ecg powerpoint presentation slides

Cardiac Cells

• Electrically polarized….meaning inside of cell is negatively charged and the outside positive
• Difference in electrical potential across a resistive barrier is voltage
• Depolarization: cells lose internal negativity which causes systole (contraction)
• Repolarization: cells gain back internal negativity which causes diastole (relaxation)

The Normal Conduction System� SA node: pacemaker cells, do not have a true resting potential, they discharge at a rate of 60-100x/min�Purkinje fibers: long thin cells, electrical pathways that cause the myocardial cells to depolarize and repolarize� �

What is an EKG?

The electrocardiogram (EKG) is a representation of the electrical events of the cardiac cycle.

Each event has a distinctive waveform, the study of which can lead to greater insight into a patient’s cardiac pathophysiology.

Patient Indicators for an EKG

• Palpitations (intermittent accelerations)
• Pulse 150-250beats/min
• Lightheadedness/syncope
• ED, erectile dysfunction, especially in young men

Preparing the Patient

• Explain procedure to patient. Lay patient on back. Drape for privacy. They can wear jewelry.
• Take a BP and pulse!
• Applying electrodes
• Make sure electrodes are within expiration and not dry
• Prepare the skin by shaving if necessary – hair interferes with the contact between the electrode disc and the skin
• Remove skin oil – use a dry washcloth or soap and water, alcohol
• Attach electrode to cable
• Avoid placing over bony areas

12 Lead EKG

• Uses 10 electrodes to obtain a more complete view the heart
• Records 12 different views of the heart, at different angles
• Provides a complete picture of the hearts electrical activity

EKG Electrodes, Placement and Leads

Leads and electrodes are not equivalent!

Electrodes are the sensors attached to the EKG machine. (10)

Leads are the view of the heart from the combination of electrode placement. (12)

EKG Electrodes & Placement�

• Chest placement (Precordial electrodes
• V1 fourth intercostal space at right margin of sternum
• V2 fourth intercostal space at left margin of sternum
• V3 midway between V2 and V4
• V4 fifth intercostal space at left midclavicular line
• V5 placed midway between V4 and V6
• V6 fifth intercostal space at the left midaxillary line
• Limb placement of electrodes
• RA right arm
• LA left arm
• RL right leg
• LL left leg

EKG 12 Leads: views of the heart

• Bipolar Limb leads- record electrical activity between two electrodes
• Lead I heart view between LA and RA electrodes
• Lead II heart view between LL and RA electrodes
• Lead III heart view between LL and LA electrodes

EKG Leads: views of the heart

• Unipolar Limb Leads -One point on the body and a virtual reference point with zero electrical potential, located in the center of the heart . Augmented: small waveforms enhanced by EKG
• aVR (RA electrode)
• aVL (LA electrode)
• aVF (LL electrode)
• Precordial (Chest leads): equate to the chest electrodes

The standard EKG has 12 leads:

3 Standard Limb Leads

3 Augmented Limb Leads

6 Precordial Leads

The axis of a particular lead represents the viewpoint from which it looks at the heart. 3 dimensional

Variations in anatomy can cause waves to look different.

Right leg is also the “ground”

• Standardized paper with a combination of small and large blocks to measure cardiac activity.
• Horizontal line: time
• Vertical line: voltage
• Paper speed 25mm/sec adults; 1 large square=.2sec
• Calibration: 2 large squares=1mV
• Small block: represents 0.1mV
• Large block: 5mm x 5mm represents 0.5mV and 0.20 second therefore
• 5 large blocks =1 second

Waves, segments, and intervals

• Waveform: refers to movement away from the isoelectric line either upward deflection (positive) or downward deflection (negative)
• Segment: line between two waveforms
• Interval: waveform plus a segment
• Complex: several waveforms

� Deflections can be positive or negative depending on electrode placement and direction of the wave traveling. ��Upward deflections…wave is traveling toward positive lead.�

