medical ecg
TRANSCRIPT
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Teresa Camp-Rogers, MDDepartment of Emergency MedicineVirginia Commonwealth University Medical Center
Richmond, Virginia
The Basic 12 Lead
Electrocardiogram
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Objectives
How do they work?
Common mistakes
How to read an EKG Artifacts
Cases
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What is an EKG?
Tracing of electrical activity of the heart
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History of the EKG
William Einthoven
Early 1900s
String galvanometer
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How does an EKG work?
Voltmeter
Saline
Bucket
Saline
Bucket
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How does an EKG work?
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How does an EKG work?
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How does an EKG work?
Einthoven I, II, III
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How does an EKG work?
Wilson augmented leads
aVF, aVR, aVL
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How does an EKG work?
Pre-cordial leads
V1 V6
Standardized in 1938 by the AHA
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Why PQRST?
Uncorrected tracings ABCD
Corrected tracing PQRST
Familiar with Descartes
Middle of alphabet (afterthought)
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Indications Chest pain
Syncope Shortness of breath
Nausea/Vomiting
Palpitations
Diaphoresis Stroke symptoms
Before and after cardioversion
Hemodynamic instability
Suspected electrolyte disorder Overdose
Arrhythmia
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Common Mistakes
Limb lead placementRIGHT WRONG
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Common Mistakes
Pre-cordial lead placement
Angle of Louis
V1 What about breast
tissue?
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How to read an EKG
The Paper
The Waveform
The Plan
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How to read an EKG
The paper Up and down 1 box = 0.1 mV
Across 1 box = 4 ms
The rate
10 seconds per page
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How to read an EKG
The Waveform
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How to read an EKG
P wave
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How to read an EKG
PR segment
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How to read an EKG
QRS complex
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How to read an EKG
ST segment
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How to read an EKG T wave
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How to read an EKG QT/QTc
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How to read an EKG R-R
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The Plan
Rate
Rhythm
Axis
Interval
Disease
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Rate
300 method
300, 150, 100, 75, 60
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Rate
10 second method Each EKG is 10 seconds
Count total QRS complexes
Multiply by 6
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Rate Normal
60 100
Bradycardia< 60
Tachycardia> 100
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Rhythm
Sinus Atrial
Supraventricular
Junctional
Ventricular
Narrow QRS
Wide QRS
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Rhythm
Normal Sinus
Sinus Arrhythmia
Sinus Arrest
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Rhythm
ATRIAL Atrial Flutter
Atrial Fibrillation
Premature Atrial
Contraction
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Rhythm Supraventricular
Catch all term
Supraventricular
Tachycardia
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Rhythm
JUNCTIONAL
Junctional Escape
Accelerated Junctional
Premature Junctional
Contraction
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Rhythm
VENTRICULAR V Fibrillation
V Tachycardia
Premature Ventricular
Contraction
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Axis
General direction of electrical activity
Will not change your management
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Interval PR
Block between atria and ventricles
Heart Block First, second, and third degree
QRS Block in the conduction system Bundle Branch Block
LBBB, LAFB, LPFB, RBBB
QT/QTc
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QRS Interval
QRS complex = ventricular depolarization
QRS widening = delay in depolarization
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QRS Interval Causes of QRS widening
Ventricular rhythm
Damage to the conduction system BBB
MI
Metabolic/Drugs
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QRS Interval
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QT/QTc Interval
QT
Normal
Prolonged
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EKG Artifact
60 Hz interference
Muscle tremor
Wandering baseline
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12 leads So far weve just done basic rhythm
recognition with a single lead.
What about the other 11 leads?
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12 leads Each lead represents a different view of
the heart
More = better.
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12 leads II p waves
Axis
Diseases Myocardial infarction
PE Hyperkalemia
Pericarditis
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Practice
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Practice
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Practice
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Practice