Electrocardiogram (EKG OR ECG)

1. EKG - Records the electrical changes of the cardiac cycle.

Identifies if the conduction system is working properly.

a. P wave – the sinoatrial node (SA node, neural impulse) initiates

atrial depolarization (which initiates atrial muscle
contraction), the neural impulse spreads throughout the
myocardium of the right and left atria, which then pushes blood
from the atria through the tricuspid and bicuspid (mitral) valves
into the right and left ventricles, respectively & simultaneouly.
 The PR segment reflects the time delay between atrial and
ventricular activation. PR segment abnormalities occur in
two main conditions: Pericarditis and Atrial ischemia.

b. QRS complex – the atrioventricular node (AV node, neural

impulse) initiates ventricular depolarization (ventricular
muscle contraction), the neural impulse spreads throughout
the myocardium of the right and left ventricles via the AV
Bundle, Right and Left Bundle Branches and then the Purkinje
fibers, which then pushes blood from the ventricles through the
pulmonary semilunar valve (to the lungs) and aortic semilunar
valve (to the aorta & then to the rest of the body), respectively&
simultaneouly.

 In addition, the atria are repolarizing (atria muscle

relaxation) at this time, not visible, masked by ventricle
depolarization.

c. T waves – indicates ventricles repolarization (ventricular

muscle relaxation)
  The ST segment represents the interval between
ventricular depolarization and repolarization. ST-segment
elevation myocardial infarction; early repolarization;
pericarditis; and ST elevation secondary to an abnormality
of the QRS complex (left bundle branch block, left
ventricular hypertrophy, or pre-excitation). Other
processes that may be associated with ST elevation
include hyperkalemia, pulmonary embolism.

http://en.wikipedia.org/wiki/Purkinje_fibers

PATHOLOGY – HEART DISEASE

3. Arrhythmia – is an abnormality or irregularity in the heart’s
rhythm resulting from a disturbance in the conduction
system of heart
a. heart block (electrical system disease of the heart)
1. tachycardia (fast heart rate - >100 beats per
minutes)
2. bradycardia (slow heart rate - <60 beats per
minute)
3. asystole (no cardiac activity) - flatliner
http://www.madsci.com/manu/ekg_rhy.htm
4. Cardiovascular disease – includes several types of
cardiac diseases including:

 Stroke (loss of brain function, due to disease of the

blood vessels supplying blood to the brain)
o tPA – Tissue Plasminogen Activator

 Aneurysm (balloon-like bulge of the blood vessel

caused by weakness in the vessel), may burst
 Thrombus (stationary clot formed at the blockage point,
is not carried somewhere else in the body), a thrombus
can be a bubble of air, fat from broken bones, or
potentially a piece of debris can be transported by the
blood

 Embolism (clot migrates from one body part to another

and causes a blockage of a blood vessel in another part
of the body)
 Phlebitis (inflammation of a vein, usually in the legs)
NOT FOR TEST PURPOSES

http://www.scribd.com/doc/2155828/EKG-Examples
http://www.madsci.com/manu/ekg_rhy.htm
http://www.skillstat.com/Flash/ECGSim531.html
http://en.wikipedia.org/wiki/File:ECG_principle_slow.gif
 There are several abnormalities that should be noted.

 Inversion - this change is often found in conditions where

the impulse travels through the atria via an abnormal
pathway, such as ectopic atrial (pacemaker)
 Increased Amplitude usually indicates atrial hypertrophy
and is found especially in A-V valvular disease,
hypertension, and congenital heart disease.
 Increased Pulse Width often indicates left atrial
enlargement or diseased atrial muscle.
 Notching is considered significant when the distance
between peaks is greater than 0.04 seconds.
 Peaking indicates right atrial strain.
 Absence of P waves occurs in A-V nodal rhythms and S-A
Block.