ECG for nurses
Schema:
Introduction.
Basic ECG understanding.
Basic Concept.
Conduction system.
ECG parts
Important measures
Normal ECG
Myocardial Ischemia.
What to look at?
Arrythmias
Tachyarrythmias
Sinustachy.
Atrial fibrillation
Atrial flutter
VT and VF
Bradyarrythmias
AV block
Sinus arrests
Questions
Basic ECG understanding
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Heart parts.
Depolarization and Repolarization.
Conduction system
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The conduction system of the heart
How signals conducted ?
SA node
AV node
Bundle branches
ECG parts
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PQRST
Which part represent which?
Important measures
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1 second = 100 millisecond.
Saudi ECG speed standard = 25mm/s
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Normal PR/PQ
Normal QRS
Calculating heart rate
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Easier method
60000
heartrate =
nr of big squares X 200
Normal ECG
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Many and many normal varient.
Check symptoms + Previous/old ECG.
Myocardial Ischemia
Important!! Should not be missed.
Sympyoms + ECG changes
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STEMI (ST elevation MI)
Very distinguish pattern
Very symptomatic...Most of the time.
Anterior MI:
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Inferior MI:
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NSTEMI (non ST elevation MI)
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Arrhythmias:
Considered to be difficult even among cardiologist who are not specialized.
Depends 100% on your understanding of the ECG.
Tachy VS Bradi
Tachyarrhythmias
Sinustachycardia
Normal conduction pathway
Usually secondary to a reversible factor
Pain, fever, stress, caffeine, nicotine are the usual culprit
Can also be secondary to some serious issue like Pulmonary embolism or
tamponade.
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P waves are somehow visible and precede every QRS.
If the HR is very fast ⇒ P waves can hide in the T wave forming a camel hump
🐫 .
Atrial Fibrillation
Simply a chaos in the atrium.
Normal rhythm = Normal football match with one referee ⚽
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Atrial Fibrillation = A football match with 100 balls and 100 referee!!! ⚽⚽⚽⚽
Fast HR and usually tired patient.
Irregular rhythm.
No P waves.
⬆ risk for thrombus in the left atrium → Stroke!!
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Atrial flutter
The signals circles in the right atrium creating a reentry.
Fast HR. Usually predictable rate depending on how many flutter waves
between every RR.
Sawtooth shaped P waves.
Same risk of stroke as in Afib.
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VT and VF
Very serious. Alarm the team!!
The ventricle take over the lead and The hear beat so fast that no optimal
cardiac output is delivered.
Caused by MI, Heart failure or electrolyte imbalance. Other causes may occur
also.
Distinguish pattern.
The patient feels really sick. Lose of consciousness.
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Bradyarrhythmias
Slow heart rate.
Normal sinus bradycardia while sleeping at night.
AV block
Problem in the AV node.
The conduction slows down.
3 degrees/types.
1st degree AV block.
Prolonged PR/PQ interval. PR interval > 200ms.
Can be normal at night.
Usually Medication related. Can be others.
2nd degree AV block
2 subtypes. Mobits type 1 and 2
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2nd Degree AV block : Mobits type 1 (Wenchebach)
gradual prolongation of PR/PQ until one beat drops.
Can be normal at night.
like AV block 1.
2nd Degree AV block : Mobits type 2
Constant PR interval until suddenly a beat or more drops.
We cant rely on the AV node as its really inconsistance.
If not medication related a pacemaker may be indicated.
3rd degree AV block
The connection is completely cut out between the atrium and ventricle.
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every part will work alone.
PP intervals are consistent. RR intervals are consistent, but PR varies ie. No
relation between P and QRS complexes.
Pacemaker is needed.
Sinus Arrests
The problem in the Sinus node SA.
A pause occur with no sinus activity ⇒ No p waves.
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Is this a sinus arrest???
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