ET&P EKG interpretation and cardiac diagnosis

who captured the first actual electrical rhythym? when?

Alenxander Muirhead, 1869

capillary electrometer

electric potentials produced movement 1873

who recorded the first electrogram? when? what did it do?

AD waller, 1887, used capillary electrometer to measure through the chest wall

what did Einthoven do?

•used the capillary electrometer, revised it, improved it and decided it was inadequate

Einthoven created the String Galvanometer (first EKG machien)

very big, 600 pounds

used until vacuum tube amplififer develoepd in 1920s

true or false EKG is by nature 3 dimensional?

true

Einthovens triangle

what is Ohm’s?

unit of resistance

general overview inspection; step 1

•Rate

•Rhythm

•Shape of each Wave (and how tall and wide)

•Ventricular Activity

•Atrial Activity

•Atrioventricular relationship

–Normal Sinus Rhythm

Cardiac Dysrythmias

describe ventricular activity

•Rate

–Irregular can be identified immediately

–Bradychardia

–Tachycardia

–

•Shape and Duration

–QRS – each one identical?

–Narrow QRS less than .10 second = supraventricular origin

–Distorted shape greater than .10 second = ectopic focus

         (originates outside the ventricle)

describe atrial activity

•P Waves

•Rate, Rhythm and Shape

•PR interval

-below 120ms can mean signal traveling between atria and ventricles too quickly

-begininning of P wave to beginnning of QRS complex

-prenatal contaction=extra P-wave

•Unexpected P waves

•Atrial flutter or fibrillation

•P waves initiated outside the atrium

atrioventricular relationship

• P wave to QRS ratio 1:1,

  —-2:1 or more means not all atial impulses get through

•1) is each P wave followed by a QRS complex?

•2) is each QRS followed by a single P Wave?

•Does a pattern exist?

•PR interval – start of P wave to start of QRS

—-Represents the start of atrial depolarization to the start of ventricular depolarization

•PR interval should be consistent, no longer than .2 seconds

slide11

identify normal sinus rhythm

which?

• bradycardia

• preventricular contractiuons

• atrial flutter

• atrial fibrilation

• complete AV block

bradycardia

which?

• bradycardia

• preventricular contractiuons

• atrial flutter

• atrial fibrilation

• complete AV block

preventricular contractions

• which?

  • bradycardia

  • preventricular contractiuons

  • atrial flutter

  • atrial fibrilation

  • complete AV block

atrial flutter

• which?

  • bradycardia

  • preventricular contractiuons

  • atrial flutter

  • atrial fibrilation

  • complete AV block

atrial fibrillation

• which?

  • bradycardia

  • preventricular contractiuons

  • atrial flutter

  • atrial fibrilation

  • complete AV block

comlpete AV block

atrial fib vs artial flutter

Atrial Flutter

• Atria beat regularly but much faster than usual and more often than the ventricles

• Atrial Conduction is coordinated

Atrial Fibrillation

• Atria beat irregularly, more chaotic.

• Atrial Conduction is disorganized

• FAR MORE COMMON

• Atrial ablation treatment technique (catuerizes/burns on either end to prevent electrical activity (around heart), need multiple times

what is the instant recognition of a heart attac?

ST elevation

electrolyte changes in EKG

explain heart cath. factors

• outpatient procedure

• minimally invasive (compared to open heart)

• diagnostic as well as theraputic

what is the called the widow maker?

the left anterior descending artery→ if it stops, heart dies

echocardiagram

ultrasound of the heart

can look at the chambers

3d

CAT scan

• purely software driven

• pixels of calcium solidified are counted to generate3 a score. calcium # found as it appears white and it counted

• not as intense as MRI

• calcium score

→ 0-100=good

→ 100-200=get checked out

→ 200-300=cath lab

→ 400+=surgery asap

scale goes to 1200

EKG stress test

• regular stress test annual vs diagnostic(if something came it, can get checed)

• nuclear stress test = radioactive nucleotide→ visible via CAT scan to see what heart looks like

• incremntally stressing the heart to monitor the adaptability of the heart muscles effectiveness

angiogram

• diagnostic oimaging

• ability to make a picture of the inside of vessels and organs

• echocardiogram usually better