ELECTROCARDIOGRAM

by: Aldrin Jayson Almaden

IN THIS LESSON:
Learn the basics about
electrocardiogram

Know the concept of PQRST

Interpret different waveforms

when EKG is being used

Describe abnormalities in ECG

interpretation
Electrocardiogram
Reflects the electrical activity of
cardiac cells and records electrical
activity at a speed of 25 mm/ second

Each event has a distinctive waveform,

the study of waveform can lead to
greater insight into patient’s cardiac
pathophysiology
 ECGs can identify....
ARRYTHMIAS MI AND PERICARDITIS ELECTROLYTE
ISCHEMIA IMBALANCES

Swelling of Hyperkalemia,
pericardium hypokalemia
Electrical Conduction of the Heart

Mnemonic

Send SA Node

A AV Node

Big Bundle of HIS

Bounding Bundle Branches

Pulse Purkinje Fibers

 EKG Waveforms

Signs and Symptoms

Atrial contraction (squeeze)
DE-polarization
DE-compressing

PQRST Ventricle contraction (squeeze)

DE-polarization
DE-compressing

complex
Ventricles
RE-laxing
RE-polarizing
RE-filling with blood
EKG Waveforms
PR interval
Movement of electrical activity from
atria to ventricles

ST segment
Time between ventricular
depolarization and
repolarization

QT interval
Time between ventricular
depolarization and
repolarization
5-lead placement
Using five leads gives the option of
getting a chest lead in addition to
bipolar limb leads, enhancing
detection of ischemia during
procedures

Remember:

WHITE ON RIGHT - RA
SMOKE OVER... - LA
FIRE - LL
GREEN GOES LAST - RL
CHOCOLATE IN MY HEART - V1
12-lead placement The 12 Lead Electrocardiogram
(EKG) checks the health of your
heart by seeing if you have
irregular and/or dangerous heart
beats.

The test is painless, has no risks

and is often routine before
surgery
You’ll be asked to loosen or
remove your clothes from the
waist up
Please tell the technician if
you’re wearing any cream,
lotion or powder. This must be
removed to get a good reading
INTERPRETING EKGs

FIRST STEP: P-WAVE

Identify & examine the P-waves
Should be present & upright
Comes before QRS complex
One P-wave for every QRS
compelex
INTERPRETING EKGs

SECOND STEP : PR INTERVAL

Measure PR interval

Normal PR interval:
0.12 - 0.2 seconds
INTERPRETING EKGs

THIRD STEP : QRS WAVE

Is every P wave followed by
a QRS complex?
Should not be widened
or shortened (this may
indicate problems)
Normal QRS complex:
Widen is often seen in PVCs, 0.06 - 0.12 seconds
electrolyte imbalances & drug toxicity
INTERPRETING EKGs

FOURTH STEP : R-R

Are the r to R intervals

consistent?
Regular or irregular
INTERPRETING EKGs
FIFTH STEP : DETERMINE THE HEART RATE

6 SECOND-METHOD BIG BOX METHOD

6 SECOND-METHOD

Count the number

of R’s in between
the 6 second strips
& multiply by 10
BIG BOX METHOD 300 divided by the
number of big boxes
between 2 R’s
INTERPRETING EKGs

FINAL STEP :IDENTIFY THE EKG FINDING!

NORMAL SINUS RHYTHM

Rate: 60 - 100 bpm

Rhythm: Regular
P-wave: Upright & uniform before QRS
PR interval: Normal
QRS complex: Normal
SINUS BRADY

The sinus node creates an impulse at a

slower-than-normal rate

Rate: < 60 bpm

Causes: Treatment:
Rhythm: Regular
Lower metabolic needs
Sleep, athletic training, Correct the underlying cause!
P-wave: Upright & uniform before QRS hypothroidism
PR interval: Normal Vagal stimulation
Medications
Increase the heart rate to normal

QRS complex: Normal Calcium channel blockers, beta

blockers, Amiodarone
SINUS TACHY

The sinus node creates an impulse at a

faster-than-normal rate

Rate: > 100 bpm

Causes: Treatment:
Rhythm: Regular Physiologic or psychological stress
Identify the underlying cause!
Blood loss, fever, exercise,
P-wave: Upright & uniform before QRS dehydration
PR interval: Normal Heart failure Decrease the heart rate to normal
Medications
QRS complex: Normal Cardiac tamponade
Hyperthyroidism
VENTRICULAR TACHYCARDIA (VT)

Irregular, coarse waveforms of different

shapes. The ventricles are quivering
and there is no contractions or cardiac
output which may be fatal.

TRICK: LOOKS LIKE TOMBSTONES

Rate: > 100 bpm

Causes: Manifestations:
Rhythm: Regular Myocardial ischemia / Patient is usually awake
infarction (unlike V-Fib)
P-wave: Upright & uniform before QRS Electrolyte imbalances Angina
PR interval: Normal Digoxin toxicity
Lethargy

QRS complex: Normal Stimulants: coffee &

Anxiety
Syncope
methamphetamines Palpitations
VENTRICULAR TACHYCARDIA (VT)

Treatment: Untreated VT can lead to

Stable with pulse: Unstable with no pulse:

CPR
Oxygen ACLS protocol for de-fib Ventricular Fibrillation
Anti-dysrythmics Possible intubation
(Amiodarone) Drug therapy (Epinephrine,
vasopressin, amiodarone) Death