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Depolarisation
initiated in SA node
Slow conduction
through AV node
Rapid conduction
through Purkinje
fibres
Basic electrocardiography
P Wave : PR Interval:
Atrial depolarization Conduction time from
atrium to ventricles
.
Relationship of ECG to anatomy
Anatomical relations of leads in a standard 12 lead
electrocardiogram
II, III, and aVF: inferior surface of the heart
V1 to V4: anterior surface
I, aVL, V5, and V6: lateral surface
V1 and aVR: right atrium and cavity of left ventricle
How to monitor the ECG (1):
Monitoring leads
3-lead system
approximates to I, II, III
Colour coded
Remove hair
Apply over bone
Lead setting (II)
Gain
Lead
positions:
Ride
Your
Bike (B)
Rapid look
Adhesive pads
ECG. Interpretation
Is there any electrical Activity?
What is the QRS Rate?
What is the QRS Rhythm?
What is QRS Width?
Is there P wave?
What is the relation between P & QRS?
Is there any electrical
Activity ?
ECG. Interpretation
Rhythm
Regular R-R equal distance.
Irregular R-R unequal distance.
ECG. Interpretation
Rate
ECG. Interpretation
Rate
If regular
________ 300____________
Number of big square bet.RR
If irregular
a) Count 30 big square
b) Count number of R waves inside 30 big square (6seconds)
c) Number of R X 10 = HR/min
What is the heart rate?
www.uptodate.com
(300 / 6) = 50 bpm
What is the heart rate?
www.uptodate.com
(300 / ~ 4) = ~ 75 bpm
What is the heart rate?
33 x 6 = 198 bpm
ECG. Interpretation
R Wave
Present or no,
Width must be less than 3 small square otherwise it is wide.
If R wave not present,means Asystole or VF
P Wave :
Present or no,
If no, means atrial fibrillation, junction beat or rhythm and
premature ventricular beat or rhythm.
ECG. Interpretation
P-R Interval: normal length 3-5 small squares.
If more than 5 means heart block.
S-T Segment: It must be iso-electric. If raised or
depressed means ischemia. To say there is S-T
Segment changes,it must be raised 1mm in limb leads or
2 mm in chest leads(v1-v6)
ECG. Interpretation
T Wave :
- Increase magnitude of T (hyperacute T )
- Flat T
- Inverted T
All Are Signs of Ischemia
What Is This Rhythm?
First-degree AV block
Diagnosis?
Third-degree AV block
Third-degree AV block
The wide QRS indicates that the block is occurring at the ventricular level.
There is no relation between the atrial and ventricular rhythm. Ventricular
rhythm is regular and very slow (38 bpm).
The QRS is wide because block is at the bundle branch level, usually
involving both bundle branches. The ventricular pacemaker is downstream
from that level.
Damage to both bundle branches indicates extensive conduction system
disease below the AV node. This is most often caused by extensive anterior
myocardial infarction.
CRITERIA FOR NORMAL
ECG
Regular rhythm
Rate for adult (60-100)
R & P waves are present with normal P-R interval
(3-5 small square)
S-T segment isoelectric
T wave upright of double size P wave.
Cardiac Ischemia
Dr. Hamid Shaalan.
Cardiac Ischemia
Definition Of The Terms:
Arteriosclerosis means thickening and lost
elasticity.
Atherosclerosis means arteriosclerosis plus
irregular inner wall due to fat deposits. So blood
flow is reduced.
Coronary heart disease means coronary
atherosclerosis plus angina or history of acute
MI.
Ischemic Heart Disease is a more general term
(poor oxygen supply to the myocardium).
Atherosclerosis
Risk Factors
Non-Changeable Risk Factors
Heredity – sex – race – age.
May include
− Shortness of breath
− Syncope
− Lightheadedness
− Weakness
− Nausea or vomiting
− Diffuse pain
Treatment
PT baseline
ST-segment deviation
= 4.5 mm
Acute Myocardial Infarction
Acute Myocardial Infarction
Acute Myocardial Infarction
Acute Myocardial Infarction
Summary Of Ischaemic
Changes
P-waves / PR-interval
Do not exist, VENTRICULAR rhythm
QRS complex
Wide, dependent on focus
>0.12 seconds
Ventricular Fibrillation
Shockable
(VF)
Check 2 on monitor:
Leads (change lead)
Gain (increase QRS
size)
Pulseless Electrical Activity (PEA )
(Electromechanical Dissociation)
Non-shockable
(PEA)
During CPR:
Correct reversible causes
Check electrode position and contact
Attempt / verify:
IV access
airway and oxygen
Give uninterrupted compressions
when airway secure
Give adrenaline every 3-5 min
Consider: amiodarone, atropine,
magnesium
Pulseless Electrical Activity (PEA )
(Electromechanical Dissociation)
H’s T’s
Hypovolemia Toxins/tablets
Hypoxia (drug overdose)
Hydrogen ion Tamponade, cardiac
(acidosis) Tension
Hyperkalemia/ pneumothorax
hypokalemia/ Thrombosis, coronary
metabolic disorders Thrombosis,
Hypothermia/ pulmonary
hyperthermia