EKG Exam Notes PDF

Okay, here is the converted text from the images provided, formatted in Markdown. I've done my best to retain the information and structure. ### Conduction Pathway 1. **SA Node** 2. **Interatrial Tracts** 3. **Atria** 4. **Internodal Tracts** 5. **AV Node** 6. **Bundle of His** 7. **Bundle...

Okay, here is the converted text from the images provided, formatted in Markdown. I've done my best to retain the information and structure. ### Conduction Pathway 1. **SA Node** 2. **Interatrial Tracts** 3. **Atria** 4. **Internodal Tracts** 5. **AV Node** 6. **Bundle of His** 7. **Bundle Branches** 8. **Purkinje Fibers** 9. **Ventricles** * SA = 60-100 * AV= 40-60 * Vent = 20-40 #### Process * **Sinus Node**: Interatrial Tracts Atrium Internodal Tracts AV Node * **Bundle of His**: Bundle Branches Purkinje Fibers Ventricles * **Depolarization (Contraction)**: 0.1 second between Atria + Ventricles #### Atrioventricular Node * This delay allows for a coordinated movement of blood through the AVT * The atria beat together. The ventricles beat together. * AV creates a bundle away. * Bundle of HIS * Posterior Vesicle * Anterior Fascicle * Bachmann's Bundle ### ECG Placement Leads #### Limb Electrodes * Right Arm (White) * Left Arm (Black) * Right Leg (Green) * Left Leg (Red) #### Precordial * **V1**: 4th ICS R of sternum * **V2**: 4th ICS L of sternum * **V3**: Midway between V2 + V4 * **V4**: 5th ICS mid-clavicular line * **V5**: 5th ICS anterior axillary line * **V6**: 5th ICS mid-axillary line #### Measurements * **Lead I**: Measures electrical activity between Right Arm (-) and Left Arm (+). * **Lead II**: Measures Right Arm (-) and Left Leg (+). * **Lead III**: Measures Left Arm (-) and Left Leg (+). This can diagnose heart conditions, arrhythmias, and ischemia. A lead is a (recording) view of the electrical activity of the heart from a specific angle. Some electrocardiogram electrodes communicate with each other, which is why there are 12 leads. MCL is modified chest lead for continuous monitoring. #### MCL Placement * Abdomen * Right Shoulder * Left Shoulder * Aligns with heart's natural electrical axis. Clear visual of P wave. ### Interpretation Guidelines (EKG) #### Grids The graph of ECG is made of grids to measure the voltage and time of the patient. * Voltage is show on the y-axis. * Time is shown on the x-axis. * **Voltage**: * 0.20 / 0.5mV * 0.04s = 0.1mV * **Time**: 5 blocks = 1 second ### Eight Steps to interpreting an EKG 1. Measure HR. 2. Examine R-R int. 3. Examine P wave. 4. Measure PR int. 5. Determine if each P wave is followed by QRS. 6. Examine/Measure QRS complex. 7. Examine and measure QT int. 8. Diagnose Rhythm * **Ectopic beats**: Extra or premature beats – “skipping/fluttering” #### R-R Interval * If R-R are regular interval (constant) rhythm = regular. * If not = irregular. #### Examine P Waves * Smooth/upward deflection * If altered/missing = SA is primary pacemaker #### Measure PR PR - measures amount of time an impulse travels from atrium to ventricle. Measures beginning of P wave to beginning of QRS. Normal Range 0.12 – 0.20 or 3-5 little boxes. Greater than 5 boxes suggests conduction delay. #### Pr waves Precede each QRS = stable 1:1 relationship between these two waves. #### Examine/Measure QRS Complex Normal Range = 0.12 s (3 little boxes). * Typically 0.6-0.10 s (1-2.5 boxes) * Do they look identical? * Abnormally wide? = delayed conduction through bundle branches. #### Measure QT int Less than \(\frac{1}{2}\) of R-R int. < 0.40 s * ↑HR, QT short * ↓HR QT lengthens ### Rhythms Originating in the Atria #### PAC - Premature Atrial Complexes Premature beat that originates in the SA Node | Atrial rate @ regular rate than a premature beat between. * (Lead II) Due to irritation of Atria & automaticity. * Narrow QRS complex * Upright P wave * Different morphology - P wave * can't see on back of page #### Wandering Atrial Pacemaker/Multifocal Atrial Tachycardia (WAP) (MAT) Pacemaking impulses originate fare from at least 3 different foci in the atria. Each focus produces own P wave, resulting in 3 different shapes of P wave. * **WAP** = slow atrial arrhythmia * **MAT** = Rapid | Attribute | WAP | MAT | | :-------- | :----------------------------------- | :----------------------- | | Rate | <100 (between 50-60) | \>100 | | Regularity | Irregular | | | P waves | 3 diff. shapes. | | | Interval | PR varies | | | QRS | < 0.12 s | | | Cause | Meds SE, hypoxia, vagal stimulation | COPD, medical disease. | ### Adverse effects * WAP = none. * MAT = ↓ CO if HR too fast. ### Treatment * WAP – None * MAT – Beta blockers/Ca channel blockers if signs of ↓CO **Atrial in Origin** 1. **Matching upright P is atrial rate \>160** Rest or... 2. **No P waves at all** warry or sawtooth baseline * * * ORS or .... 3. **Premature Abnormal P wave** w/our w/out QRS inturrupting another phuturm OR **HR \>130** phuturm regular p wave... discirnible * maybe presint but unsure ### PAC cont'd * Premature P wave may be followed by QRS * Rate can occur anytime * Regular - but interrupted * Shapes differ from sinus P wave- may be hidden in T wave far end of and. * If PAC'S P wave is miert Ed the P print should be normal. ### Causes Atria becon "hyper" and fire early- * Meds (stimulants, caffeine, Bronchodialators), tobacco, hypoxia, odz ### Adverse Effects * Frequent= HF (impenalny or impenting atrial tachycardia or atrial fibrilation occassional ill = effects * None - omit caffeine, tobacco other stimulants- can give digitslis Ca Chan blockers Beta Hlokus ### Non conducted PAC **NOT P waue o followed by QRS complex** **PAT Paroxysmal Atrial Tachycardia (PAT)** Is a sudden burst of 3 or more POCS in a row that usweps the underlying rhytum and then becomes its own khytum for a pehrod of tume * Paroxysmal = starts / stops suddenly * Resembles sinus tachy but HR is faster * Pat is 1)x when PAC intiates it is seen ### Rate * (160-250) The rhythm it interrupts will have diff rate ### Reg **(Atrial Tachy)** is reg but it is interruplo another rhythm *(Regular but interrupted)* Pwaues atrial tachy is will be shaped the same as each other, but diffently from sinus Pnaks * Int P(R=0.12 – 0.20) constant O(R(S <0.12 sec ### Cause **PAC's or Sinus tach** * (1D **CO** * (1x (digitalis, ca Chan block, B B's, sedatun, amiodarone, adenosine and OZ Elective cardiovertion ### Atrial Putter (TAT ANGASHST INPIAN TAPI) * One irritable atrial Focus fores out Regular impulses at a rate so thah paped that a Putteru Patlern is produced instead of 1) Waves * Av node is hombawded w/ impukes ### Rate **250-150** ### Red Peg * Peg it conduction Ratior to Qrs is courtont Iwey it conductou Ratin vanies ### Rwares **None runt sawtooth- shaped** ### Int Pr messund _O(R)< **0.12* ### Cause Adzo, pul embolue, valmlar dzo thyrid strom lung da If you need any further assistance, just ask.