EKG Review

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EKG Review
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Function of Heart

• With any functioning unit you need
• Electricity and Plumbing
• ELECTRICITY electrical current that stimulates
  the heart and tells it to beat or contract
• PLUMBING When the heart contracts it provides
  blood and oxygenation to vessels, tissue and
  organs
• Keep in mind how electricity and plumbing
  affect each other!!!

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Electricity

• SA AV Bundle of HIS BB PF
• SA 60-80bpm
• AV 40-60bpm
• BH-BB 20-40bpm
• ACCIDENTS ON A HIGHWAY- will be detoured around
  the blockage.
• increased distance to travel increased time to
  get to location

Electrical current needs healthy tissue to
conduct- dead tissue will not allow signal to
pass through
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Plumbing

• Beats contractions
• Each beat requires atrial and ventricular
  contraction
• Heart is like a sponge. It absorbs and squeezes
  out blood with each contraction. If it is not
  rung out fully with each squeeze- it cannot
  absorb its full potential. (preload, afterload)
• Ventricular contraction- pushes blood into
  arteries to be sent to body, tissues, organs and
  lungs
• Tissue needs oxygen and blood to survive. Without
  this, it cannot function

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Basic principals of EKG

• Rate? FAST, SLOW, NORMAL
• Complex? P in front of every QRS
• P- atrial contraction
• QRS- ventricular contraction

qrs
p
T
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What is my rate

• Each Full complex is one beat
• Most strips are 6 seconds long

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2
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( of complexes in 6 sec strip) X (10) Heart
Rate (5 complexes) X (10) 50 beats per minute
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ARRYTHMIAS

• Normal 60-100 bpm
• Slow lt 60 bpm
• Sinus Bradycardia, Junctional
• Fast gt100 bpm
• Sinus Tachycardia, Supraventricular Tachycardia,
  VTach.
• -CARDIA heart beat including contraction
  relaxation

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Sinus Rhythm

• Sinus rhythm is normal electricity and normal
  plumbing.
• Electrical signal fires from Sinus node.
• Rate is either slow, fast or normal.
• P wave is present in front of every QRS

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SLOW ARRYHMIAS

• Sinus Bradycardia
• SLOW sinus rhythm
• Junctional Rhythm
• P wave is inverted or absent

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FAST ARRYTHMIAS

• Sinus Tachycardia
• Fast sinus rhythm
• Supraventricular Tachycardia
• Supra-superior above the ventricular
• Rate is greater than 160 bpm, QRS is narrow.

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Ventricular rhythms

• Ventricular Tachycardia
• Tachycardia- firing from the ventricle
• WIDE QRS, no P
• Ventricular Fibrillation
• Fibrillation or quivering of the ventricles- no
  contraction/relaxation. No organized rhythm

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Atrial Arrhythmias

• Atrial Fibrillation
• Underlying rhythm is sinus, with fibrillation
  between complexes/beats
• Atrial Flutter
• Look at sawtooth pattern between waves

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Asystole

• No movement of heart muscle

Just remember Dead meat dont beat
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EKG GRIDS
Time (secs)
V O L T A G E
5 Large blocks 1 sec. on strip
SMALL blocks 0.04 sec LARGE blocks 0.20 sec
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BLOCKS

• Underlying rhythm is sinus, (must have P-QRS)
• Normal P-R interval is .12-.20 sec (one big
  block)
• 1st degree prolonged P-R interval (gt.20)
• 2nd degree I (WB) P-R gets longer, then drops
  beat
• 2nd degree II more Ps than QRS (kids w/o
  parents)
• 3rd degree total disassociation, no
  communication

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Premature Complexes

• PAC- premature Atrial complex
• P wave upright in front of QRS
• PJC- premature Junctional complex
• P wave is inverted or absent
• PVC- premature Ventricular complex
• Wide and bizarre, No P wave

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Other things to look at.

• S-T segment
• Depression- Ischemia or injury
• Elevation- infarct or death of tissue

Classified as significant if gt 1 mm
STEMI- is key point in ACS algorithm
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Pacemaker spikes

• If Pacemaker is pacing the heart you will see a
  spike. To determine what is being paced, Look at
  location of spike

Before P pacing ATRIA
Both- pacing both
Before QRS Pacing VENTRICLE