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Estremos | Golo | Padilla | Rita
OBJECTIVES
After 5 hours of lecture-discussion, the level 4 nursing students will be able to:
a. Electrocardiogram
b. Electrocardiography
c. ECG complex
d. Rhythm strip
e. Electrodes
f. Lead
g. Plane
h. Depolarization
i. Repolarization
OBJECTIVES
2. discuss the anatomy and physiology of the heart
3. identify the transmission of electrical impulses
4. differentiate the depolarization and repolarization cycle
5. explain the phases of the cardiac cycle
6. name the indications and contraindication of ECG interpretation
7. recognize the types of ECG reading
8. illustrate the component of the ECG complex
9. cite down the guidelines in ECG interpretation
10. enumerate the nursing responsibilities before, during and after the ECG interpretation
Electrocardiogram
(source: hopkinsmedicine.org)
Electrocardiography
- T h e p r o c e s s o f a c q u i r i n g a n E CG
-T h e E CG i s o b t a i n e d b y p l a c i n g d i s p o s a b l e
electrodes in standard positions on the
s k i n o f t h e c h e s t wa l l s a n d e x t r e mi t i e s .
HOLTER TEST
-A small and wearable device that uses
electrodes and a recording device to
track the heart’s rhythm for 24 to 72
hours
STRESS TEST
-To determine the amount of stress that
your heart can take before
$4,999 it develops an
ONWARDS
abnormal rhythm or decreased blood
flow to the heart muscle.
ECG
COMPLEX
(source: ecg.utah.edu)
DEPOLARIZATION
-Process by which cardiac muscle cells
change from a more negatively charged to a
more positively charged intracellular state.
REPOLARIZATION
-Process by which cardiac muscle cells
return to a more negatively charged
intracellular condition
$4,999 ONWARDS
-Indicates myocardial resting state
S
M
IO
TO
LOGY
A N A
-V a l v e s o p e n a n d c l o s e i n r e s p o n s e t o
pressure changes in the heart
=V a l v e s a c t a s o n e w a y d o o r s t o k e e p b l o o d
moving forward
c. Heart Walls consist 3 layers
a. Electrical cells
- make up the conduction system of the
heart
- are distributed in an orderly fashion
through the heart
- possess specific properties:
O
TR
N
OF ELECTRICAL IMPULSES
(Source: Seeley’s anatomy and Physiology textbook)
Inherent firing rate is the rate at which the
SA node or another pacemaker site
normally generates electrical impulses.
i. AV node
Is responsible for delaying the impulses
that reach it.
Th e n o d a l t i s su e i t s e l f h a s n o p a c e m a k e r
c e l l s , t h e t i s s ue s u r r o u nd i n g i t ( c a l le d
t h e j u n c t i o n a l t i s s ue ) c o nt a i n s
pacemaker cells that can fire at an
inherent rate of 40 – 60 beats per
minute.
ii. Bundle of His
N
C
The movement of ions across the The closing of sodium ion channels
cell membrane through sodium, and the opening of potassium ion
potassium and calcium channels, is channels.
the drive that causes contraction of
the cardiac cells/muscle.
DEPOLARIZATION REPOLARIZATION
Ventricular Systole
-At the beginning of the ventricular
systole, contraction of the
ventricles push blood toward the
atria, causing the AV valves to close
as the pressure begins to increase.
As the ventricular systole
continues, the increasing
pressure in the ventricles
exceeds the pressure in the
pulmonary trunk and aorta, the
semilunar valves are forced
open, and blood is ejected into
the pulmonary trunk and aorta.
Ventricular Diastole
-At the beginning of ventricular
diastole, the pressure in the
ventricles decreases below the
pressure in the aorta and pulmonary
trunk The semilunar valves close and
prevent blood from flowing back
into the ventricles
As diastole continues, the pressure
continues to decline in the ventricles
until atrial pressure is greater than
ventricular pressure. Then the AV
valves open, and blood flows directly
from the atria into the relaxed
ventricles. During the previous
ventricular systole, the atria were
relaxed and blood collected in them.
When the ventricles relax and the AV
valves open, blood flows into the
ventricles and they begin to fill again.
C O NTRA
& IN
N S D
O I
C
AT
AT
IC
IO
IND
NS
OF ECG INTERPRETATION
INDICATIONS
To help determine the overall health of the heart before procedures such as
surgery; or after treatment for conditions such as a heart attack (myocardial
infarction, or MI), endocarditis (inflammation or infection of one or more of
the heart valves); or after heart surgery or cardiac catheterization.
