Lead II Interpretation

WAVE WAVE WAVE

Electrode

Conductive sensor pad that attached to the skin to allow the electrical current to be recorded

Bipolar Lead Placements

• Lead I = Right Arm to Left Arm

• Lead II = Right Arm to Left Leg

• Lead III = Left Arm to Left Leg

Uni-polar Leads

• aVR = Right Arm

• aVL = Left Arm

• aVF = Left Foot

Einthoven’s Law

• Lead I + Lead III = Lead II (QRS)

• Lead II should always be the tallest QRS

ECG Paper Y-Axis

• Voltage

• 1 small square = 0.1mV

ECG Paper X-axis

• 1 small square = 0.04 sec

• 1 large square = 0.2 sec

Standard Paper speed

25mm/sec

Normal Sinus Rhythm

• Rate: Normal

• Positive P-wave

• P wave before every QRS

• QRS after Every P

• PR interval: < 0.2s

• QRS interval: <0.12s

Sinus Tachycardia

• Rhythm: Regular

• Rate: Irregular

• (+) P wave

• P wave before every QRS

• QRS after every P

• PR: < 0.2s

• QRS: < 0.12

Causes of Sinus Tachycardia

• Physical Exhertion

• Emotional states

• Stimulants

• Fever

• Stimulants

Adverse Effects of Sinus Tachycardia

• Worsening Heart Failure

• Blood Clots

• Stroke

• Reduced quality of life

Sinus Tachycardia Treatments

Sinus Bradycardia

• Rhythm: Regular

• Rate: Irregular

• (+) P-wave

• P wave before every QRS

• QRS after every P

• PR: < 0.2s

• QRS: < 0.12s

Sinus Bradycardia

• Rhythm: Regular

• Rate: Irregular

• (+) P-wave

• P wave before every QRS

• QRS after every P

• PR: < 0.2s

• QRS: < 0.12s

Causes of Sinus Bradycardia

• Increased vagal tone

• Ischemic Heart Disease

• Thyroid disorders

• (+) ICP

• Beta-Blockers

Adverse Effects of Bradycardia

• Syncope

• Cardiogenic Shock

• Fatigue and weakness

• Dizziness or lightheadedness

Treatments of Bradycardia

• address underlaying cause

• Medication adjustments

• Epinephrine

• Pacemaker

Sinus Dysrhythmia

• Rhythm: Irregular

• Rate: Regular

• (+) P wave

• P wave before every QRS

• QRS after every P

• PR: < 0.2s

• QRS: < 0.12s

Causes of Sinus Dysrhythmia

• Thrid-Degree AV block

• Hemodynamic Changes

• Medications

Adverse Effects of Sinus Dysrhythmias

none

Treatment of Sinus Dysrhythmias

• Pacemakers

• Medication Adjustment

Sinus Arrest

• Rhythm: Irregular

• Rate: Regular

• (+) P wave

• P wave before every QRS

• QRS after every P

• PR: < 0.2s

• QRS; < 0.12s

Sinus Arrest

• Rhythm: Irregular

• Rate: Regular

• (+) P wave

• P wave before every QRS

• QRS after every P

• PR: < 0.2s

• QRS; < 0.12s

Causes of Sinus Pause/Arrest

• Age related degeneration

• Ischemia

• Heart Surgery scars

• Cardiomyopathies

Adverse Effects of Sinus Pause/Arrest

• Syncope

• Palpitations

• Dizziness

• Weakness

Treatments of Sinus Pause/Arrest

• Medications

• Electrolyte Therapy

• Atropine

• Pacemaker

Premature Atrial Contraction

• Early beats originating in the Atria

• Rhythm: Irregular

• Rate: Regular

• (+) P wave

• P wave before every QRS

• QRS after every P

• PR: < 0.2s

• QRS; < 0.12s

Causes of PAC

• Stimulants

• Electrolyte Imbalances

• Atrial Changes

• Endocrine issues

Adverse effects of PAC

• Atrial Fibrillation

• Heart Failure

• Ischemic Stroke

• Increased Motrality

Atrial Flutter

• Rhythm: Reglular

• Rate: Regular

• (+) P wave

• SawTooth waveform

• No P-waves

• PR: < 0.2s

• QRS; < 0.12s

Causes or Atrial Flutter

• Hypertension

• CAD

• Excessive Alcohol consumption

• hyperthyroidism

Adverse Effects of Atrial Flutter

• Stroke

• Heart Failure

• Progression to A-Fib

• Infarction

Atrial Fibrillation

• Rhythm: Irregular

• Rate: Regular/Irregular

• Irregular patterns

• PR: < 0.2s

• QRS; < 0.12s

Causes of Atrial Fibrillation

• Hypertension

• Heart Disease

• Thyroid Disease

• Heavy alcohol consumption

• Age

Adverse Effects of Atrial Fibrillation

• Stroke

• Heart Failure

• Palpitations

• Syncope

Wandering Atrial Pacemaker

Causes or Wandering Atrial Pacemaker

Adverse Effects Atrial Pacemaker

Supraventricular Tachycardia SVT

Causes of SVT

Adverse effects of SVT

Wolff-Parkinson White Syndrome (WPW)

Causes of WPW

Adverse Effects of WPW

Junctional Rhythm

Causes of Junctional Rhythm

Adverse Effects of Junctional Rhythms

Accelerated Junctional Rhythm

Causes of Accelerated Junctional Rhythm

Accelerated Junctional Rhythm adverse effects

Junctional Tachycardia

Junctional Tachycardia Causes

Junctional Tachycardia Adverse effects

Premature Junctional Contractions (PJC)

PJC Causes

PJC Adverse effects

1st Degree Heart Block

1st Degree Heart Block Causes

1st Degree Heart Block Adverse effects

2nd Degree Heart Block -MOBITZ Type I

Mobitz Type I Causes

Mobitz Type I Adverse Effects

MOBITZ Type II

MOBITZ Type II Causes

MOBITZ Type 2 Adverse effects

3rd Degree Heart Block

Premature Ventricular Contractions PVC

Bigeminy & Trigeminy

Idoventricular

Accelerated Idioventricular

Agonal Rhythm

60 Cycle Interference

Loose Lead Artifacts

Wandering Baseline

Pulse Rate

Number of bear per min that can be palpated

Heart Rate

Number of times the heart contracts per min

Monitored Rate

Rate of electrical conduction in the heart as per the cardiac monitor

Dual Chamber Pacemakers

• Leads implanted in both atria and ventricle

• Produces spikes followed by P-waves + QRS complex

Ventricular Pacemakers

• Lead implanted in ventricle

• Produces a spike followed by a QRS complex

Fixed Rate pacemaker

Fires at the same rate

Demand Pacemaker

Only provides impulses if the intrisinc rate falls below the rate the pacemakers is set to

AICD Purpose

• Monitors Pt Heart Rhythm

• Shocks Pt when they are in VT or VFib

Reasons to be careful with an AICD

• Given to Pt with experiences with shockable cardiac arrest or other ventricular arrythmias

• They have long QT syndrome (risk of VT)