Overview of Cardiac Cycle

• Consists of one beat, or one P-QRS-T-U sequence.
• 1. P wave Atrial depolarization, contraction, systole
• 2. QRS Complex: ventricular depolarization, contraction, systole
• 3. T wave: ventricular repolarization, relaxation, diastole
• 4. U wave: maybe not be present, represents the recovery period of the Purkinje fibers, best seen with slow heart
• 5. The cardiac cycle is measured on ECG from one R wave to the next R wave
• 3. Between cycles the ECG recorder returns to baseline or isoelectric line – the flat line between the T wave and the next P wave

Cardiac Cycle

• Sinus node (SA) fires spontaneously and a wave of depolarization propagates through both atria: P Wave

The first deflection after the diastole (relaxation), produced by atrial depolarization (contraction)

• There is an “electrical gate” at the junction between the atria and the ventricles that prevent the wave of depolarization to go thru that route….There is a slight delay (fraction of a second) at the AV node to allow the ventricles to fill.
• The signal is funneled along the intraventricular septum.
• Represents the time required for the electrical impulse to leave the SA node and travel through the atria, AV node, bundle branches, and Purkinje fibers. PR Interval
• Ventricular depolarization, contraction, systole. QRS Complex
• Q: interventricular septum depolarizing
• Why is R wave more prominent than P wave?
• Atrial repolarization is obscured due to the large wave created by ventricular systole
• Ventricle repolarization. T wave
• U Wave: Represents the repolarization of the Purkinje fibers…if prominent it is usually due to hypokalemia…most times the U wave is insignificant

Cardiac Cycle Review

Interpretation of EKG printout

• Waves present or absent
• Duration of waves
• Amplitude of waves
• Configuration (shape and appearance)

Determining the Heart Rate

Rule of 300

10 Second Rule

Take the number of “big boxes” between neighboring QRS complexes, and divide this into 300. The result will be approximately equal to the rate

Although fast, this method only works for regular rhythms.

What is the heart rate?

(300 / 6) = 50 bpm

www.uptodate.com

(300 / ~ 4) = ~ 75 bpm

(300 / 1.5) = 200 bpm

As most EKGs record 10 seconds of rhythm per page, one can simply count the number of beats present on the EKG and multiply by 6 to get the number of beats per 60 seconds.

This method works well for irregular rhythms.

33 x 6 = 198 bpm

The Alan E. Lindsay ECG Learning Center ; http://medstat.med.utah.edu/kw/ecg/

EKG Artifacts- some artifacts resemble arrhythmias!

• Battery depletion, loose connections…etc
• Wandering baseline: patient has lotion on skin or is sweating…clean electrode area and properly placing it
• Somatic tremor: patient is shivering or shaking wires….help patient relax
• Reversed leads or misplaced electrodes:

Improperly grounded electrical equipment: ��disconnect and remove all electrical objects from the patient or near the machine, ex cell phones�

Pathologies

• Arrhythmias
• EKG’s do this best
• any disturbance in the rate, regularity, site of origin or conduction of the cardiac electrical impulse
• Hypoxia (pulmonary disorders)
• Myocarditis from viral or bacterial infections
• Sympathetic nervous system disorders (hyperthyroidism or drug toxicity)
• Electrolyte disturbances, K, Ca, Mg
• Hypertrophy of myocardium
• Pulmonary hypertension due to COPD
• Asthma exacerbations
• Conduction blocks (delay in flow of electricity)
• Pre-excitation syndromes
• Instead of the electrical pathway from SA to AV the heart short circuits and makes a new pathway so there is no delay of message to the AV node
• Myocardial Infarction
• Usually when a coronary artery becomes occluded and tissue dies from lack of oxygen and nutrients
• Prolonged crushing substernal chest pain radiating to the jaw, shoulders, or left arm with nausea, SOB, diaphoresis, troponin increased

EKG on a Treadmill!

