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ECG Analysis, Interpretation and Computation

Objectives: After 1 hour of varied learning activities the level III students will be able to: 1. define the following terms: 1.1 electrocardiograph 1.2 Electrocardiogram 1.3 Electrophysiology 1.4 electrodes 1.5 lead 1.6 SA node 1.7 excitability 1.8 automaticity 1.9 depolarization 1.10 bradycardia 1.11 tachycardia 1.12 rhythm 1.13 arrhythmia/ dysrhythmia 1.14 cardiac arres 2. state the importance of ECG analysis, interpretation and computation 3. give the following: 3.1 indications 3.2 types of ECG 4. review the following: 4.1 basic concepts of electrophysiology 4.1.1 membrane potential 4.1.2 resting membrane potential 4.1.3 action potential 4.2 electrical conduction of the heart 4.3 electrode (P) movement 4.3.1 precordial electrodes 4.3.2 limb electrodes 5. identify the different waves and complexes in relation to the events that occur during electrical conductions of the heart 6. discuss the nursing responsibilities before, during and after electrode placement 7. apply beginning skills in ECG analysis, interpretation and computation 7.1 compute for the atrial and ventricular rate using the 7.1.1 cycle method 7.1.2 bos method 7.1.3 triplicate method 7.2 compute the duration of the following: 7.2.1 PR interval 7.2.2 QRS complex 7.2.3 ST segment 7.2.4 QT interval 7.3 interpret the following: 7.3.1 normal heart rhythm 7.3.2 common abnormal heart rhythm 7.3.2.1 sinus tachycardia 7.3.2.2 sinus bradycardia 7.3.2.3 atrial tachycardia 7.3.2.4 ventricular bradycardia 7.3.2.5 ventricular tachycardia 7.3.2.6 atrial flutter 7.3.2.7 ventricular flutter

7.3.2.8 7.3.2.9 7.3.2.10 7.3.2.11 7.3.3 7.3.3.1 7.3.3.2 7.3.3.3

ventricular fibrillation premature atrial contraction (PAC) premature ventricular contraction (PVC) heart blocks other abnormalities: electrolyte imbalance angina myocardial infarction

definition of terms: 1.1 electrocardiograph - a device used for recording the electrical activity of the myocardium to detect transmission of the cardiac impulse through the conductive tissues of the muscle. 1.2 electrocardiogram records the hearts electrical activity as waveforms 1.3 electrophysiology - is the study of the electrical properties of biological cells and tissues. 1.4 electrodes small pieces of metals attached to the skin to detect electric currents moving through the heart 1.5 lead provides a view of the hearts electrical activity between two points or poles 1.6 SA node is the hearts main pacemaker 1.7 excitability ability of a cardiac cell to respond to an electrical impulse 1.8 automaticity ability of a cardiac cell to initiate an impulse on its own 1.9 depolarization occurs when a wave of stimulation passes through the heart and causes the heart muscle to contract 1.10 bradycardia - heart rate is slower than 60 beats per minute, slow heart rate 1.11 tachycardia a heart rate of more than 100 beats per minute 1.12 rhythm - a measured movement; the recurrence of an action or function at regular intervals 1.13 arrhythmia disturbance of the normal cardiac rhythm from the abnormal origin, discharge, or conduction of electrical impulses 1.14 cardiac arrest - is a condition in which the heart suddenly and unexpectedly stops beating

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Importance aids in diagnosing and monitoring conditions such as myocardial infarction and pericarditis identifies rhythm disturbances, conduction abnormalities and electrolyte imbalances to check the condition of the heart

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3.1 Indications patients with inflammation disease of the heart patients with myocardial infarction, cardiac enlargement and cardiac dysrhythmias

3.2 Types of ECG 3.2.1 12 Lead ECG - records information from 12 different views of the heart and provides a complete picture of electrical activity - the six limb leads I, II, III, augmented vector right (avr), augmented vector left (avl), augmented vector foot (avf) provides information about the hearts frontal plane - the six precordial leads v1,v2, v3, v4, v5, v6 provides information about the hearts horizontal plane 3.2.2 Rhythm strip - provides continuous information about the hearts electrical activity from one or more leads simultaneously - hearts electrical activity can be displayed on a monitor - the monitor can display other measurements and can print out strips of cardiac rhythms 3.2.3 Holter monitor - is a portable device for continuously monitoring various electrical activity of the cardiovascular system for at least 24 hours

3.2.4 Stress test - also called a stress test, exercise electrocardiogram, treadmill test, graded exercise test, or stress ECG - is a test used to provide information about how the heart responds to exertion. - It usually involves walking on a treadmill or pedaling a stationary bike at increasing levels of difficulty, while your electrocardiogram, heart rate, and blood pressure are monitored.

