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Topic : Electrocardiogram
Duration :
1. define ECG
2. list out the purpose of taking ECG
3. enlist the indications
4. enumerate the procedure for taking an ECG.
5. learn the basics of ECG.
6. identify the abnormalities in ECG.
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1 1 introduce INTRODUCTION lecture Lcd Teacher
min the topic. teaches
ECG represents the electrical activity of heart and helps the
students
healthcare members to identify heart conduction abnormality, blocks, listen
ischemia/ infarct of the myocardial cells, heart rate, heart rhythm. So
that the patient can be given the exact treatment needed to restore
normal heart function.
2. 1 define
Lectur Teacher What do you
min ECG. teaches
DEFINITION e mean by
students ECG?
The electrocardiogram is a graphic tracing of the electrical impulses listen
Lectur What are the
produced in the heart. e cum purposes?
3. discuss
1 list out the ion
min purpose of PURPOSE
taking
ECG To detect heart rhythm (arrhythmias)
To detect the type of myocardial infarction.
To identify heart conduction abnormalities.
To identify heart structural problems Lectur hand
e cum outs Teacher What are the
To detect the electrolyte imbalance discuss teaches
4. 1 enlist the indications
min ion students for taking
indications listen
INDICATIONS FOR TAKING ECG ECG?
Atypical Chest pain
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Epigastric pain
Palpitation
Left side radiating chest pain
Syncope Lectur
5. e cum Teacher
2 enumerate Pulmonary edema
discuss demo teaches How do we
min the Exertional dyspnea ion students take an ECG?
procedure ask
for taking Diaphoresis associated with chest discomfort. doubts
an ECG.
PROCEDURE FOR TAKING AN ECG
Make the patient lie down in a supine position and shave off the
chest hair in male patients to easily place the leads. There are 6
chest leads and 4 limb leads. 4th ICS is the right of the sternum is
the place for placing chest lead V1, V2 in 4th ICS left of the
sternum, V4 lies in the 5th ICS mid clavicular line left of the
sternum, V3 lies midway between the V2 and V4. V5 lies in the 5th
ICS in the nipple line, and V6 lies in the 5th ICS mid axillary line
left of sternum. The limb leads are connected as white coded lead
on the right arm, black on the left arm, green on the right leg and
red on left leg. Attach the leads well and on the machine. look
ECG tracings on screen for clarity then if clear click print button.
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Write the name, date and time of ECG.
Electrocardiography (ECG, EKG). ECG records the electrical
activity generated by heart muscle depolarizations, which
propagate in pulsating electrical waves towards the skin. Although
the electricity is in fact very small, it can be picked up reliably
with ECG electrodes attached to the skin (data unit: microvolt,
uv). The full ECG setup comprises at least six electrodes which
are placed on the chest or at the four extremities according to
standard nomenclature (RA = right arm; LA = left arm; RL = right
leg; LL = left leg). Of course, variations of this setup exist in
order to allow more flexible and less intrusive recordings, for
example, by attaching the electrodes to the forearms and legs.
ECG electrodes are typically wet sensors, requiring the use of a Lectur
e cum
conductive gel to increase conductivity between skin and discuss Teacher
6. mode teaches
10 learn the electrodes. ion What are the
l students
min basics of ask durations of
s ECG. doubts waves in
ECG?
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ECG WAVES
Normal ECG
A normal ECG is illustrated above. Note that the heart is beating in a
regular sinus rhythm between 60 - 100 beats per minute (specifically
82 bpm).
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BASICS OF ECG
NORMAL WAVES
1. P wave:
First positive deflection indicates atrial depolarisation
P wave upright in leads I,II, III, aVL.
normal duration is less than or equal to 0.11 seconds( 3 small
squares width and height)
p wave depressed in aVR, V1
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shape is generally smooth, not notched or peaked
2. PR interval:
it starts from the beginning of P wave to end of R wave.
Normally between 0.12 and 0.20 seconds (5 small squares).
3. QRS complex:
4. ST segment:
isoelectric, slanting upwards to the T wave in the normal ECG
can be slightly elevated (up to 2.0 mm in some precordial
leads)
never normally depressed greater than 0.5 mm in any lead,
depression indicates MI
5. T wave:
T wave deflection should be in the same direction as the QRS
complex in at least 5 of the 6 limb leads.
