Electrocardiogram (1)
Transcript of Electrocardiogram (1)
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Electrocardiogram
Clinical Skills III
NYIT Physician Assistant Studies
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Electrocardiogram: (ECG or EKG
ECG is a gra!hic record o" electric currents generated #y the heart muscles$
Electrical im!ulses are !icked u! #y a sur"ace e%hich are !laced at &arious !oints on the #connected the ECG machine$
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Indications "or Electrocardiogra
'aseline e&aluation
es!onse to thera!y
Prior to surgery
)edication o&erdose
Electrical in*ury (arrhythmia Synco!e (#radycardia
Pain+ ,ys!nea
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Cardiac Pathology ,iagnosed #y EKG:
Arrhythmias ( slo%+ ra!id+ irregular heart #eat)yocardial ischemia and in"arctionCham#er hy!ertro!hyCongenital heart de"ects in&ol&ing the conducting (electricsystemA#normal !osition o" the heart
Pericarditis or myocarditisCardiac Arrest,istur#ances o" the heart-s conducting system (heart #locElectrolyte distur#ances,rug To.icity
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Assessment
Assess age+ gender+ current medication history (m!ossi#le cardiac or hemodynamic e/ects$ 0ther data #e re1uired such as height+ %eight+ #lood !ressure$
,etermine that the !atient is a#le to tolerate a su!ineand that ade1uate e.!osure o" chest and lim#s is !o
electrode !lacement$
,etermine !resence o" neck+ arm+ *a%+ or other !!ossi#le cardiac origin$ Chest or other !ain mayadditional in"ormation use"ul in serial com!arison o" ECG
Assess !atient need "or in"ormation a#out the !rocedure
and re1uirements and a#ility to coo!erate:
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E1ui!ment Needed
2 T%el&e3lead ECG machine %ith charged #attery+
ca#les and leads+ gra!h !a!er
2 ,is!osa#le electrodes
2 Alcohol %i!es
2 Pillo%s2 Sheet or dra!e
2 ,is!osa#le ra4or i" needed
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Com!lications o" EKG:
3 Sa"e !rocedure
3 No kno%n risks
3 No electric current sent to #ody
3 Possi#le allergic or sensiti&ity to electrodes
(local skin reaction
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Normal Conduction System ofHeart:
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'asic Electrical Acti&ity o" the 5ea
)yocardial cells (muscle cells o" heart: interior cells 3 negati&ely charge at rest
the sur"ace 3 !ositi&ely charged
Contraction o" heart muscle: Electrical stimulation !ositi&ely charges cells
Cells !re!are to contract 6de!olari4ation7 occurs
,e!olari4ation !asses through heart contraction o" myocardium
Depolarization : stimulates myocardial cells to contract cell changes to !ositi&e
Repolarization: gain negati&e charge
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P %a&e: (de!olari4ation o" the right and le"t atria
8S com!le.: right and le"t &entricular de!olari4ation
ST3T %a&e: &entricular re!olari4ation
9 %a&e: origin "or this %a&e is not clear
(!ro#a#ly se!tal re!olari4ation
PR interval: time interval from onset of atrial
depolarization (P wa&e to onset o"
&entricular de!olari4ation (8S com!le.8S duration: duration o" &entricular de!olari4ation
8T inter&al: duration o" &entricular de!olari4ation and re!olari4ation
inter&al: duration o" &entricular cardiac cycle (&entricular rate
PP inter&al: duration o" atrial cycle (atrial rate %a&e 3 rst !ositi&e de;ection a"ter ! %a&e
8 %a&e 3 rst negati&e de;ection a"ter ! %a&e 'E
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12 ead !C":
The >3lead ECG !ro&ides 6&ie%s7 o" cardiac
acti&ity "rom > di/erent &antage !oints on the #odyCom!osed o" > se!arate leads: D lim# leads ( B and B augmented leads and D chest leads (!recordia
,is!lays the cardiac cycle in "our lead grou!s that the cardiac cycle in relation to lead !lacement
ead grou!s: ateral ( I+ aF+ F and FD
In"erior (II+ III and aF and F
Anterior (FB and F@
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ECG EA,S:
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Anatomical Grou!s:
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Precordialeads (chestleads
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Identi"y Placement o" Chest eads (Preco
F> H @th intercostal s!a#order
F H @th intercostal s!a#order
FB H mid%ay #etween
F@ H mid3cla&icular line+inters!ace
F H anterior a.illary lininters!ace
FD H mid3a.illary line at
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Identi"yPlacement im# eads
R $ Any%here a#o&e the ankle and #elo% the torso
R% $ Any%here #et%een the shoulder and the el#o%
$ Any%here a#o&e the ankle and #elo% the torso
% $ Any%here #et%een the shoulder and the el#o%
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> ead EKG
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Arti"acts on ECG:
S%eat: shorts electrodes
Pulse arti"act: electrode on !ulse and mo&es
)o&ement arti"acts: !atient mo&es
Electrical arti"act: electrical acti&ity near !atient
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hythm Stri!s:
hythm stri! longer look at rate and rhythm
Each machine 3 set at certain lead #ut can #e ch
Set multi!le leads 3multi!le rhythm stri!s at a tim
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ECG Fariations
> lead ECG adds B additional chest leads
across the right !recordium Falua#le tool "or the early diagnosis o" right&entricular and !osterior le"t &entricularin"arction$
>J3lead ECG adds B !osterior leads to the >3lead ECG
Fery use"ul "or early detection o" myocardialischemia and in*ury
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Holter &onitor:
Porta#le EKG
Electrodes !laced on chest 3 !atient %ears recorderaround neck or %aist "or @3@J hours
A diary 3 times sym!toms occur and readings
5el!s identi"y conditions 3 s!oradic and not ca!tured
EKG
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Fideo on 5o% to Per"orm EKG:
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In"erior )I
Pathologic 8 %a&es and e&ol&ing ST3T changes inII+ III+ aF
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In"ero!osterior )I ECG changes are seen in anterior !recordial leads F>3B+ #ut a
the mirror image o" an anterose!tal )I+
Increased %a&e am!litude and duration (i$e$+ a L!athologic
%a&eL is a mirror image o" a !athologic 8$ 5y!eracute ST3T %a&e changes: i$e$+ ST de!ression and large
in&erted T %a&es in F>3B$
ate normali4ation o" ST3T %ith symmetrical u!right T %a&es F>3B$
0"ten seen %ith in"erior )I (i$e$+ Lin"ero!osterior )IL
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ight Fentricular )I
ight Fentricular )I (seen %ith !ro.imal right coocclusion
ECG ndings usually re1uire additional leads on chest (F> to FD+ analogous to the le"t chest le
ST ele&ation+ =>mm+ in right chest leads+ es!ec
F@$
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Anterior )I
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5igh ateral )I