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Review the 4.1 basic concepts of electrophysiology 4.1.1 membrane potential - is the difference in electrical potential between the interior and the exterior of a biological cell. 4.1.2 resting membrane potential - negatively charged ions flow into the cell, creating an electrical difference across the membrane 4.1.3 action potential - when the cell is stimulated by an electrical impulse 4.2 electrical conduction of the heart After depolarization and repolarization, the electrical impulse travels through the heart beginning with the Sinoatrial Node Bachmanns Bundle Atrioventricular node Bundle of His right bundle branch Left Bundle Branch Purkinje fibers 4.3 electrode (P) movement 4.3.1 precordial electrodes - six leads are placed across the chest to view the hearts horizontal plane

Lead v1 - placed on the right side of sternum at fourth intercostals space Shows the P wave, QRS complex and ST segment

Lead v2 placed to the left of the sternum at the 4th intercostals space Lead v3 goes between v2 and v4 at the fifth intercostals space Lead v4 placed at the 5th intercostal space at the midclavicular line produces a positive deflection

lead v5 placed between leads v4 and v6 anterior to the axiliary line lead v6 placed level with lead v4 at the midaxillary line 4.3.2 limb electrodes

lead I provides a view of the heart that shows moving from right to left produces a positive deflection on ECG

lead II produces a positive deflection, placed on patients left leg and negative electrode on the right arm, results in tall P, R, T waves. Lead III produces a positive deflection, placed on left leg and negative electrode on left arm

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identify different waves and complexes in relation to events that occur during electrical conductions of the heart

5.1 P wave is the first component of a normal ECG waveform, it represents conduction of an electrical impulse through the atria

Location: precedes the ORS complex Duration: 0.06 to 0.12 sec 5.2 PR interval tracks the atrial impulse from the atria through the atrioventricular node, bundle of His, and bundle branches

Location: from the beginning of the P wave to the beginning of the ORS complex Duration: 0.12 to 0.20 sec 5.3 QRS complex follows the P wave and represents impulse conduction through the ventricles, represents intraventricular conduction time

Duration: 0.06 to 0.10 sec Configuration: consists of Q wave, R wave and S wave 5.4 ST segment represents the end of ventricular conduction or depolarization and beginning of ventricular recovery or repolarization

Location: extends from the S wave to the beginning of the T wave 5.5 T wave the peak represents the relative refractory period of repolarization

Location: follows the ST segment Configuration typically rounded and smooth 5.6 U wave represents repolarization of the His Purkinje system

Location: follows the T wave Configuration: typically upright and rounded

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Nursing Responsibilities Before

prepare all materials needed explain the procedure to the patient have the patient lie in a supine position in the center of the bed with his arms at his sides expose his arms and legs, and drape him appropriately select flat, fleshy areas to place the electrodes During

connect the limb wires to the electrodes white or RA right arm green or RL right leg brown or v1 to v6 lead wires chest red or LL left leg black or LA left arm

expose the patients chest apply conductive gel place electrode at each electrode position instruct patient to lie still and to not talk press the auto button observe tracing quality After

remove the electrodes clean the patients skin after disconnecting, the lead wires from the electrodes, dispose the electrodes

apply beginning skills in ECG analysis, interpretation and computation 7.1 compute the duration of the following: 7.1.1 PR interval Is measured from the beginning of the P wave to the beginning of the QRS complex. It is usually 120 to 200 ms long. On the usual 25 mm/s ECG tracing, this corresponds to 3 to 5 small boxes. 7.1.2 QRS complex Is measured from the beginning of the Q wave to the end of the S wave it normally lasts 0.06 - 0.10 s 7.1.3 ST segement is measured from the end of the S wave to the beginning of the T wave has a duration of 0.08 to 0.12 sec (80 to 120 ms) 7.1.4 QT interval is measured from the start of the Q wave and the end of the T wave the start of the Q wave and the end of the T wave Lasts from 0.36 to 0.44 sec 7.2 interpret the following: 7.2.1 normal heart rhythm normal conduction of impulse 7.2.2 common abnormal heart rhythm 7.2.2.1 sinus tachycardia acceleration of the firing of the SA node beyond its normal discharge, sinus rate more than 100 beats/min. 7.2.2.2 sinus bradycardia sinus rate less than 60 beats/min and a regular rhythm

7.2.2.3 atrial tachycardia- the impulses driving the rapid rhythm originate above the ventricles, has an atrial heart rate of 150 to 250 beats/min 7.2.2.4 ventricular bradycardia - slowness of ventricular rate, usually implying the presence of atrioventricular block 7.2.2.5 ventricular tachycardia occurs when three or more PVCs strike in a row and the ventricular rate exceeds 100 beats/ mi, may precede VF and sudden cardiac death 7.2.2.6 atrial flutter a rapid atrial rate of 250 to 350 beats/min 7.2.2.7 ventricular flutter - a tachycardia affecting the ventricles with a rate over 200 beats/min

7.2.2.8 ventricular fibrillation a chaotic disorganized pattern of electrical activity, arises from electrical impulses coming from multiple ectopic pacemakers in the ventricles, noeffective mechanical activity, no cardiac output 7.2.2.9 premature atrial contraction they arise from a single ectopic focus of from multiple atrial foci that supersede the SA node as pacemaker for one or more beats 7.2.2.10 premature ventricular contraction are ectopic beats that originate in the ventricles and occur earlier than expected 7.2.2.11 heart blocks an interruption or delay in the conduction of electrical impulses between the atria and the ventricles