ECG INTERPRETATION (IR) LECTURER: RYAN ALEXANDER LIM,

USRN
POWER DEVELOPMENT REVIEW CENTER NOTES BY: GROUP 5

AV NODE
NORMAL ECG
- Traveling of impulse
- Gateway to the ventricles
P WAVE
- Represents: Atrial depolarization or BUNDLE OF HIS
contraction - Pathway to the ventricles (muscles)
- Conduction site: SA node
- Duration: < 0.11 seconds (< 3 small boxes) PURKINJE FIBERS
- Site: Ventricular muscles
PR INTERVAL - Electrical contraction: Depolarization (QRS)
- Measurement: Beginning of P wave to the
beginning of QRS
- Conduction sites: SA to AV node to Bundle STEPS IN INTERPRETING
of His
- Duration: 0.12-0.20 seconds (3-5 boxes) 1. Rhythm
- Measure R wave to R wave
QRS COMPLEX - Determine: Regular or irregular
- Represents: Ventricular depolarization or 2. Rate
contraction - Determine: Normal (60-100),
- Conduction site: Purkinje Fibers tachycardic (>100), or bradycardic
- Duration: <0.10 or <0.12 seconds (<60)
- Method: Count the number of R waves
ST SEGMENT in 6 second trip and multiply by 10
- Early repolarization or relaxation - Normal: 6-10 R waves (multiplied by
- Measurement: End of the QRS to the 10)
beginning of T wave - Types:
● Sinus Bradycardia
T WAVE - Rate:<60
- Represents: Ventricular repolarization or - DOC: Atropine sulfate 0.5-
relaxation 1 mg (increases the HR)
- Resting mode ● Sinus Tachycardia
- Rate: >100 bpm
QT INTERVAL - DOC: Beta Blockers to
- Whole cycle of contraction and relaxation decrease the HR
- Measurement: Beginning of QRS to end of - Calcium Channel Blockers
T Wave (Verapamil, Diltiazem) to
decrease HR
3. P Wave
CONDUCTION SYSTEM
- Identify the P wave
- Ask
SA NODE ● Is there a P wave before each
- Impulse originated: Pacemaker (Generator) QRS complex?
- Site: Junction of the superior vena cava and ● Are the P waves similar in size,
the right atrium shape, and position?
- Rate: 60-100 bpm
ECG INTERPRETATION (IR)
USRN
POWER DEVELOPMENT REVIEW CENTER
●Are the P waves normal in
appearance?
4. PR Interval
- Normal: 0.12-0.20 seconds (duration)
- Beyond 0.20 seconds is heart block
- Ask:
● Is the PRI consistently the same
length?
● Is the PRI normal?
5. QRS Complex
- Normal QRS Duration: < 0.10-0.12
seconds
- If more than 0.12 seconds: Ventricular
problem
DYSRHYTHMIAS
PREMATURE ATRIAL CONTRACTION
- Problem: P wave; early, not consecutive
- Management:
● It does not require treatment
● Needs rest and to avoid caffeine
(stimulate tachycardia)
ATRIAL TACHYCARDIA
AV BLOCK
- Causes:
● Fibrosis: Scarring
- Ischemia (decreased O2 →
heart muscles)
- Infarction → cell death (+)
necrosis
- Impaired conduction (blocked)
● Partial: 1st and 2nd degree
AV block
● Complete: 3rd degree AV
block
- Impulses cannot reach ventricles
1ST DEGREE AV BLOCK
- Impulse: Slow or delayed but still makes it
LECTURER: RYAN ALEXANDER LIM,
NOTES BY: GROUP 5
- PR interval: Prolonged (> 0.20 seconds)
- S/S: None
2ND DEGREE AV BLOCK
● Type 1 (Mobitz or Wenckebach)
- PR interval: Prolonged (> 0.20
seconds)
- Progressively longer
- S/S: Syncope, dizziness, ↓ LOC
● Type 2 (Mobitz 2)
- PR interval: Prolonged (> 0.20
seconds)
- Intermittent (on and off)
- Duration of PRI: Constant
3RD DEGREE AV BLOCK
- Impulse or signal: Completely blocked
- HR: < 40-60 bpm
- S/S: Same with 2nd degree + dyspnea,
chest pain
NURSING MANAGEMENT
● Identify underlying cause
● Treatment
- Atropine (0.5-1 mg)
- Transcutaneous Pacing
● Through electrodes on the skin
● For emergency
- Permanent pacing
● Device implanted → Pacemaker
PACEMAKER
- Indicated:
● AV Block (Heart Block)
● Bradycardia
- Minor surgery
- Action:
● Control abnormal heart rhythm
● Uses electrical impulses
- Parts:
● Battery (5-10 or 5-15 years)
● Computerized generators
ECG INTERPRETATION (IR) LECTURER: RYAN ALEXANDER LIM,
USRN
POWER DEVELOPMENT REVIEW CENTER NOTES BY: GROUP 5

● Wires with sensors

HEALTH TEACHINGS
● Avoid vigorous exercise
- Lifting > 3 lbs weekly
● Report malfunction S/S
- Irregular pulse: Check pulse daily
- ↓ CO (dyspnea, ↓ UO, edema)
- Hiccups
● Avoid close contact with strong magnetic
field devices
- MRI
- Metal detectors
● Medic Alert bracelet