ECG REVIEW

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ECG REVIEW

• RECOGNIZING
• BASIC CRITICAL VALUES
• ON THE 12-LEAD ECG

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THE HEART

• 4 CHAMBERS
• 4 VALVES
• SEPTUM

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CONDUCTION SYSTEM

• SA NODE
• AV NODE
• Bundle of HIS Purkinje system

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CARDIAC CYCLEand how it relates to the Heart
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CARDIAC CYCLE AND ITS MEASUREMENT
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GRAPH PAPER
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Lay out of the 12-Lead ECG
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THE 12-LEAD ECG

• Is the ECG hooked up correctly?
• Is the ECG free of artifact?
• Is this ECG a Critical Value that needs immediate
  attention?

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IS the ECG HOOKED UP CORRECTLY?

• LIMB LEADS
• Normal 12-lead
• AVR alway negative
• Lead I alway positive

• CHEST LEADS
• COLUMN III
• R wave progression
• Small to Tall
• COLUMN IV
• R wave progression
• Tall to Small

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BASIC WAY TO ANALYSISRHYTHM STRIP

• LOOK TO SEE IF THE RHYTHM STRIP IS REGULAR OR
  IRREGULAR
• IS THERE A P WAVE FOR EVERY QRS COMPLEX
• ARE THERE ANY ABNORMAL BEATS
• WHAT IS THE HEART RATE.

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RHYTHM STRIP

• Is the Rhythm strip regular?
• How many large boxes between two R-R
  intervals?
• If not Regular
• Find the longest R-R interval and also the
  shortest R-R interval for the heart rate.

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LETS REVIEW

• First two things to look at on the 12-lead ECG.
• Is it hooked up correctly?
• Is it free of artefact?

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LETS REVIEW

• FIRST TWO THINGS
• TO LOOK AT ON THE 12-LEAD ECG
• Is it hooked up correctly?
• 2. Is it free of artefact?

• ANALYSIS RHYTHM STRIP NEXT.
• 1. Is the Rhythm strip regular or irregular
• What is the Heart Rate
• 3. Are there any abnormal beats?

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LOOKING FOR THE MI

• INJURGY
• ISCHEMIA
• INFARCTION

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ISCHEMIA

• ECG changes characteristic of Ischemia
• - Are temporary changes in the ST segment and T
  wave.

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INFARCTION

• Is the actual death of the myocardial cells.
• ECG changes characteristic of infarction
• Pathologic Q waves
• (.04sec duration and 25 of the amplitude of the
  R wave in that lead)

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INJURY

• ECG characteristic of Injury are
• ST elevation of more than 1mm above the baseline.
• Needs to be in two or more leads facing the
  anatomic area of the heart.

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PULLING IT TOGEATHER

• Look to see if the ECG is hooked up correctly and
  free of artefact.
• Look to see if the rhythm is regular or
  irregular. What is the Heart Rate?
• Are there any abnormal beats in the Rhythm strip?
• 4. Is there any ST elevation in the 12-lead ECG?

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