INDICATIONS
To get a baseline tracing of the heart's function during a physical exam; this
may be used as a comparison with future ECGs, to determine if there have
been any changes.
CONTRAINDICATIONS
Heart rhythm that’s slower than expected (fewer than 60 beats per minute in
an adult). SA node creates an impulse at a slower-than-normal rate.
Management: 0.5 mg of atropine & catecholamines.
SINUS TACHYCARDIA
CONTRAINDICATIONS
Management: Synchronized
cardioversion vagal maneuvers &
adenosine.
SINUS ARRHYTHMIA
CONTRAINDICATIONS
Management: infrequent, no
treatment is necessary
reduction of caffeine intake,
correction of hypokalemia.
ATRIAL FIBRILLATION
CONTRAINDICATIONS
Management: infrequent, no
treatment is necessary
reduction of caffeine intake,
correction of hypokalemia
JUNCTIONAL RHYTHM
CONTRAINDICATIONS
Management: Amiodarone or
sotalol
VENTRICULAR TACHYCARDIA
Management: antiarrhythmic
medications, antitachycardia
pacing & direct cardioversion
VENTRICULAR FIBRILLATION
Management: Administering IV
epinephrine, vasopressor medications &
initiating emergency transcutaneous
pacing.
VENTRICULAR ASYSTOLE
Management: pacemaker
implantation & IV bolus of atropine
N M E D I CA
M O T IO
M N
O
S
ADMINISTERED DURING A CODE
GENERIC NAME CLASSIFICATION PURPOSE
- Ventricular Dysrhythmia
Lidocaine Antidysrhythmics (Class I) Sodium Channel Blocker
- Ventricular Tachycardia
- Slows the nerve impulses in the heart
Procainamide Antidysrhythmics (Class I)
Reduces sensitivity of heart tissues
- Ventricular Tachycardia
- Slows the nerve impulses in the heart
- Reduces sensitivity of heart tissues
- Paroxysmal supraventricular tachycardia, Wolff-
Adenosine Antidysrhythmics (Class III)
Parkinson White Syndrome
- Slows cardiac conduction through the AV node
- Prolongs repolarization
GENERIC
CLASSIFICATION PURPOSE
NAME
GENERIC
CLASSIFICATION PURPOSE
NAME
GENERIC
CLASSIFICATION PURPOSE
NAME
- Bradycardia
- Increases heart rate
Atropine Anticholinergic
Improves atrioventricular conduction
GENERIC
CLASSIFICATION PURPOSE
NAME
GENERIC
CLASSIFICATION PURPOSE
NAME
L U S T R AT
I L E
QRS complex
-Results from depolarization if the ventricles.
= 0.11 seconds or less in duration.
T wave
-Represents repolarization of the ventricles.
PR interval
-Time it takes for sinus node stimulation, atrial depolarization,
and conduction through the AV node to occur before
ventricular depolarizations happens.
= 0.12-20 seconds in duration.
QT interval
-Total time for ventricular depolarization and repolarization.
ST segment
-Early ventricular repolarization
TP interval
-Isoelectric line
PP interval
-Determines atrial rate and rhythm
RR interval
-Determines ventricular rate and rhythm
Big box
= .20 seconds
Small box
= 0.04 seconds
I D E L INE
G U S
IN ECG INTERPRETATION
GUIDELINES
Determine the ventricular rate
Identify the QRS shape; if not consistent, then identify other shapes.
IT
RS
IE
NU
S
BEFORE, DURING & AFTER ECG
BEFORE
Ensure to empty the bladder. Instruct the patient to void prior and
to change into a gown.
BEFORE
Encourage the patient to cooperate. Advise the patient to remain
still during the test because movement may distort results. He may
also be asked to breathe in or out or to briefly hold his breath
during the exam.
Explain the need to darken the examination field. The room may be
darkened slightly to aid visualization on the monitor screen, and
that other procedure (ECG and phonocardiography) may be
performed simultaneously to time events in the cardiac cycles.
Position the patient on his left side. Explain that the transducer
is angled to observe different areas of the heart and that he
may be repositioned on his left side during the procedure.
AFTER
Remove the conductive gel from the patient’s skin. When the
procedure is completed, remove the gel from the patient’s
chest wall.
Remove the conductive gel from the patient’s skin. When the
procedure is completed, remove the gel from the patient’s
chest wall.
PA
OF AN ECG MACHINE
thank you for listening!