7/31/2019 Nurses ECG - 1
1/72
ECG Basics forNursesProf. Dr. Aswinikumar Surendran. MD
Professor, Department of MedicineGovernment medical College Hospital
Thiruvananthapuram, South India.+9147124699824, +9194447799984
mailto:[email protected]:[email protected]:[email protected]:[email protected]7/31/2019 Nurses ECG - 1
2/72
What is ECG?Graphical Depiction of Electrical Forces
7/31/2019 Nurses ECG - 1
3/72
Importance of ECGLife Line of the Patient
7/31/2019 Nurses ECG - 1
4/72
7/31/2019 Nurses ECG - 1
5/72
NursesRole in the ICU
7/31/2019 Nurses ECG - 1
6/72
Why Learn ECG?Valuable Easily Attained Skill
7/31/2019 Nurses ECG - 1
7/72
Uses of ECGSpecific for Nurses
Heart RateNormal / Tachycardia /
Bradycardia
ArrhythmiasVentricular /
Supraventricular
Heart BlocksAV Nodal / RBBB /
LBBB
Electrolyte ImbalanceHypokalemia /Hyperkalemia
CarditisMyocarditis /Pericarditis
Drug EffectDigoxin / Quinidine /
Adriamycin
Coronary Circulation
Ischemia / Injury /Infarct
Electrical AxisNormal / Right axis /Left axis
Chamber EnlargementLAE / RAE / LVH / RVH
ICU monitoringEarly detection of arrhythmia
Stress testing
Early detection of Ischemia
Holter monitoringAarrhythmia testing
7/31/2019 Nurses ECG - 1
8/72
Conduction PathwayFrom SA Node to Ventricular Muscle
SA Node
Right Atrial muscle
Left Atrial muscle
His Bundle
AV Node
Right Bundle Branch Left Bundle Branch
Right Ventricular Muscle Left Ventricular Muscle
7/31/2019 Nurses ECG - 1
9/72
Pacemakers of HearrrrrtIf one fails, the other will take over
Inherent Rate60-80
Inherent Rate
40-60
Inherent Rate
20-40
7/31/2019 Nurses ECG - 1
10/72
InventorEinthoven
7/31/2019 Nurses ECG - 1
11/72
ECG MachineModified Galvanometer
7/31/2019 Nurses ECG - 1
12/72
ECG PaperMoves at a spped of 25mm/sec
Black paper
Cheap: Rs1/- per ECGHeat sensitive substance coated
Erased by heated stylus
7/31/2019 Nurses ECG - 1
13/72
ECGRecording
7/31/2019 Nurses ECG - 1
14/72
7/31/2019 Nurses ECG - 1
15/72
6 Limb LeadsOriented to frontal plane
II III and aVF Inferior Wall
7/31/2019 Nurses ECG - 1
16/72
6 Chest LeadsOriented to horizontal plane
1 aVL V5V6 Lateral Wall
V1V2V3V4 Anterior Wall
7/31/2019 Nurses ECG - 1
17/72
Standardization1 mv of current produces 10mm deflection
7/31/2019 Nurses ECG - 1
18/72
StandardizationHalf Standardization
1 mV
10 sd
1 mV
5 sd
7/31/2019 Nurses ECG - 1
19/72
7/31/2019 Nurses ECG - 1
20/72
RestOnly multiples
7/31/2019 Nurses ECG - 1
21/72
ECG WavesPQRSTU named by Einthoven
P: First positive wave of cardiac cycleQ: First negative deflection of the cycleR: First positive deflection of the cycleS: 2 nd negative deflection of the cycleS: can also be a 1 st -ve wave following RT: Positive wave following QRS complexU: Small +ve wave following the T wave
PQ
T U
R
S
7/31/2019 Nurses ECG - 1
22/72
7/31/2019 Nurses ECG - 1
23/72
IntervalsFor Calculation of Heart rate
PR Interval QT interval
RR interval
QRS duration
PR: AV nodal delayQRS: Vent Conduction
RR interval for heart rate calculation
QT: Total time, Cardiac Cycle
7/31/2019 Nurses ECG - 1
24/72
PQRSTElectrical correlation
P wave T wave
U wave
QRS
Atrial depolarization
Ventricular depolarization
Ventricular repolarization
Ventricular repolarization
Atrial repolarization?
PR/QRS
7/31/2019 Nurses ECG - 1
25/72
7/31/2019 Nurses ECG - 1
26/72
P WaveShape - Widening
Wide and notched
Normal P P Mitrale
Left Atrial Enlargement
7/31/2019 Nurses ECG - 1
27/72
P WaveShape peaked
Tall and Peaked
Normal P P Pulmonale Signifies RAE
Right Atrial Enlargement
7/31/2019 Nurses ECG - 1
28/72
PR IntervalDenotes AV nodal delay
PR Interval Normal 3-5 SD
PR interval A physiological necessity
7/31/2019 Nurses ECG - 1
29/72
PR IntervalAbnormalities
Prolonged PR:0.21sRheumatic Fever I0 Heart Block
Short PR:
7/31/2019 Nurses ECG - 1
30/72
QRS DurationTime for Ventricular contraction
Normal 0.06 to 0.10 sec Abnormal > 0.11 sec
Prolonged QRS Ventricular contraction Delay
7/31/2019 Nurses ECG - 1
31/72
Right Bundle Branch BlockConduction Delay in Right Ventricle
RBBB
R
r
S
T R
q
Deep slurred S
V1 V6
7/31/2019 Nurses ECG - 1
32/72
RBBBECG
7/31/2019 Nurses ECG - 1
33/72
Left Bundle Branch BlockConduction Delay in Left Ventricle
LBBB LBBB
T
V1 V6
7/31/2019 Nurses ECG - 1
34/72
LBBBECG
7/31/2019 Nurses ECG - 1
35/72
Q WaveComes After PR Interval
P QRS P
No Q T
Normally No Q 1 st negative deflection
7/31/2019 Nurses ECG - 1
36/72
Q WaveAbnormal Dimensions
P Q P Q
>0.04sec
Width >0.04sec Depth > 1/4th
of height
7/31/2019 Nurses ECG - 1
37/72
Importance of Q WaveIndicates Heart Attack
.
