
Description
Ventricular Tachycardia (VT) is defined as three or more beats of ventricular origin in succession at a
rate greater than 100 beats per minute. There are no normal (narrow) looking QRS complexes.
Consequences of VT depend on accompanying myocardial dysfunction. It may be well tolerated or
associated with life-threatening hemodynamic compromise. Treatment: If patient is stable, they are
initially treated with lidocaine, procainamide, or bretylium tosylate. Hemodynamically unstable VT (with
a pulse) is cardioverted at 200J, 300J, 360J as needed. VT without a pulse is treated like VF and
defibrillated.
EKG Criteria
No normal looking QRS complexes, often bizzare with notching. Width of QRS>0.12 sec. ST segment
and T wave are opposite polarity to the QRS. Sinus node may be depolarizing normally. There is
usually complete AV dissociation. P waves are sometimes seen between QRS complexes. They have
no impact on the QRS complexes.
Rate: Generally 100 to 220 bpm
Rhythm: Generally regular, on occassion can be modestly irregular.
Interpreting Basic ECG
VENTRICULAR FIBRILLATION
DescriptionVentricular Fibrillation is a rhythm in which multiple areas within the ventricles display marked variation in
depolarization and repolarization. There is no organized depolarization, therefore the ventricles do not
contract as a unit. The myocardium is quivering when visualized grossly. There is no cardiac output. This is
the most common arrythmia seen in cardiac arrest from ischemia or infarction. The rhythm is described as
coarse or fine VF. Coarse VF indicates recent onset of VF. Prolonged delay without defibrillation results in
fine VF and eventually asysyole. Resuscitation becomes more difficult as VF becomes finer. Treatment is
always immediate unsynchronized defibrillation at 200J, 300J, 360J for adult patients.
EKG CriteriaRate: Very rapid, too disorganized to count.
Rhythm: Irregular, waveform varies in size and shape
No normal QRS complexes.
Absent ST segments, P waves, T waves.
Interpreting Basic ECG
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ASYSTOLE
Description
Asystole represents the total absence of ventricular electrical activity. Since depolarization does not occur,
there is no ventricular contraction. This may occur as a primary event in cardiac arrest, or it may follow VF
or pulseless electrical activity (PEA). Ventricular asystole can occur also in patients with complete heart
block in whom there is no excape pacemaker. VF may masquerade as asystole; it is best always to check
two leads perpendicular to each other to make sure that asystole is not VF. Treatment for each arrythmia is
very different. Fine VF which may mimic asystole should be treated with defibrillation. But defibrillating
asystole is potentially harmful. Treatment: Epinephrine and Atropine are administered. Consider causes:
pulmonary embolism, acidosis, tension pneumothorax, cardiac tamponade, hyperkalemia, hypokalemia,
hypoxia, hypothermia, overdose, myocardial infarction.
EKG Criteria
Complete absence of ventricular electrical activity. Occasional P waves or erratic ventricular beats may be
seen. These patients will be pulseless. Treatment must be immediate if the patient is to have any chance at
resusctiation.
Rate: None
Rhythm: None
Interpreting Basic ECG
Myocardial Infarction
ECG will reflect thethree pathologicchanges of a MI :
Ischaemia
Injury Infarction/Necrotic
Interpreting Basic ECG
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Zone of Infarction / Necrotic Area of myocardial necrosis may develop within an hour of an infarct / a few
days later.
Irreversibel & permanent
Pathologic Q wave (1/3 R wave)
Interpreting Basic ECG
Zone of Injury
Marked by an elevated ST-segment
Result from prolonged lack of blood supply
Interpreting Basic ECG
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Zone of ischaemia Results from an interrupted blood supply
Represented by T-wave inversion or
J-point depression
Interpreting Basic ECG
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EVOLUTION OF AMI
Assessing AMI
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Conclusion
It is important for nurses not only to
record the patients ECG but also
interpret it to give the best treatment
for their patient based on his/her
problem
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