2. 1
Discussion Topics
0 ECG Monitoring Basics a
Standardized Methods & Devices
a Components & Measurements of the
ECG Complex
0 ECG Analysis
3. 2
Objectives
n To learn how to properly set up your ECG leads. a To
Learn What a lead is. a To learn the anatomy of a
normal ECG.
0 To define Normal Sinus Rhythm.
0TO quantify the various components of a normal ECG
4. 3
ECG Monitoring
a Recording of Electrical Activity
a Uses Bipolar or Unipolar leads
The ECG DOES NOT provide a recording
or evaluation of Mechanical Activity!!!
5. 4
0 The five lead ECG is becoming a standard feature
on all new monitors.
0The 12 leads you can monitor are:
I II III
aVR,aVL,aVF and V1,V2,V3.V4,V5 &V6 0 This allows
more precise diagnosis of cardiac events
5
10. This is a 12 lead ECG or simply 12
different views of the heart.
10
11.
12.
13.
14. In Emergency
0 Patients can be monitored with only 2 Leads
attached.
These is done either with the Defibrillator Paddles
or with Defibrillator Patches
15. Note the placement in each case is upper right
and lower left chest which will sandwich the heart
in between the electrodes.
16. Which coincidentally is one of the correct
placements for defibrillation and will also work for
external pacing .
16
17. 13
Remember all that an ECG is looking at is
the electrical activity and electical activity
is not always associated with contraction.
24. Time Sequences on ECG Strips
The strip is read from
left to right in seconds
25. and up and down on
millivolts.
Standardized
Methods & Devices
sECG Paper
24
26. s Device Paper Speed 0
Device Calibration
0 Electrode Placement 0
Variations Do Exist!
27. Rule of 300
Take the number of “big boxes” between
neighboring QRS complexes, and divide this into
300. The result will be approximately equal to the
rate.
Although fast, this method only works for regular
rhythms.
62. D
Downsloping
0 Upsloping 0
Horizontal
JPotbt
Horizontal STUpsloping STDownsloping ST
The J point occurs at the end of the QRS comples.
I he ST segment begins at the J point and extends to a user defined interval
ST Segment Depression
67. First and second days
Transmural infarction
nearly complete. Some
ischemia and injury may
be present at borders
Transmural infarction
complete
Infarcted tissue replaced by
fibrous scar, sometimes bulging
(ventricular aneurysm)
70. After several
First several days weeks or months
Some subendocardial muscle dies, Lesion heals Some subendocardial
but lesion does not extend through fibrosis may occur but does not
entire heart wall involve entire thickness of heart wall
R wave persists T wave
ST segment
but may diminish may or may notinversion and
somewhat return to normalmay occur T wave
CT
72. Anterior infarct
Occlusion of proximal left anterior
descending coronary artery
Significant Q waves and T wave inversions in
leads I, V2) V3 and V4
Anterior Septal (Left
74. Inferior infarct
Occlusion of right
coronary artery
Significant Q waves and T wave inversions in leads II,
III and aVF. With lateral damage, changes also may
be seen in leads V5 and V6
Inferior (Right Coronary
75.
76.
77. Summary
a Basic physiology of the conduction system
0 Origin of a normal EKG 0 Systematic
approach to reading an EKG