2 Function 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!!!
3 dead 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
4 Plumbing 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
5 Basic principals of EKG Rate? FAST, SLOW, NORMALComplex? “P” in front of every “QRS”P- atrial contractionQRS- ventricular contractionqrspT
6 What 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
8 Sinus 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”
9 SLOW ARRYHMIAS Sinus Bradycardia Junctional Rhythm SLOW sinus rhythm “P” wave is inverted or absent
10 FAST ARRYTHMIAS Sinus Tachycardia Supraventricular Tachycardia Fast sinus rhythmSupraventricular TachycardiaSupra-superior : “above” the ventricularRate is greater than 160 bpm, “QRS” is narrow.
11 Ventricular 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
12 Atrial Arrhythmias Atrial Fibrillation Atrial Flutter Underlying rhythm is sinus, with fibrillation between complexes/beatsAtrial FlutterLook at sawtooth pattern between waves
13 Just remember : “Dead meat don’t beat” AsystoleNo movement of heart muscleJust remember : “Dead meat don’t beat”
14 EKG 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
15 BLOCKS 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
16 Premature 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
17 Other 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
18 Pacemaker 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