ECG, EKG, ECG, EKG, ElectrocardiogramElectrocardiogram

The ECG is easy to understand

The abnormalities happen for a reason

CONSTANT VIGILANCE !!

!

The electricity of the The electricity of the heartheart

What to expect from What to expect from the ECGthe ECG

Essential monitor

Rate, rhythm, propagation of the excitation

wave, heart position, muscle hypertrophy,

regional ischemia

NO information about pump function

3-lead system3-lead system

Lead Selection• Lead II is the same as

standard lead two as

seen in a 12 lead ECG

.

• It is the most

common monitoring

lead.

• It is not the optimal

monitoring lead.

Lead Selection

• V5 = the best lead

to detect ST-T

change

• Move the LA lead

to V5 position

• Monitor lead I

The shape of the The shape of the ECGECG

PP T

QR S

QR S

Normal ECGNormal ECG

ECG interpretationECG interpretation

1. Rate

2. Rhythm

3. Intervals

4. QRS complexes

5. ST segments & T waves

Abnormal

Normal

ECG abnormalitiesECG abnormalities

Myocardial ischemia / infarction

arrhythmias

Myocardial ischemia / Myocardial ischemia / infarctioninfarction

ST depression

(0.1mv)

ST elevation

(0.2mv)

T wave inversion

Abnormal Q

Myocardial ischemia / Myocardial ischemia / infarctioninfarction

Condition associated with perioperative dysrhythmias

Electrolyte disturbances (hypokalemia, hypocalcemia, hypomagnesemia)

Hypothermia

Medications such as digitalis, theophylline, anesthetic agents

Metabolic alkalosis

Presence of indwelling central venous or pulmonary artery catheters

Sympathetic stimulation (hypoxia, hypercarbia, surgical or anesthetic stimulation)

Parasympathetic stimulation (distention of bladder or bowel)

BradyarrhythmiasBradyarrhythmias

Bradyarrhythmias Bradyarrhythmias

BradyarrhythmiasBradyarrhythmias

BradyarrhythmiasBradyarrhythmias : 2: 2ndnd degree AVBdegree AVB

BradyarrhythmiasBradyarrhythmias : 2: 2ndnd degree AVBdegree AVB

BradyarrhythmiasBradyarrhythmias : 3: 3rdrd degree AVBdegree AVB

TachyarrhythmiasTachyarrhythmias : : Premature complexesPremature complexes

TachyarrhythmiasTachyarrhythmias : : Premature complexesPremature complexes

TachyarrhythmiasTachyarrhythmias

TachyarrhythmiasTachyarrhythmias

TachyarrhythmiasTachyarrhythmias

TachyarrhythmiasTachyarrhythmias

TachyarrhythmiasTachyarrhythmias

TachyarrhythmiasTachyarrhythmias

AsystoleAsystole