why do we use Ekg (ecg)?
1.easy to do, its cheap
2. Non invasive
3.cant detect structural problems
What does an ekg do?
it detects the electrical impulses of the heart
what is the P wave represent?
represents the atria depolarization
what does the QRS complex represent?
ventricular depolarization. normally not wider than 3mm(0.12 seconds)
What does the T wave represent?
represent ventricular repolarization
what does the PR interval determine?
time that the impulse travels from SA node to AV node (<0.20 sec)
What does a long PR interval mean?
that there is a delay or block. Needs immediate attention. sign of 1st degree AV block
What does the ST segment represent?
it is time from the end of ventricular depolarization to re-polarization. Normally flat.
What do abnormalities represent in in ST segment?
means depression or elevation and it represent ischemia(lack of blood flow) or MI
what does the vertical axis represent?
it measures voltage( how strong contraction is), and horizontal time
Axis deviations is what?
ex. driving on freeway, there is a blockage, you exit to by pass blockage. then get back on path
normal axis value is?
between 0 to +90 degrees
right axis deviation is?
between 90 to +180
Right axis deviation means?
is consistent with Right ventricular hypertrophy, found with Cor pulmonale and/or COPD.
Left axis value is?
between 0- -90
Left axis deviation is consistent with?
left ventricular hypertrophy, CHF
The PR interval is always?
<0.20 seconds
The QRS complex should never be longer than?
0.12 seconds
Having a inversion T wave means?
ischemia=inadequate blood flow
The ST segment if depressed/elevated means?
ischeme or MI
means serious problems of myocardium
to calculate RR you count what?
the QRS complex or P waves in 6 seconds( 30 large boxes) and X by 10
sinus rhythm
1.A heart rhythm initiated by the SA node;
2.a normal rhythm.
3.PR complex is <.20 sec,
4.QRS complex are identical and no longer than .12 sec
5. ST segment flat
6. RR interval is 60-100 BPM
Sinus Tachycardia
1. Each QRS complex is preceded by P wave
2.rate greater than 100
3. regular rhythm
What are some causes of Sinus tachycardia?
1.hypoxemia
2. pain, anxiety, fever
3. hypervolumemia(low vol. blood)
4.bronchodilators
what is sinus bradycardia?
1.When the SA node fires at a rate of less than 60 beats per minute.
2.P wave and the QRS complex are normal.
3.rate less than 60
What is a effective treatment for sinus bradycardia?
atropen
what is first degree heart block?
1.With first degree heart block, the PR interval is greater than 0.20 sec and after QRS is P wave
2. May occur after MI or with use of beta blockers
3.inpulse delayed in AV node
4. treatment not needed
what is a third degree heart block?
(Complete heart block) the atria and ventricles are paced independently and there is no relationship between the P waves and QRS complex
what is treament for 3rd HB?
medications that speed up the hear and placement of pacemaker
what is atrial flutter?
Characterized by a "saw-toothed" wave formation with a slower ventricular rate. The atrial rate generally ranges form 220 to 350 beats/min.
what is treatment for atrial flutter?
Cardioversion(50-100jewels) may be used a long with medications.
what is atrial fibrillation?
1.Electrical impulses move randomly throughout the atria, causing the atria to quiver instead of contracting with a normal rhythm.
2.no true P waves
what does atrial fibrillation cause?
cardiac output to drop and may lead to thrombi in atria due to blog stagnation. cardio version used
premature ventricular contraction
1.ventricles contract before they should,
2. QRS complex is wide and has no preceding P wave
what is ectopic?
out of place; in an abnormal location
PVCS are a result from?
hypoxia, electrolyte imbalances, and acid base disorders
frequent PVC's call for a treatment of?
lidocaine, are not a major concern
PVC's can be dangerous when?
1. occur in multiple configuration
2. 3 or more PVCs in a row (considered V. tach)
3. more than 1 in 10 beats
4. land near a T wave, which can lead to V. tach
5. Cardioversion is synchronized to avoid this
what are couplets?
2 PVCS in a row
what is Bigeminy?
every other beat
what is trigeminal?
every 3rd beat
what does ventricular tachycardia represnt?
1.represent a run of 3 or more PVC's
2. series of QRS complexes with no preceeding P wave
3. rate 100 to 250/min
4.serious arrythmia leads to V fib
5.usually regular rhythm
6.rapid V-tach= cant see P waves(with slower rates may see P waves but dont match
how do you treat ventricular tachycardia?
with cardioversion and medication. common causes MI, CAD, HTN
ventricular fibrilliation
1. rate very rapid, too disorganized to count
2. rhythm irregular
3. waves vary in size and shape. No QRS, ST,P or T wave
sinus arrhythmia
1.All criteria for sinus rhythm meet with the exception of rhythm variation
2. RR interval is continually changing
3. PR interval is constant
If there is no QRS then what must the rhythms be?
asystole or ventricular fibrilation
Ventricular asystole
1. complete absence of ventricle action
2. occasional PVC or rare erratic ventricular escape beat
3. patient has no pulse
Torsades de pointes
Form of V-tach where QRS appears to be constantly changing
Pulseless electrical activity
1. no palpable pulse
2.presence of some type of electrical activty other than v-fib or v tach
if there is no P wave what does that mean?
1.if there are unorganized, very rapid signals present between QRS complexes and no P waves= atrial Fib