ECG Interpretation.

Slides:



Advertisements
Similar presentations
EKG Review.
Advertisements

ECG TRAINING MODULE 4 BY BRAD CHAPMAN RCT.
ECG Rhythm Interpretation
By Dr.Ahmed Mostafa Assist. Prof. of anesthesia & I.C.U.
EKG for ACLS Amanda Hooper
EKG 101 Deborah Goldstein Georgetown University
ACLS Rhythms Cheat Sheet
The Electrocardiogram
ECGG Interpretation Najib Ul Haq coyright 2004 Anna Story.
“ Heart Blocks”.
ECG Rhythm Interpretation
Name That Rhythm!.
Introduction to Electrocardiography & Dysrhythmias
ECG Rhythm Interpretation
ECG interpretations.
Chapter 11 Interpretation of Electrocardiogram Tracings
Welcome to ASATT Region 7 Educational Meeting
Cardiovascular Monitoring Cardiac Dysrhythmia
ECG’s Jake Turner.
Heart Arrhythmia's Brandy Parker Brianne Negen Jeremy Grimm
What’s Wrong With My Patient?
ELECTROCARDIOGRAM (ECG)
Normal ECG: Rate and Rhythm
Cardiovascular System Block Cardiac Arrhythmias (Physiology)
Arrythmia Interpretation (cont’d) Rates of automaticity – Too fast (tachycardia) – Too slow (bradycardia) – Too irritable (Premature) – Absent (block)
EKG Interpretation.
Electrocardiogram Primer (EKG-ECG)
When Your Heart Doesn't Work as It Should
Cardiovascular System ANALYSIS Dr.Mohammed Sharique Ahmed Quadri Asst. Professor Physiology Almaarefa College بسم الله الرحمن الرحيم 1.
 Any atrial area may originate an impulse.  Rhythms have upright P waves preceding each QRS complex.  Not as well-rounded  Heart rates usually from.
Chapter 17 Interpreting the Electrocardiogram
Disease of Cardiac System
EKG Interpretation.
ECG interpretations.
ECG Rhythm Interpretation
The Basics of ECG Interpretation Dr Tim Smith. Summary Cardiac conducting system and the ECG waveform Cardiac conducting system and the ECG waveform The.
Cardiac Conduction. Physiology of Cardiac Conduction The excitatory & electrical conduction system of the heart is responsible for the contraction and.
Fast & Easy ECGs – A Self-Paced Learning Program
Basic EKG Interpretation
EKG. Objective: The student will become familiar with an EKG and how it works to record the electrical activity of the heart The student will become familiar.
You Are Now Entering The IMC/TeleUNIT. Designed to provide care for those who need less monitoring than those in the Intensive Care units, but, still.
In Summary….. Understand? Could you label this???
ELECTROCARDIOGRAM (ECG)
ECGs AFMAMS Resident Orientation March Lecture Outline ECG Basics Importance of systematically reading ECGs Rate Rhythm Axis Hypertrophy Intervals.
Q I A 12 Fast & Easy ECGs – A Self-Paced Learning Program Origin and Clinical Aspects of AV Heart Blocks.
Adel Hasanin, MRCP (UK), MS (Cardiology)
Normal EKG – P wave: Atrial depolarization – PR interval: < 0.20 sec – QRS complex: ventricular depolarization – QRS interval < 0.10 sec SA 0.10 – 0.12.
ECG Basics.
Fast & Easy ECGs, 2nd E – A Self-Paced Learning Program
ECG intereptation Abdualrahman ALshehri Lecturer King Saud University
EKG’s Kelly Marchant RN July 28, 2015 Adapted from NURO 438
1. CARDIOVASCULAR SYSTEM ELECTROCARDIOGRAM (E.C.G.) LECTURE - 5 DR. ZAHOOR ALI SHAIKH 2.
ECG Rhythm Interpretation Module I ECG Basics Share what you know, learn what you don’t.
Electrocardiography – Abnormalities (Arrhythmias) 7
Introduction to the EKG. Electricity of the Heart The contraction of any muscle is associated with electrical changes called depolarizations and can be.
Fast & Easy ECGs – A Self-Paced Learning Program
1 © 2013 The McGraw-Hill Companies, Inc. All rights reserved. Fast & Easy ECGs, 2E P Waves Fast & Easy ECGs, 2nd E – A Self- Paced Learning Program 66.
Introduction to Cardiac Arrythmias Arrythmia is a generalized term used to denote disturbances in the heart's rhythm. Normal sinus rhythm is characterized.
Fast & Easy ECGs – A Self-Paced Learning Program
Electrocardiogram (ECG/EKG) Allied Health II. Heart Sounds Primarily from blood turbulence caused by closing of the heart valves 4 heart sounds 1 st 2.
Chapter 5. Remember…  If sinus node loses its pacemaking role for whatever reason, the next fastest site will take over.  Rhythms that start in the.
22nd April 2009 ECG Recording and Basic Interpretation.
Heart Blocks Leaugeay Webre BS, CCEMT-P, NREMT-P.
The Cardiac Cycle and The ECG
MAKING ECG’S EASY EVALUATING THE ECG Dr Nick Robinson
ECG Basics.
ECG Rhythm Interpretation
Electrocardiogram (ECG)
ECG Basics.
ECG Dr. Sara Al Abdulhadi.
Presentation transcript:

ECG Interpretation

What is an ECG Electrocardiogram Traces the electrical activity of the heart 12 lead, 15 lead

Uses of ECG Tracing Ischemia/infarct Arrhythmias Ventricular and atrial enlargements Conduction defects Pericarditis Effects of some drugs and electrolytes

ECG

How to Conduct an ECG Patient lies flat on back Electrodes are placed on the body Sites may need to be shaved or cleaned to ensure the leads will stick properly. Patient will lie as still as possible, hold breath, or put hands under bottom to keep from moving. The results are then printed out on paper for MD to review.