Teacher
It is the electrical recovery of ventricles (ventricular teaches
repolarization). students
ask
normally rounded and asymmetrical, with a more gradual doubts
ascent than descent
7. should be upright in leads V2 - V6, inverted in aVR Lectur
10 identify the e cum
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min abnormaliti amplitude of at least 0.2 mV in leads V3 and V4 and at least discuss
es in ECG. ion LCD
0.1 mV in leads V5 and V6 Interpret
T wave inversion indicates ischemia / previous myocardial these ECG
tracings?
infarction.
6. QT interval:
Durations normally less than or equal to 0.40 seconds for
males and 0.44 seconds for females.
It is measured from beginning of QRS interval to end of T
wave.
7. Q wave:
First negative deflection. Not clearly seen in normal ECG.
If the Q wave is 1/3rd of R wave it indicate old MI.
If Q wave is more than 1/3rdof R wave it indicates
pathological Q (necrosis).
8. U wave
Not seen in normal ECG, seen in hypokalemia.
It is due to the repolarization of purkinje fibres.
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ECG ABNORMALITIES
IWMI- ST↑ in lead II, III, aVF and ST ↓ in lead I, aVL, V1,
V2
AWMI- ST ↑ in lead I, Avl, V1 –V6 and ST ↓ in lead II, III,
aVF.
LWMI- ST↑ in lead I aVL or V5 , V6 and ST ↓ in II, III aVF.
PWMI- ST ↑ in lead V7 –V9 and ST ↓ in V1, V2.
RVMI- ST ↑ in lead V3R- V4R.
AV BLOCK
SINUS BRADYCARDIA
The patient heart rate will be less than 60 bts/min, regular PR
interval. Impulse originates at the SA node at a slow. Inj. Atropine is
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given if HR goes below 50
ATRIAL FIBRILLATION
Atrial fibrillation is the most common type of irregular heartbeat.
Atrial fibrillation causes the heart to work inefficiently so it can
reduce the person’s ability to exercise and may lead to heart failure.
Atrial fibrillation makes the blood flow inside the heart somewhat
irregular, which can cause blood clots to form there. Rate increases
and irregular R-R interval with unclear P waves. Cordarone is the
drug of choice.
ATRIAL FLUTTER
Regular rhythm is present with atrial rhythm 2-1/ 3-1 and has no
true P waves.ECG waves appear like a saw tooth pattern flutter
waves.
TORSADES DE POINTES
It starts a spindle shaped negative deflection and increasing QRS
amplitude then again end of spindles and start of node this pattern
continues. We cannot determine atrial; ventricular rate of 150-250
complexes/ min, irregular ventricular rhythm, non existent P and PR
waves, QRS displays spindle node.
ELECTROLYTE CHANGES IN ECG
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Hyperkalemia: QT interval shortened, T wave tall and peaked, ST
segment elevated.
Hypokalemia: QT interval wide T wave flattens, U wave increased,
PR interval prolonged.
ASYSTOLE
Asystole indicates heart has stopped and ECG shows a straight line.
Immediately CPR should be initiated to revert back the pa
SUMMARY
So far we learned about the definition of ECG, its purpose is to identify heart rhythm and rate, indications like atypical chest pain, epigastric
pain, Palpitation, left side radiating chest pain, diaphoresis with chest discomfort, procedure of taking ECG like placement of chest and limb leads,
abnormalities in ecg like myocardial infarction, AV block, ventricular tachycardia, bradycardia, asystole, axillary idioventricular rhythm, bundle
branch block, atrial fibrillation, flutter, torsades pointes, electrolyte imbalances, etc.
CONCLUSION
So from this class we learn that electrocardiogram is a graphic tracing of the electrical impulses produced in the heart and helps us to
identify the abnormal heart rhythms and conduction abnormalities. It is one of the easiest, non invasive technique widely used all over the world.
Based on ECG medical treatments, shocks or other mode of treatment can be initiated. It is a very important part of care in critical areas of hospital.
BIBLIOGRAPHY
sr Nancy, ‘a reference manual for nurses on coronary care nursing’, published by kumar publishing house, delhi.
Pg no: 97-100
Lewis ‘textbook of medical surgical Nursing’, second south Asian edition, published by elseviers Pg No: -1610-1620
Joye.M. Black. Textbook of medical surgical Nursing’, 8th edition, 2010, published by elseviers pvt, Ltd, New Delhi, page No: 1571 – 1580