Basic EKG Interpretation. Nirja Parikh, PT, DPT

Transcription

1 Basic EKG Interpretation Nirja Parikh, PT, DPT

2 Electrocardiogram (EKG) Using surface electrodes record the electrical activity of the heart electrical activity (usually) correlates to mechanical function Information from EKG Heart Rate Heart Rhythm Heart Size Ischemia/Infarction Drug and electrolyte abnormalities

3 Bachman s Bundle SA Node Internodal Branches Atrial Muscle AV Node Bundle of His R & L Bundle Branches Purkinje Fibers Ventricular Muscle Fibers

4 Sequence of Electrical and Mechanical Alterations

5 R Normal EKG T P U Q S P wave = atrial depolarization QRS = ventricular depolarization T wave = ventricular repolarization

6 EKG Rhythm Strips Normal & Dysrhythmias

7 Simple Rules of Reading EKG s Pattern Recognition Check R wave - size, shape, distance Check QRS complex (ventric depolariz=should be nice and skinny) Check P wave size, shape, distance Check PR interval Check T wave - size/shape Check ST segment Notify medical personnel when changed from normal or life threatening

8 Normal Sinus Rhythm (NSR) Rate between 60 and 100 beats per minute (bpm) SA Node in control Rhythm is regular (on EKG look for R wave distance to be the same)

9 Rate of 300: Rule of 300- Divide 300 by the number of boxes between each QRS = rate

10 Rate Abnormalities Normal Sinus Rhythm NSR bpm Bradycardia < 60 bpm This is normal in? Tachycardia > 100 bpm This is normal in?

11 What is the heart rate? 75 bpm

12 Inherent Rates SA Node = 100 bpm Atria = 75 bpm AV Node = 60 bpm Ventricles = bpm (effect CO) Emergency rates bpm

13 Rhythms Regularly regular (NSR): normal Irregularly irregular: no pattern Regularly irregular: pattern will be there

14 Dysrhythmia's Alteration in: Rate Rhythm Ectopic Focus/Foci irritable cell (one bad apple) consequence gap junction

15 NSR Irregular R waves

16 Causes of Ectopic Foci (Irritable Cells) Ischemia/Hypoxia of the myocardium Sympathetic Discharge - anxiety, exercise Acidosis Alterations in electrolytes (primarily K+) Excessive stretch of the myocardium (heart failure) Pharmacological Agents SNS mimetics - caffeine Anti-arrhythmic drugs

17 Simple Rules of Reading EKG s Check QRS wave: Size( should not be wider then 3 small blocks) shape distance between R waves

18 QRS

19

20 Simple Rules of Reading EKG s Check P wave: size/shape distance from Q wave

21 Simple Rules of Reading EKG s Check PR interval - should be <.2 seconds or 1 large box PR interval PR interval

22 Simple Rules of Reading EKG s Check T wave: size/shape

23 Simple Rules of Reading EKG s ST segment depression measured in mm - each small box is 1 mm. myocardial ischemia ST segment

24 ST-Segment - Measured in mm What s this? 2 mm ST - Depression

25 ST Elevation Acute myocardial infarction

26 Premature Beats Premature atrial contractions PAC Ectopic foci from atria Premature ventricular contraction PVC Ectopic foci from ventricles

27 Premature Atrial Contraction (PAC) I1lyBZR82dQ

28 Premature Ventricular Contraction (PVC)

29 Unifocal PVC s

30 Unifocal PVC

31 Multiifocal PVC s

32 Multifocal PVCs

33 Bigeminy - 1 Normal: 1Abnormal

34 Trigeminy - 2 Normal:1 Abnormal What would the pulse feel like? Regular, Regularly-Irregular, Irregularly-Irregular

35 Quadrigeminy - 3 Normal:1 Abnormal

36 More Names for PVC s Couplet

37 Couplet

38 More Names for PVC s > 3 PVC s in a row is Ventricular (V) Tach As the PT working with this patient, what would you do?

39 Ventricular Tachycardia - Rate of bpm Rate? Rhythm?

40 Ventricular Tachycardia Non sustained VT (6 beat run of VT) Sustained VT

41 Consequence of V-tach

42 Ventricular Fibrillation What do you need to do?

43 More Rhythms Arial Flutter: one ecetopic Atrial Fibrillation: multiple ecetopic

44 Arial Flutter Can be described by: Saw tooth pattern One cell is irritated and beating fast >bpm Multiple P waves

45 Atrial Flutter

46 Atrial Fibrillation Multiple Cells

47 Irregularly, Irregular fixspydexgm

48 What the Hey is Going On???? Heart rate? Atrial rate? Ectopic sites location? Will you exercise this patient if prior rhythm was NSR? Why or why not?

49 What is This Heart rate? Rhythm? What would you do?

50 Would you walk this person? Heart rate? What would you do?

51 AV-Node Blocks Damage or fibrotic change to the AV Node leads to varying degrees of AV Node Block 1st degree - mild 2nd degree 3rd degree complete block

52 1st Degree AV-Block Check PR interval - will be >.2 seconds or 1 large box PR interval Normal PR interval 1st Degree AV-Block

53 2nd Degree AV-Block 2-3 P Waves/QRS P P QRS P P QRS P P QRS P P QRS AV node is holding on to the signal and does not get to the ventricles SA node is still firing away 2 P waves to every QRS complex

54 nd Types of 2 Degree AV Block Wenckebach Every successive PR interval is longer until a QRS complex is dropped Starts all over again PR Interval PR Interval PR Interval PR Interval

55 Second Degree AV Block Mobitz I (Wenckebach)

56 nd Other Types of 2 Degree AV Block Mobitz II PR interval stay the same but a QRS complex is dropped Starts all over again PR Interval PR Interval PR Interval PR Interval

57 3rd Degree AV-Block Complete Block

58 3rd Degree AV-Block P QRS P P QRS P P QRS P

59 3rd Degree HB Complete HB or AV Block

60 For what it's worth: it's never too late or, in my case, too early to be whoever you want to be. There's no time limit, stop whenever you want. You can change or stay the same, there are no rules to this thing. We can make the best or the worst of it. I hope you make the best of it. And I hope you see things that startle you. I hope you feel things you never felt before. I hope you meet people with a different point of view. I hope you live a life you're proud of. If you find that you're not, I hope you have the strength to start all over again."