7/31/2019 Nurses ECG - 1
38/72
Normal ST segment
PR
ST
ST SegmentFrom End of S to Beginning of T
ST segment elevationPR
ST
7/31/2019 Nurses ECG - 1
39/72
ST Segment ElevationStraight and Coving
Coving ST segment elevationStraight ST segment elevation
PRPR
ST
Coving ST
7/31/2019 Nurses ECG - 1
40/72
7/31/2019 Nurses ECG - 1
41/72
ST Segment ElevationActual Measurement
0.08 sec to the right of J point
PR
ST
7/31/2019 Nurses ECG - 1
42/72
STEMI and NSTEMIChanges in ST segment
7/31/2019 Nurses ECG - 1
43/72
ST Segment ElevationImportance
.
7/31/2019 Nurses ECG - 1
44/72
ST Segment DepressionSuggestive of Angina
Normal ST segment ST segment Depression
7/31/2019 Nurses ECG - 1
45/72
T WaveNormal And Abnormal
Normal T Peaked T Symm T Biphasic T
7/31/2019 Nurses ECG - 1
46/72
Tall peaked T WaveAcute myocardial Infarction
Tall peaked T wave
Hyperacute MI
7/31/2019 Nurses ECG - 1
47/72
Tall peaked T WaveAcute myocardial Infarction ECG
.
7/31/2019 Nurses ECG - 1
48/72
Tall Peaked T WaveHyperkalemia (High potassium)
Hyperkalemia
7/31/2019 Nurses ECG - 1
49/72
Tall peaked T WaveHyperkalemia ECG
.
7/31/2019 Nurses ECG - 1
50/72
T InversionSuggestive of Ischemia
Symmetrical T InversionBiphasic T wave
7/31/2019 Nurses ECG - 1
51/72
T InversionIn Anterior and Inferior Leads
7/31/2019 Nurses ECG - 1
52/72
7/31/2019 Nurses ECG - 1
53/72
7/31/2019 Nurses ECG - 1
54/72
Acute Myocardial InfarctionProgressive Changes
Early changesof AMI
VAT
Peak T
ST
ST
T Biphasic
Q appears
ST downs
ST Normal
T upright
Acute Myocardialinfraction
Healing and oldinfarction
15 min
30 min
1 hour
2 hours
3 hours
4 hours
1 week
1 month
1 year
7/31/2019 Nurses ECG - 1
55/72
Myocardial InfarctionAnterior Wall
Seen in V2 to V4If in V1 - Anteroseptal
Thrombus
Anterior descending branch
Left coronary artery
7/31/2019 Nurses ECG - 1
56/72
ECGAcute Anterior Wall MI
7/31/2019 Nurses ECG - 1
57/72
Myocardial InfarctionLateral Wall
Changes of Acute MI , when seen in the lateral chest leads, 1, aVL,V5 V6, is diagnostic of Lateral Wall Myocardial Infarction
Thrombus
7/31/2019 Nurses ECG - 1
58/72
7/31/2019 Nurses ECG - 1
59/72
Myocardial InfarctionAntero Lateral MI
Changes of Acute MI are seen in all the anterior chest leads, fromV1 through V6; diagnostic of Antero-lateral Wall MI
Thrombus
Thrombus
Thrombus
7/31/2019 Nurses ECG - 1
60/72
Myocardial InfarctionAntero Lateral MI - ECG
7/31/2019 Nurses ECG - 1
61/72
7/31/2019 Nurses ECG - 1
62/72
ECGInferior Wall MI
7/31/2019 Nurses ECG - 1
63/72
7/31/2019 Nurses ECG - 1
64/72
7/31/2019 Nurses ECG - 1
65/72
Sh Q
7/31/2019 Nurses ECG - 1
66/72
Short QTIncreased susceptibility to Torsade de
Short QT
7/31/2019 Nurses ECG - 1
67/72
7/31/2019 Nurses ECG - 1
68/72
Ri h V i l H h
7/31/2019 Nurses ECG - 1
69/72
Right Ventricular HypertrophyR/S in V1 is > 1
..
S i V1 R i V6
7/31/2019 Nurses ECG - 1
70/72
S in V1 + R in V6Normally less than 35mm
Lead V1
Lead V6
20mm
25mm
7/31/2019 Nurses ECG - 1
71/72
7/31/2019 Nurses ECG - 1
72/72
Top Related