ECG

THIS is only study perpas

1. ECG PATEL.YASH.GIRISHBHAI (KAPC)

2. TYOES IF CARDIAC CELLS MAYOCARDIAL CELLS Working or mechanical cells Contain contractile filaments PACEMAKER CAELLS -specialized cell of the electrical conduction system - Responsible for the spontaneous generation and conduction of electrical impulses

3. Cardiac Conduction

4. From Basic ECG Module - AACN SA Node

5. Cardiac Cycle & the ECG Isometric line ST Segment

6. Lead Placement – 6 lead system From Basic ECG Module - AACN

7. ECG Paper ECG paper is graph paper made up of small and larger, heavy-lined squares Smallest squares are 1 mm wide and 1 mm high 5 small squares between the heavier black lines 25 small squares within each large square

8. What Does the ECG Measure? V O L T A G E T I M E

9. PR INTERVAL Normal P wave – small, round, Upright PR INTERVAL: Begins with the onset of the P Wave and ends with the inset of QRS Complex normally measures 0.12 To 0.20 seconds 5 small boxes

10. QRS COMPLEX A QRS complex normally Follows each P wave Consists of Q wave, R wave, And S wave Represents the spread of electrical Impulse through the ventricles normal – 0.04- 0.12 seconds

11. ST SEGMENT ST – segment Begins with the end of the QRS complex and ends with the of the onset of the T wave and is on the same line as the PR interval ST segment depression of more than 1 mm is suggestive of myocardial ischemia ST segment elevation of more then 1 mm is suggestive of myocardial injury or pericarditis.

12. T WAVE T WAVE : Represent ventricular repolarization The beginning of the T wave the slope of the ST segment appears to become abruptly or gradually steeper The T wave ends when it returns to the baseline

13. ST Segment The ST segment is considered: “Elevated” if the segment deviates above the baseline of the PR segment “Depressed” if the segment deviates below it

14. STEPS OF RHYTHM ANLAYSIS What is ate ? Ventricular Atrial 2 is the rhythm regular or irregular? Is there 1 P wave before each QRS? Is the PR interval (.12- .20)? Is the QRS narrow or wide(.04- .10)

15. Determining the Rate 1500 ÷ No of small boxes within an RR interval (regular rhythms) 300 ÷ No of Large boxes within an RR interval (regular rhythms) 10 x No of R complexes in 6 seconds(30 large box) 10 x No of R complexes in 6 seconds

16. Rhythm: Regular / Irregular Distance between the ‘R’ waves

17. Normal Sinus Rhythm Ventricular rate: 60-100; Regular rhythm Atrial: Same as ventricular P consistent shape – always positive P-R interval: 0.12-0.20 QRS complex: 0.04-0.10 1 P wave for every QRS

18. DYSRHYTHMIAS Disorders of electrical impulse: Formation Conduction Named by Site of origin of impulse Mechanism of formation or conduction involved

19. DYSRTHMIAS Site of origin SA node Bradycardia, tachycardia AYRIAL tissue Flutter, fibrillation AV node blocks

20. SINUS TACHYCARDIA ETIOLOGY ↑ CNS response : anxiety; pain; fever; anemia INTERVANTION Identify cause, select best treatment Goal : ↓ HR to normal levels β -blockers, ACE Inhibitors

21. Sinus Tachycardia Ventricular rate: > 100 (up to180); Regular rhythm Atrial: Same as ventricular P consistent shape P wave for every QRS QRS complex: Normal Sinus Tachycardia

22. Sinus Bradycardia Ventricular rate:< 60; regular rhythm Atrial: same as ventricular P consistent shape P wave for every QRS QRS complex: Normal

23. Sinus Bradycardia Etiology PNS dominant; Excessive vagal (Valsalva) stimulation to the heart (↓ SA node discharge = ↓ HR, ↓ conduction) Interventions Atropine = Tx of choice Pacemaker placement

24. PAC (premature atraial contractions): Irregular P-R rhythms Premature, irregular P waves (sometimes “lost” in the T Wave.

25. Premature Atrial Contractions: Triggered by: Alcohol, nicotine, anxiety, fatigue, fever, and infections Clinical Manifestations: Palpitations or “skipped beats”

26. Flutter and Fibrillation

27. Atrial Flutter Etiology AV node selectively blocks # impulses that reach ventricles (protective mechanism) Rheumatic Heart disease, CHF, AV valve disease, post cardiac surgery Clinical manifestations dependent upon ventricular response

28. Atrial Flutter Ventricular rate: Variable, Atrial: 250-300/minute P shape – “sawtooth” formation P-R interval: Absent No P wave QRS complex: Normal

29. Atrial Fibrillation Etiology Most common dysrhythmia in US Aging, MI, MS, Cardiomyopathy Multiple, rapid impulses many atrial foci; Atrial depolarization disorganized

30. Atrial Fibrillation Commonly seen after cardiac surgery (transient) Can be intermittent or chronic Symptoms: SOB Fatigue Weakness, Distended neck veins Anxiety Palpitations Chest discomfort Irregular pulse

31. Atrial Fibrillation Ventricular rate: < 100 (controlled) Atrial: Unable to determine (>350) No P waves (fibrillatory waves) P-R interval: Absent QRS complex: Normal

32. Atrial Fibrillation

33. Premature Ventricular Contractions Etiology Early ventricular complexes, followed by pause Ventricular contraction originating in an ectopic focus outside ventricles Aging, MI, Caffeine, ↓ K +

34. Premature Ventricular Contractions No P wave QRS wide and unusual ST segment often slops in the opposite direction PVC

35. Ventricular Tachycardia Etiology Repetitive firing of an irritated ventricular ectopic focus Intermittent Sustained: > 15-30 sec

36. Ventricular Tachycardia (V Tach) Unable to determine rhythm No P waves present QRS complex > 0.10 sec

37. Ventricular Fibrillation Cardiac arrest Etiology Ventricles quiver, consume lots of O 2 , No cardiac output, no perfusion AMI, ↓ K + , ↓ Mg + Rapidly fatal (3-5 min) No proper QRS Complex is noted

38. Ventricular Fibrillation Assessment LOC, Absence of Pulse Apnea Seizures Development of respiratory & metabolic acidosis Treatment CPR (ACLS) Defibrillation

39. Ventricular Fibrillation (V Fib) Coarse Fine

40. Heart Blocks Occur when there is a delay in the conduction of the impulse through the AV node PR is > 0.20 seconds SA node function is normal

41. Heart Block Overview 1 st degree – PR interval > 0.20 seconds All impulses reach the ventricles 2 nd degree – (2 types) Mobitz I – each impulses takes longer to conduct until 1 is blocked and a QRS complex is dropped and a pause occurs; then cycle repeats Mobitz II – None conduction to ventricles.2-4 p waves between QRS. 3 rd degree – None of the atrial impulses reach the ventricles Activity of the atria and ventricles is ‘divorced’ Results in inadequate cardiac output Requires pacemaker

42. 2 nd degree Type 1 1 st degree

43. 3 rd degree 2 nd degree Type II

44. Pacemakers