ECG Strip

Lead Placements V1 - Junction of the 4th ICS, Right sternal border V2 - Junction of the 4th ICS, Left sternal border V3 - Midway between V2 and V4 V4 - Junction of 5th ICS, Mid clavicle V5 - Anterior aspect of axilla, same line as V4 V6 - Mid axilla, same line a V4 4 limb leads (for grounding etc)

Lead Placements Cont’

Normal Conduction Pattern

Understanding the Waves

Each wave P Q R S T

ECG Strip r/t heart

Understanding the Waves One small box = 0.04 seconds One large box = 0.2 seconds 5 large boxes = 1 second

http://en.wikipedia.org/wiki/File:ECG_principle_slow.gif

Understanding the Waves Baseline (what is it?) P wave Length of time it takes the impulse to pass from the SA node to the AV node Should precede every QRS wave PR interval Should be no longer than 0.12 – 0.2

Understanding the Waves QRS Should be no longer than 0.12 If energy is going towards a positive electrode (camera), the picture will show a positive QRS complex If energy is going away from positive electrode, the picture will show a negative QRS complex If energy is toward the positive electrode and then passes by it, the QRS will be biphasic Ventricle contracting

Understanding the Waves T wave Should always start from baseline Will indicate ischemia

Understanding an ECG Is as easy as… 1. 2. 3. = rate = intervals = rhythm

Step 1 = Rate Different ways to calculate a rate: a) ECG usually tells you b) Locate a QRS that is close to a big line and count to next big line: 300, 150, 100, 75, 60, 50 c) take a 6 second strip, count QRS and multiply by 10 (hint: the middle of V3 on the lead II strip is 6 seconds) One small box = 0.04 sec. One large box = 0.2 sec. 5 large boxes = 1 sec. 300, 150, 100, 75, 60, 50, 45, 37…

Step 1 = Rate (cont’) Checking the regularity: map out QRS’s

Step 2 = Intervals We assess intervals to see where the impulse is coming from (pacemaker beat) Remember: PR interval: normal is 0.12 - 0.2 QRS interval: normal is less than or equal to 0.12 One small box = 0.04 sec. One large box = 0.2 sec. 5 large boxes = 1 sec.

Step 3 = Rhythm The biggest question in relation to rhythm is…

Is this rhythm affecting my patient?

(Normal) Sinus Rhythm 60-80 bpm P preceding each QRS Normal intervals What do we want to do for this patient?

Normal ECG

Other Sinus Rhythms Sinus bradycardia a sinus rhythm with a rate <60 bpm What do we want to do for this patient?

Other Sinus Rhythms Sinus tachycardia a sinus rhythm with a rate >80 bpm What do we want to do for this patient?

Atrial Arrhythmias Atrial fibrillation (A-fib) irregular rate no discernable P waves increased risk of strokes due to clots that might form due to fibrillation (patients are usually on anticoagulation therapy) What do we want to do for this patient?

Atrial fibrillation

Atrial Arrhythmias Cont’ Atrial flutter saw tooth in appearance irregular rate

Atrial flutter What do we want to do for this patient?

Blocks 1st degree AV block a PR interval that exceeds 0.20 sec What do we want to do for this patient?

Blocks Cont’ 2nd degree AV block (Mobitz) a) type I (Wenckebach) longer and longer PR intervals until a QRS is dropped What do we want to do for this patient?

Blocks Cont’ b) type II P waves and then suddenly a QRS is dropped P’s are regular What do we want to do for this patient?

Blocks Cont’ 3rd degree AV block HR <40 bpm a complete block of electrical activity from atria to ventricle P’s are regular What do we want to do for this patient?

Ventricular Rhythms Ventricular fibrillation complete breakdown of all rhythm a) course b) fine What do we want to do for this patient?

V-fib What’s the first thing to do when coming up on a patient with this rhythm?

Ventricular Rhythms Cont’ Ventricular tachycardia (V-tach) impulse originates in the ventricle always has a wide QRS complex What do we want to do for this patient?

V-tach What’s the first thing to do when coming up on a patient with this rhythm?

Asystole Pulseless What do we want to do for this patient?

Coronary Arteries

MI’s

MI’s

MI’s How can you tell on an ECG that your patient is having a heart attack? T waves Different views of heart will show different injured areas of heart

MI’s T wave shouldering is classic

MI’s How else can you tell that your patient has had an MI? Cardiac Markers CK will show in 4-6 hours (starts to come back down after 1 day) Troponin will show in 4-6 hours (may stay elevated for weeks) Others are: LDH, CK-MB, myoglobin, AST

Locating an MI

I Lateral (circumflex) aVR V1 Anterior (Lt ant desc) V4 Anterior II Inferior (Rt coronary) aVL Lateral V2 Anterior V5 Lateral III Inferior aVF Inferior V3 Anterior V6 Lateral Your paper should look like this now…

ECG Tissue Damage Locations

Where is this MI?