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Anatomy ECG Electrodes ECG Waveform The 12 lead ECG How does the heart work AV node activated by Atrial depolarization Sends signal through His-purkinje bundle Get depolarization of SEPTUM Left and Right BUNDLES transmit signal to Left and Right VENTRICLES Net “Vector” towards the LV Should be narrow (<120msec) if bundles working properly Then have REPOLARIZATION = Twave The appearance of this electrical activity depends on which lead you are using to look at it Review of waveforms How to Look at an ECG • Rate: • Rhythm: • Axis: • • • • • Is the heart rate too fast or slow? Sinus rhythm or not? Where does the majority of electrical activity point? P wave: How big are the atria? PR interval: How healthy is the AV node? QRS wave: Is there abnormal conduction or a ventricular source? QT: Long is bad Ischemia and hypertrophy ECG Paper Can Determine Heart Rate Rule: 300, 150, 100, 75, 60, 50 counting over for each big sqaure What is the heart rate? Answer = 75 per min Rhythm : Is there a p wave? = Sinus Is it followed by a QRS? Is the rhythm regular or irregular? Reasons to have an irregular rhythm • Irregular pacemaker – Multifocal atrial rhythm – Atrial fibrillation – Atrial fib/flutter • Ectopic beats – PVC – PAC – PJC • Irregular conduction – AV node block • 1st degree: – PR interval > 200 msec • 2nd degree: – Type 1: Wenkebach – Type 2: dropped beat • 3rd degree: – p waves marching independent to QRS Examples of Rhythms Multifocal Atrial Rhythm AFIB Atrial Flutter AFIB V TACH Example of a PVC Telling the Axis from the leads The axis wheel The P wave The QRS QRS < 120 msec QRS > 120 msec Rabbit ears in V1 & V2 Wide S wave in V5 & V6 R axis deviation QRS > 120 msec Deep slurred S wave in V1 Wide R wave in V6, I & avL L axis deviation Ishcemia vs Acute Infarct Example of Ischemia Examples of Infarctions Review • Rate: • Rhythm: • Axis: • • • • • Is the heart rate too fast or slow? Sinus rhythm or not? Where does the majority of electrical activity point? P wave: How big are the atria? PR interval: How healthy is the AV node? QRS wave: Is there abnormal conduction or a ventricular source? QT: Long is bad Ischemia and hypertrophy Describe this ECG Describe this Strip
