1. Anatomy

2. ECG Electrodes

3. ECG Waveform

4. The 12 lead ECG

5. How does the heart work

6. AV node activated by Atrial depolarization Sends signal through His-purkinje bundle Get depolarization of SEPTUM Left and Right BUNDLES transmit signal to Left and Right VENTRICLES Net “Vector” towards the LV Should be narrow (<120msec) if bundles working properly Then have REPOLARIZATION = Twave The appearance of this electrical activity depends on which lead you are using to look at it

7. Review of waveforms

8. How to Look at an ECG Rate: Is the heart rate too fast or slow?
Rhythm: Sinus rhythm or not?
Axis: Where does the majority of electrical activity point?
P wave: How big are the atria?
PR interval: How healthy is the AV node?
QRS wave: Is there abnormal conduction or a ventricular source?
QT: Long is bad
Ischemia and hypertrophy

9. ECG Paper Can Determine Heart Rate
Rule: 300, 150, 100, 75, 60, 50 counting over for each big sqaure

10. What is the heart rate?
Answer = 75 per min

11. Rhythm :
Is there a p wave? = Sinus
Is it followed by a QRS?

12. Is the rhythm regular or irregular?

13. Reasons to have an irregular rhythm
Irregular pacemaker
Multifocal atrial rhythm
Atrial fibrillation
Atrial fib/flutter
Ectopic beats
PVC
PAC
PJC
Irregular conduction
AV node block
1st degree:
PR interval > 200 msec
2nd degree:
Type 1: Wenkebach
Type 2: dropped beat
3rd degree:
p waves marching independent to QRS

14. Examples of Rhythms Multifocal Atrial Rhythm AFIB Atrial Flutter AFIB
V TACH

15. Example of a PVC

16. Telling the Axis from the leads

17. The axis wheel

18. The P wave

19. The QRS QRS < 120 msec QRS > 120 msec QRS > 120 msec
Rabbit ears in V1 & V2
Wide S wave in V5 & V6
R axis deviation
QRS > 120 msec
Deep slurred S wave in V1
Wide R wave in V6, I & avL
L axis deviation

20. Ishcemia vs Acute Infarct

21. Example of Ischemia

22. Examples of Infarctions

23. Review Rate: Is the heart rate too fast or slow?
Rhythm: Sinus rhythm or not?
Axis: Where does the majority of electrical activity point?
P wave: How big are the atria?
PR interval: How healthy is the AV node?
QRS wave: Is there abnormal conduction or a ventricular source?
QT: Long is bad
Ischemia and hypertrophy

24. Describe this ECG

25. Describe this Strip