• Stress Test, Exercise Tolerance Test
• Patients may have normal resting EKG’s, then the demands of exercise bring out evidence of subclinical coronary artery disease.
• MI: thrombolytic agents, plasminogen activators
• Antiarrhythmics: propranolol, procainamide, lidocaine, atropine, digoxin
• Pacemaker and Defibrillator: electrodes placed just above R atrium or ventricle or both
• pacemakers keep the heart beating at the proper rate and from beating too slow. It also will only activate if it is needed, it is not shocking the heart all the time.
• An implanted defibrillator is a bigger device. It is there to prevent death from a cardiac arrest. The device shocks the heart if it needs to be shocked, because of a life-threatening rhythm disturbance from the lower chambers of the heart.

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ECG Interpretation.

Published by Steven McBride Modified over 8 years ago

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Electrocardiogram ECG

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115 Best Ecg-Themed Templates for PowerPoint & Google Slides

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Widescreen (16:9) Presentation Templates. Change size...

Anatomy of human organs with kidney failure and ECG wave in the forefront

Human anatomy with heart and ECG rays in foreground

Anatomy depiction of a human heart with ECG rays and medical symbol over dark background

Human brain with a highlighted small part of the brain and ECG waves

Heart and ECG rays with human skeleton in background

Anatomy depiction of a human red heart and ECG graph over blue background

Heart and a stethoscope on a white background, with red ECG waves

ECG wave in front and brain tumor being vaporized with radio surgery

Anatomy depiction of human organs with highlighted intestines and ECG graph

Depiction of a human anatomy with ECG wave placed over a technology background

Red human heart with ECG waves and huan body over dark background

Man opening first aid box with medical symbol on it and ECG wave in background

Red color human heart with ECG rays in the foreground

Human anatomy with highlighted head indicating pain with ECG rays in foreground

Broken red heart with blood on floor and ECG wave in background

Medical collage with doctors team performing operation on patient, with ECG rays over green background

Medical collage with doctors and patient with ECG wave and medical symbol in background

Red heart with stethoscope and ECG wave over white background

Red heart and stethoscope with ECG graph on green background

Digital human body with heard and electrocardiogram on the middle of a dark red background

Anatomy depiction of human organs with a highlighted heart and ECG waves in foreground

Health protection pills and syringe with stereoscope and ECG waves in background depicting health care

Brain lobes in head silhouette with ECG wave in the background

Heart graphing paper showing pulse

Red color heart with stethoscope and ECG rays in background

Female medical doctor with nose mask writing on cardiogram

Medical caduceus with nice ECG wave in the background

A surgeon with a heartbeat line in the background - widescreen format

Anatomy depiction of an active receptor with ecg wave and black color

3D people with medical shield protecting health with ecg gde

A depiction of the ECG report along with mentioning heart attack and stroke

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Heart rhythm or ECG monitor with pulse in blue background

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Theme featuring patient during exercise ecg on stationary bike

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Powerpoint Templates and Google slides for Ecg

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12-Lead ECG Interpretation

Oct 10, 2014

420 likes | 1.87k Views

12-Lead ECG Interpretation. Lead “Views”. Lead “Views”. Precordial Leads. The 12-Lead view. Each limb lead I, II, III, AVR, AVL, AVF records from a different angle All six limb leads intersect and visualize a frontal plane

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• intercostal space
• st elevation
• assessing st elevation
• chest leads precordial v1

Presentation Transcript

Lead “Views”

Precordial Leads

The 12-Lead view • Each limb lead I, II, III, AVR, AVL, AVF records from a different angle • All six limb leads intersect and visualize a frontal plane • The six chest leads (precordial) V1, V2, V3, V4, V5, V6 view the body in the horizontal plane to the AV node • The 12 lead ECG forms a camera view from 12 angles

