EKG Review. Function of Heart With any functioning unit you need: Electricity and Plumbing...
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Transcript of EKG Review. Function of Heart With any functioning unit you need: Electricity and Plumbing...
EKG Review
Function of Heart• With any functioning unit you need:
Electricity and Plumbing
• ELECTRICITY: electrical current that stimulates the heart and tells it to beat or contract
• PLUMBING: When the heart contracts it provides blood and oxygenation to vessels, tissue and organs
• ***Keep in mind how electricity and plumbing affect each other!!!
Electricity
• SA AV Bundle of HIS BB PF
• SA: 60-80bpm
• AV: 40-60bpm
• BH-BB: 20-40bpm
“ACCIDENTS ON A HIGHWAY”- will be detoured around the blockage.
increased distance to travel = increased time to get to location**Electrical current needs healthy tissue to
conduct- dead tissue will not allow signal to pass through
PlumbingBeats = contractions
• Each beat requires atrial and ventricular contraction
• Heart is like a sponge. It absorbs and squeezes out blood with each contraction. If it is not “rung out fully” with each squeeze- it cannot absorb it’s full potential. (preload, afterload)
• Ventricular contraction- pushes blood into arteries to be sent to body, tissues, organs and lungs
• Tissue needs oxygen and blood to survive. Without this, it cannot function
Basic principals of EKG
• Rate? FAST, SLOW, NORMAL
• Complex? “P” in front of every “QRS”
P- atrial contractionQRS- ventricular
contraction
p
qrs
T
What is my rate:
•Each Full complex is one beat•Most strips are 6 seconds long
(# of complexes in 6 sec strip) X (10) = Heart Rate(5 complexes) X (10) = 50 beats per minute
1 2 3 4 5
ARRYTHMIAS
•Normal: 60-100 bpm
• Slow: < 60 bpm • Sinus Bradycardia, Junctional
• Fast: >100 bpm• Sinus Tachycardia, Supraventricular Tachycardia, VTach.
-CARDIA : heart beat including contraction & relaxation
Sinus Rhythm
• Sinus rhythm is normal electricity and normal plumbing.
• Electrical signal fires from ‘Sinus’ node.
Rate is either slow, fast or normal.“P wave” is present in front of every “QRS”
SLOW ARRYHMIAS
• Sinus Bradycardia• SLOW sinus rhythm
• Junctional Rhythm• “P” wave is inverted or absent
FAST ARRYTHMIAS
• Sinus Tachycardia• Fast sinus rhythm
• Supraventricular Tachycardia• Supra-superior : “above” the ventricular
• Rate is greater than 160 bpm, “QRS” is narrow.
Ventricular rhythms
• Ventricular Tachycardia• Tachycardia- firing from the ventricle• WIDE “QRS”, no “P”
• Ventricular Fibrillation• Fibrillation or “quivering” of the ventricles- no contraction/relaxation.
No organized rhythm
Atrial Arrhythmias
• Atrial Fibrillation• Underlying rhythm is sinus, with fibrillation between complexes/beats
• Atrial Flutter• Look at sawtooth pattern between waves
Asystole
•No movement of heart muscle
Just remember : “Dead meat don’t beat”
EKG GRIDSTime (secs)
VOLTAGE
SMALL blocks: 0.4 secLARGE blocks: .20 sec
5 Large blocks = 1 sec. on strip
BLOCKS
• Underlying rhythm is sinus, (must have P-QRS)
• Normal P-R interval is .12-.20 sec (one big block)
• 1st degree: prolonged P-R interval (>.20)• 2nd degree I: (WB) P-R gets longer, then drops beat• 2nd degree II: more “P’s” than “QRS” (kids w/o parents)• 3rd degree: total disassociation, no communication
Premature Complexes
•PAC- premature Atrial complex• P wave upright in front of QRS
•PJC- premature Junctional complex• P wave is inverted or absent
•PVC- premature Ventricular complex• Wide and bizarre, No “P” wave
Other things to look at….
•S-T segment
• Depression- Ischemia or injury
• Elevation- infarct or death of tissue
**STEMI- is key point in ACS algorithm
***Classified as significant if > 1 mm
Pacemaker spikes
• If Pacemaker is pacing the heart you will see a spike. To determine what is being paced, Look at location of spike
Before P: pacing ATRIA
Before QRS: Pacing VENTRICLE
Both- pacing both