12-Lead EKG Interpretation for the Primary Care Provider

Transcription

1 21 st Annual Southwestern Regional Nurse Practitioner Symposium July 26, Lead EKG Interpretation for the Primary Care Provider Fran Stier MSN, ANP-BC, ACNP-BC Heart Health Care LLC Show Low, AZ 12-Lead EKG Interpretation for the Primary Care Provider, Fran Stier, ANP (Part 1 of 3 parts)

2 Objectives As listed in your handout 12-Lead EKG Interpretation for the Primary Care Provider, Fran Stier, ANP

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10 Autonomic Stimulation Sympathetic Norepinephrine Stimulates atria, but mainly Ventricles Increases: force of contraction, heart rate, AV node conduction Parasympathetic Acetycholine Stimulates SA,AV nodes, atria, ventricles, but mainly supraventricular. Decreases: heart rate, AV conduction 12-Lead EKG Interpretation for the Primary Care Provider, Fran Stier, ANP

11 Properties of Cardiac Muscle 12-Lead EKG Interpretation for the Primary Care Provider, Fran Stier, ANP

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23 Current Flow and the EKG Current flow parallel to lead Largest deflection. Upright/positive deflection - flow towards the positive electrode. Downward/negative deflection-flow away from the positive electrode. Equiphasic: = R & S wave, flow is perpendicular to the lead. 12-Lead EKG Interpretation for the Primary Care Provider, Fran Stier, ANP

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31 Frontal Leads Precordial Leads 12-Lead EKG Interpretation for the Primary Care Provider, Fran Stier, ANP

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37 QT c = QT R-R 12-Lead EKG Interpretation for the Primary Care Provider, Fran Stier, ANP

38 Lead System 12-Lead EKG Interpretation for the Primary Care Provider, Fran Stier, ANP

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46 Steps in Analyzing the 12-Lead EKG Make initial survey Most critical changes: ST segment, slow or fast rhythms, premature beats, pauses Identify P waves Determine the # P waves between complexes Does a QRS complex follow every P wave Measure the intervals, complexes Rhythm regular or irregular 12-Lead EKG Interpretation for the Primary Care Provider, Fran Stier, ANP

47 10 Step Analysis of the EKG Analyze rhythm Calculate rate 12-Lead EKG Interpretation for the Primary Care Provider, Fran Stier, ANP

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50 EKG Changes Acute Coronary Syndromes 12-Lead EKG Interpretation for the Primary Care Provider, Fran Stier, ANP

51 Types of Infarction Acute Coronary Syndromes Unstable Angina: ST depression deeply inverted T waves and negative enzymes NSTEMI: ST depression deeply inverted T waves and positive enzymes STEMI: ST elevation w/positive enzymes 12-Lead EKG Interpretation for the Primary Care Provider, Fran Stier, ANP

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54 Beware of Mimics LBBB LVH Ventricular Rhythms 12-Lead EKG Interpretation for the Primary Care Provider, Fran Stier, ANP

55 Other conditions altering the ST segment, T wave and Q wave. Cardiac Non-Cardiac T wave inversion Bundle branch block. Ventricular hypertrophy Pericarditis Electrolyte imbalances. Shock. Positional changes. CNS- subarchanoid hemorrhage. ST depression Anginal attacks. Reciprocal changes. Non-Q wave MI. Bundle branch block. Ventricular hypertrophy Hypokalemia. Hypothermia. Drugs: Digitalis, Quinidine. ST elevation Q wave change Pericarditis Ventricular aneurysm Bundle branch block Ventricular hypertrophy Diffuse myocardial disease Fascicular block 12-Lead EKG Interpretation for the Primary Care Provider, Fran Stier, ANP

56 Site & Location of MI 12-Lead EKG Interpretation for the Primary Care Provider, Fran Stier, ANP

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63 Time for a Break 12-Lead EKG Interpretation for the Primary Care Provider, Fran Stier, ANP