1. EKG Review

2. Function of Heart Electricity and Plumbing
With any functioning unit you need:
Electricity and Plumbing
ELECTRICITY: electrical current that stimulates the heart and tells it to beat or contract
PLUMBING: 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
Electricity
SA AV Bundle of HIS BB PF
SA: 60-80bpm
AV: 40-60bpm
BH-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 contraction
Heart 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 lungs
Tissue needs oxygen and blood to survive. Without this, it cannot function

5. Basic principals of EKG
Rate? FAST, SLOW, NORMAL
Complex? “P” in front of every “QRS”
P- atrial contraction
QRS- ventricular contraction
qrs p T

6. What is my rate: Each Full complex is one beat
Most strips are 6 seconds long 1 2 3 4 5
(# of complexes in 6 sec strip) X (10) = Heart Rate
(5 complexes) X (10) = 50 beats per minute

7. -CARDIA : heart beat including contraction & relaxation
ARRYTHMIAS
Normal: bpm
Slow: < 60 bpm
Sinus Bradycardia, Junctional
Fast: >100 bpm
Sinus Tachycardia, Supraventricular Tachycardia, VTach.
-CARDIA : heart beat including contraction & relaxation

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 rhythm
Supraventricular Tachycardia
Supra-superior : “above” the ventricular
Rate is greater than 160 bpm, “QRS” is narrow.

11. Ventricular rhythms Ventricular Tachycardia Ventricular Fibrillation
Tachycardia- firing from the ventricle
WIDE “QRS”, no “P”
Ventricular Fibrillation
Fibrillation 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/beats
Atrial Flutter
Look at sawtooth pattern between waves

13. Just remember : “Dead meat don’t beat”
Asystole
No movement of heart muscle
Just remember : “Dead meat don’t beat”

14. EKG GRIDS SMALL blocks: 0.4 sec LARGE blocks: .20 sec Time (secs)V O L T A G E
5 Large blocks = 1 sec. on strip
SMALL blocks: 0.4 sec
LARGE 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 beat
2nd 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 QRS
PJC- premature Junctional complex
P wave is inverted or absent
PVC- premature Ventricular complex
Wide and bizarre, No “P” wave

17. Other things to look at….
S-T segment
Depression- Ischemia or injury
Elevation- infarct or death of tissue
***Classified as significant if > 1 mm
**STEMI- is key point in ACS algorithm

18. Pacemaker spikes
If Pacemaker is pacing the heart you will see a spike. To determine what is being paced, Look at location of spike
Before P: pacing ATRIA
Both- pacing both
Before QRS: Pacing VENTRICLE