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ELECTROCARDIOGRAPHY
OBJECTIVES
• Review the anatomy and physiology of
the electrical conduction of the heart
• Interpret the term elecrocardiography
• Describe the types of ecg monitoring
• Interprets the basics of ecg
• Determine the heart rate from ecg
• Explain the cardiac rhythm determinatation
• Understand the 12 lead ecg
• Differentiate the electrode placement
• Distinguish abnormal ecg from normal ecg
CONDUCTING SYSTEM OF HEART
ELECTROCARDIOGRAM
ECG is a graphic representation of the
electrical currents of the heart
TYPES OF ECG MONITORING
• Continuous electrocardiographic monitoring
• Hardwire cardiac monitoring
• Telemetry
• Ambulatory elecrocardiography
• Transtelephonic monitoring
• Wireless mobile cardiac monitoring systems
BASIC ELECTROCARDIOGRAPHY
P WAVE
• First wave seen
• Small rounded,
upright
(positive) wave
indicating atrial
depolarization
(and
contraction)
• < 0.12 sec
QRS COMPLEX
• Three deflections following P wave
• Indicates ventricular depolarization
(andcontraction)
• Q Wave: First negative deflection
• R Wave: First positive deflection
• S Wave: First negative deflection after R wave
• < 0.10 sec
PR INTERVAL
• Distance between beginning of P wave and
beginning of QRS complex
• Measures time during which a depolarization
wave travels from the atria to the ventricles
• 0.12 – 0.20 sec
ST SEGMENT
• Distance between S wave and beginning of
T wave
• Measures time between ventricular
depolarization and beginning of repolarization
T WAVE
• Rounded upright (positive) wave following
QRS
• Represents ventricular repolarization
U WAVE
• Small rounded, upright wave following
T wave
• Most easily seen with a slow HR.
• Represents repolarization of Purkinje fibers
QT INTERVAL
• Measured from beginning of QRS to end of
T wave.
• Represents total ventricular activity
RATE DETERMINATION
LARGE BOX METHOD
• Regular rhythms can be quickly determined by
counting the number of large graph boxes
between two R waves. That number is divided
INTO 300 to calculate bpm..
SMALL BOX METHOD
• Sometimes it is necessary to count the
number of small boxes between two R waves
for fast heart rates. That number isdivided into
1500 to calculate bpm.
6 SEC STRIP
• The best method for measuring irregular rates
with varying R-R intervals is to count the
number of R waves in a 6-sec strip and
multiply by 10.This gives the average number
of bpm.
CARDIAC RHYTHM DETERMINATION
• REGULARITY
Measure R-R intervals and P-P intervals.
Regular: Intervals consistent
Regularly irregular: Repeating pattern
Irregular: No pattern
• RATE
The bpm is commonly the ventricular rate.
If atrial and ventricular rates differ, as in a 3rd
degree block, measure both rates.
Normal: 60–100 bpm
Slow (bradycardia): 60 bpm
Fast (tachycardia): 100 bpm
P WAVES
• If present: Same in size, shape, position?
• Does each QRS have a P wave?
• Normal: Upright (positive) and uniform
• Inverted: Negative
• Notched: P'
• None: Rhythm is junctional or ventricular
• P R INTERVAL
• Constant: Intervals are the same.
• Variable: Intervals differ.
• Normal: 0.12–0.20 sec and constant
• QRS COMPLEX
• Normal: 0.06–0.10 sec
• Wide: 0.10 sec
• None: Absent
LEADS OF ECG
LEAD PLACEMENT
NORMAL SINUS RHYTHM
SINUS BRADYCARDIA
SINUS TACHYCARDIA
PREMATURE ATRIAL COMPLEX
ATRIAL FLUTTER
ATRIAL FIBRILLATION
PREMATURE VENTRICULAR COMPLEX
VENTRICULAR TACHYCARDIA
• MONOMORHIC
• POLYMORHIC
VENTRICULAR FIBRILLATION
VENTRICULAR ASYSTOLE
FIRST DEGREE AV BLOCK
SECOND DEGREE A.V BLOCK
• TYPE 1
• TYPE 2
THIRD DEGREE A.V BLOCK
BUNDLE BRANCH BLOCK
ISCHEMIA ,INJURY,INFARCTION
ENLARGEMENTS
• LEFT ATRIAL
LEFT VENTRICULAR
RIGHT VENTRICULAR
ELECTROLYTE IMBALANCES
JOURNAL
TIME
ANSWERS
• RATE:214 bpm
• RHYTHM: regular
• P WAVE: none
• PR INTERVAL: none
• QRS COMPLEX: >0.12 bizarre
• INTERPRETATION: VT- MONOMORHIC
• RATE: 75 bpm
• RHYTHM: regular
• P WAVE: normal
• PR INTERVAL:0.16
• QRS COMPLEX:0.08
• INTERPRETATION: NORMAL SINUS RHYTHM
• RATE:50 -75 bpm
• RHYTHM: irregular
• P WAVE: normal
• PR INTERVAL:0.12- 0.28
• QRS COMPLEX:0.08
• INTERPRETATION:2nd DEGREE A.V BLOCK
TYPE 1
• RATE: 35 BPM
• RHYTHM: regular
• P WAVE: normal
• PR INTERVAL: 0.16
• QRS COMPLEX:0.10
• INTERPRETATION: SINUS BRADYCARDIA
REFERENCES
• Crawford M H, DiMarco J P, Paulus W J.
Cardiology.3rd ed.Philadelphia:Elsevier
publication;2010.
• Fauci A S, Braunwald E, Kasper D L, Hauser S L,
Longo D L, Jameson J L.Harrison’s Principles of
Internal Medicine.17th ed (vol I).USA:McGraw
Hill;2008.
• Michael H.C, Paulus W.J. Cardiology .3rd
edn.Philadelphia:Elsevier;2010
• Black M.J,Hawks H.K.Medical Surgical
Nursing.7th edn.Missouri:Saunders;2005
• Johnson J.Y.Brunner and Suddharth`s :
Textbook of Medical Surgical Nursing.11th
edn.Philadelphia:Lippincott;2008
electrocardiography

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electrocardiography