electrocardiogram (1)

7/25/2019 Electrocardiogram (1)

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Electrocardiogram

Clinical Skills III

NYIT Physician Assistant Studies


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Electrocardiogram: (ECG or EKG

ECG is a gra!hic record o" electric currents generated #y the heart muscles$

Electrical im!ulses are !icked u! #y a sur"ace e%hich are !laced at &arious !oints on the #connected the ECG machine$


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Indications "or Electrocardiogra

'aseline e&aluation

es!onse to thera!y

Prior to surgery

)edication o&erdose

Electrical in*ury (arrhythmia Synco!e (#radycardia

Pain+ ,ys!nea


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Cardiac Pathology ,iagnosed #y EKG:

Arrhythmias ( slo%+ ra!id+ irregular heart #eat)yocardial ischemia and in"arctionCham#er hy!ertro!hyCongenital heart de"ects in&ol&ing the conducting (electricsystemA#normal !osition o" the heart

Pericarditis or myocarditisCardiac Arrest,istur#ances o" the heart-s conducting system (heart #locElectrolyte distur#ances,rug To.icity


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Assessment

Assess age+ gender+ current medication history (m!ossi#le cardiac or hemodynamic e/ects$ 0ther data #e re1uired such as height+ %eight+ #lood !ressure$

,etermine that the !atient is a#le to tolerate a su!ineand that ade1uate e.!osure o" chest and lim#s is !o

electrode !lacement$

,etermine !resence o" neck+ arm+ *a%+ or other !!ossi#le cardiac origin$ Chest or other !ain mayadditional in"ormation use"ul in serial com!arison o" ECG

Assess !atient need "or in"ormation a#out the !rocedure

and re1uirements and a#ility to coo!erate:


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E1ui!ment Needed

2 T%el&e3lead ECG machine %ith charged #attery+

ca#les and leads+ gra!h !a!er

2 ,is!osa#le electrodes

2 Alcohol %i!es

2 Pillo%s2 Sheet or dra!e

2 ,is!osa#le ra4or i" needed


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Com!lications o" EKG:

3 Sa"e !rocedure

3 No kno%n risks

3 No electric current sent to #ody

3 Possi#le allergic or sensiti&ity to electrodes

(local skin reaction


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Normal Conduction System ofHeart:


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'asic Electrical Acti&ity o" the 5ea

)yocardial cells (muscle cells o" heart: interior cells 3 negati&ely charge at rest

the sur"ace 3 !ositi&ely charged

Contraction o" heart muscle: Electrical stimulation !ositi&ely charges cells

Cells !re!are to contract 6de!olari4ation7 occurs

,e!olari4ation !asses through heart contraction o" myocardium

Depolarization : stimulates myocardial cells to contract cell changes to !ositi&e

Repolarization: gain negati&e charge


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P %a&e: (de!olari4ation o" the right and le"t atria

8S com!le.: right and le"t &entricular de!olari4ation

ST3T %a&e: &entricular re!olari4ation

9 %a&e: origin "or this %a&e is not clear

(!ro#a#ly se!tal re!olari4ation

PR interval: time interval from onset of atrial

depolarization (P wa&e to onset o"

&entricular de!olari4ation (8S com!le.8S duration: duration o" &entricular de!olari4ation

8T inter&al: duration o" &entricular de!olari4ation and re!olari4ation

inter&al: duration o" &entricular cardiac cycle (&entricular rate

PP inter&al: duration o" atrial cycle (atrial rate %a&e 3 rst !ositi&e de;ection a"ter ! %a&e

8 %a&e 3 rst negati&e de;ection a"ter ! %a&e 'E


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12 ead !C":

The >3lead ECG !ro&ides 6&ie%s7 o" cardiac

acti&ity "rom > di/erent &antage !oints on the #odyCom!osed o" > se!arate leads: D lim# leads ( B and B augmented leads and D chest leads (!recordia

,is!lays the cardiac cycle in "our lead grou!s that the cardiac cycle in relation to lead !lacement

ead grou!s: ateral ( I+ aF+ F and FD

In"erior (II+ III and aF and F

Anterior (FB and F@


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ECG EA,S:


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Anatomical Grou!s:


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Precordialeads (chestleads


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Identi"y Placement o" Chest eads (Preco

F> H @th intercostal s!a#order

F H @th intercostal s!a#order

FB H mid%ay #etween

F@ H mid3cla&icular line+inters!ace

F H anterior a.illary lininters!ace

FD H mid3a.illary line at


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Identi"yPlacement im# eads

R $ Any%here a#o&e the ankle and #elo% the torso

R% $ Any%here #et%een the shoulder and the el#o%

$ Any%here a#o&e the ankle and #elo% the torso

% $ Any%here #et%een the shoulder and the el#o%


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> ead EKG


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Arti"acts on ECG:

S%eat: shorts electrodes

Pulse arti"act: electrode on !ulse and mo&es

)o&ement arti"acts: !atient mo&es

Electrical arti"act: electrical acti&ity near !atient


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hythm Stri!s:

hythm stri! longer look at rate and rhythm

Each machine 3 set at certain lead #ut can #e ch

Set multi!le leads 3multi!le rhythm stri!s at a tim


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ECG Fariations

> lead ECG adds B additional chest leads

across the right !recordium Falua#le tool "or the early diagnosis o" right&entricular and !osterior le"t &entricularin"arction$

>J3lead ECG adds B !osterior leads to the >3lead ECG

Fery use"ul "or early detection o" myocardialischemia and in*ury


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Holter &onitor:

Porta#le EKG

Electrodes !laced on chest 3 !atient %ears recorderaround neck or %aist "or @3@J hours

A diary 3 times sym!toms occur and readings

5el!s identi"y conditions 3 s!oradic and not ca!tured

EKG


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Fideo on 5o% to Per"orm EKG:

htt!s:youtu$#e883,C,E@38


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In"erior )I

Pathologic 8 %a&es and e&ol&ing ST3T changes inII+ III+ aF


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In"ero!osterior )I ECG changes are seen in anterior !recordial leads F>3B+ #ut a

the mirror image o" an anterose!tal )I+

Increased %a&e am!litude and duration (i$e$+ a L!athologic

%a&eL is a mirror image o" a !athologic 8$ 5y!eracute ST3T %a&e changes: i$e$+ ST de!ression and large

in&erted T %a&es in F>3B$

ate normali4ation o" ST3T %ith symmetrical u!right T %a&es F>3B$

0"ten seen %ith in"erior )I (i$e$+ Lin"ero!osterior )IL


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ight Fentricular )I

ight Fentricular )I (seen %ith !ro.imal right coocclusion

ECG ndings usually re1uire additional leads on chest (F> to FD+ analogous to the le"t chest le

ST ele&ation+ =>mm+ in right chest leads+ es!ec

F@$


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Anterior )I


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5igh ateral )I

electrocardiogram (1)

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