Unipolar and Bipolar • Limb leads I, II, III are bipolar and have a negative and positive pole • Electrical potential differences are measured between the poles • AVR, AVL and AVF are unipolar • No negative lead • The heart is the negative pole • Electrical potential difference is measured betweeen the lead and the heart • Chest leads are unipolar • The heart also is the negative pole

Lead Groups I aVR V1 V4 II aVL V2 V5 III aVF V3 V6 Limb Leads Chest Leads

Inferior Wall • II, III, aVF • Left Leg I II III aVR aVL aVF V1 V2 V3 V4 V5 V6

Inferior Wall I II III aVR aVL aVF V1 V2 V3 V4 V5 V6 Inferior Wall

Lateral Wall • I and aVL • Left Arm I II III aVR aVL aVF V1 V2 V3 V4 V5 V6

Lateral Wall • V5 and V6 • Left lateral chest I II III aVR aVL aVF V1 V2 V3 V4 V5 V6

Lateral • I, aVL, V5, V6 Lateral Wall I II III aVR aVL aVF V1 V2 V3 V4 V5 V6

Anterior Wall • V3, V4 • Left anterior chest I II III aVR aVL aVF V1 V2 V3 V4 V5 V6

Anterior Wall • V3, V4 I II III aVR aVL aVF V1 V2 V3 V4 V5 V6

Septal Wall • V1, V2 • Along sternal borders I II III aVR aVL aVF V1 V2 V3 V4 V5 V6

Septal • V1,V2 I II III aVR aVL aVF V1 V2 V3 V4 V5 V6

How to record a 12 lead ECG • Clean areas of electrode placement with alcohol wipes. • Place pads for limb and chest electrodes. • Limb leads are colour coded. Pneumonic Ride Your Green Bike will help you remember how to place the leads. Start with the red lead and attach it to the right wrist. Yellow is attached to the left wrist, green to the left leg and black to the right leg.

• Position of chest leads • V1: Fourth intercostal space at the right sternal border. (First palpable intercostals space, below the clavicle is the 2nd intercostal space. • V2: Fourth intercostal space at the left sternal border • V3: Midway between V2 and V4

V4: Fifth intercostal space in the midclavicular line • V5: Anterior axillary line at the same horizontal level as V4 • V6: Mid-axillary line at the same horizontal plane as V4 and V5

12-Lead ECG

The ECG Complex • The J point is the point where the S wave ends and the ST segment begins • ST elevation is measured after the J point • The ST segment is compared to the base line • The base line or isoelectric line is found at the bottom of the calibration bar J point

ST Segment • Starts with the J point • Ends with the beginning of the T wave • Elevation or depression of the ST segment is measured 0.08 seconds (2 small squares) to the right of the J point ST segment

PR Interval PR Interval • Begins at the end of the P wave • Ends at the beginning of the QRS • When determining the isoelectric or baseline find the PR interval of 2 consecutive complexes, draw a line using a straight edge and measure ST elevation from this line; this is the most accurate way to determine if the ST segment is elevated Isoelectric line

TP Segment • Begins at the end of the T wave • Ends at the beginning of the P wave • Can be used as a back up to the PR interval to determine the baseline when assessing ST elevation • Not as accurate as the PR interval TP segment

The ECG Tracing: Waves • P- wave • Marks the beginning of the cardiac cycle and measures the electrical impulse that causes atrial depolarization and mechanical contraction • QRS- Complex • Measures the impulse that causes ventricular depolarization • Q-wave- may or may not be evident on the ECG • R-wave- first upward deflection following P wave • S-wave- the first downward deflection following the R-wave • T- wave • Marks ventricular repolarization that ends the cardiac cycle

Intervals and Segments • P-R interval- • Time interval for impulse to go from the SA to the AV node • normal 0.12-0.20 secs • QRS Interval • Time interval for impulse to go from AV node to stimulate Purkinjie fibers • Less than 0.12 secs • QT Interval • Time interval from beginning of depolarization to the end of repolarization • Should not exceed ½ the length of the R-R • ST segment • end of the S to the beginning of the T

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