2Function of Heart Electricity and Plumbing With any functioning unit you need:Electricity and PlumbingELECTRICITY: electrical current that stimulates the heart and tells it to beat or contractPLUMBING: When the heart contracts it provides blood and oxygenation to vessels, tissue and organs***Keep in mind how electricity and plumbing affect each other!!!
3dead tissue will not allow signal to pass through ElectricitySA AV Bundle of HIS BB PFSA: 60-80bpmAV: 40-60bpmBH-BB: 20-40bpm“ACCIDENTS ON A HIGHWAY”- will be detoured around the blockage.increased distance to travel = increased time to get to location**Electrical current needs healthy tissue to conduct-dead tissue will not allow signal to pass through
4Plumbing Beats = contractions Each beat requires atrial and ventricular contractionHeart is like a sponge. It absorbs and squeezes out blood with each contraction. If it is not “rung out fully” with each squeeze- it cannot absorb it’s full potential. (preload, afterload)Ventricular contraction- pushes blood into arteries to be sent to body, tissues, organs and lungsTissue needs oxygen and blood to survive. Without this, it cannot function
5Basic principals of EKG Rate? FAST, SLOW, NORMALComplex? “P” in front of every “QRS”P- atrial contractionQRS- ventricular contractionqrspT
6What is my rate: Each Full complex is one beat Most strips are 6 seconds long12345(# of complexes in 6 sec strip) X (10) = Heart Rate(5 complexes) X (10) = 50 beats per minute
8Sinus Rhythm Sinus rhythm is normal electricity and normal plumbing. Electrical signal fires from ‘Sinus’ node.Rate is either slow, fast or normal.“P wave” is present in front of every “QRS”
9SLOW ARRYHMIAS Sinus Bradycardia Junctional Rhythm SLOW sinus rhythm “P” wave is inverted or absent
10FAST ARRYTHMIAS Sinus Tachycardia Supraventricular Tachycardia Fast sinus rhythmSupraventricular TachycardiaSupra-superior : “above” the ventricularRate is greater than 160 bpm, “QRS” is narrow.
11Ventricular rhythms Ventricular Tachycardia Ventricular Fibrillation Tachycardia- firing from the ventricleWIDE “QRS”, no “P”Ventricular FibrillationFibrillation or “quivering” of the ventricles- no contraction/relaxation. No organized rhythm
12Atrial Arrhythmias Atrial Fibrillation Atrial Flutter Underlying rhythm is sinus, with fibrillation between complexes/beatsAtrial FlutterLook at sawtooth pattern between waves
13Just remember : “Dead meat don’t beat” AsystoleNo movement of heart muscleJust remember : “Dead meat don’t beat”
14EKG GRIDS SMALL blocks: 0.4 sec LARGE blocks: .20 sec Time (secs) VOLTAGE5 Large blocks = 1 sec. on stripSMALL blocks: 0.4 secLARGE blocks: .20 sec
15BLOCKS Underlying rhythm is sinus, (must have P-QRS) Normal P-R interval is sec (one big block)1st degree: prolonged P-R interval (>.20)2nd degree I: (WB) P-R gets longer, then drops beat2nd degree II: more “P’s” than “QRS” (kids w/o parents)3rd degree: total disassociation, no communication
16Premature Complexes PAC- premature Atrial complex P wave upright in front of QRSPJC- premature Junctional complexP wave is inverted or absentPVC- premature Ventricular complexWide and bizarre, No “P” wave
17Other things to look at…. S-T segmentDepression- Ischemia or injuryElevation- infarct or death of tissue***Classified as significant if > 1 mm**STEMI- is key point in ACS algorithm
18Pacemaker spikesIf Pacemaker is pacing the heart you will see a spike. To determine what is being paced, Look at location of spikeBefore P: pacing ATRIABoth- pacing bothBefore QRS: Pacing VENTRICLE