NHA CCMA: EKG and other electrocardio tests

Bipolar leads

Leads I, II, and III

Unipolar leads

AVL, AVR, AVF (must be augmented)

Lead I records

Right arm to left arm

Lead III records

Left leg to left arm

Lead II records

Right arm to left leg

aVL lead

left leg and right arm assist with the left arm tracing

aVR lead

left arm and left leg assist with the right arm

aVF lead

right arm and left arm assist with left leg tracing

Universal leads

RA, LA, LL, RL

precordial leads

V1-V6

V1 lead placement

right side of sternum, 4th intercostal space

V2 lead placement

Left side of sternum, 4th intercostal space, directly across from V1

V4 lead placement

Left side of the chest left, 5th intercostal space, midclavicular line

V3 lead placement

Left side of the chest, between V2 and V4

V5 lead placement

Left side of the chest, 5th intercostal space, anterior axillary line

V6 lead placement

Left side of the chest, 5th intercostal space, midaxillary line

P wave represents

atrial depolarization (atrial contraction)

QRS wave represents

ventricular depolarization

T wave represents

ventricular repolarization or relaxation

U wave represents

represents repolarization

P-R interval

Time it takes for the beginning of atrial depolarization to the beginning of ventricular depolarization

Q-T interval

Time from the beginning ventricular depolarization to ventricular repolarization

S-T segment

time from the end of the ventricular depolarization to the beginning of ventricular repolarization

Sinus Bradycardia

less than 60 bpm

Sinus Tachycardia

greater than 100 bpm

Sinus Arrest

SA node doesn't fire

Atrial Flutter

The atria is beating at an extremely rapid rate

Atrial Fibrillation

No organized contractions of the atrium

Ventricular Fibrillation

Ventricles don't contract but quiver, no waves noted

Somatic Tremor (artifact )

Irregular spike throughout the tracing, Muscle movement (shivering, Parkinson's disease)

AC interference (artifact)

regular spikes, poor grounding, electrical interference (crossed wires)

Wandering baseline (artifact)

move up and down rather than be straight, may be caused by: loose electrode; body creams, oils or lotions

Interrupted baseline (artifact)

Break in tracing, may be caused by the metal tip of a lead wire becoming detached or by a broken pt. cable

EKG ratio

10:12

Widened QRS complex

PVC's

Polarization

Resting state of the myocardial wall, resulting in flatline or pause in EKG

25mm/sec

The normal running speed of the EKG paper

Heart rate calculation

divide 1500 by the number of small boxes between two R waves

asystole

absence of contractions of the heart

premature ventricular contraction

abnormal waves

P wave negative deflection

normally P waves should be positive deflected, a junctional dysrhythmia is likely present

LA

black lead

RA

white lead

LL

red lead

RL

green lead

v1

red

v2

yellow

v3

green

v4

blue

v5

orange

v6

purple

Holter monitor

a portable electrocardiograph that is worn by an ambulatory patient to continuously monitor the heart rates and rhythms over a 24-hour period

electrodes

sticky skin sensors that attach to the patient

vertical x-axis

amplitude

horizontal x-axis

time

how many seconds is each horizontal square

0.04 seconds

Paper speed

25 mm/sec

first 6 recorded leads

originate in the arms and legs

somatic tremor

AC interference

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wandering baseline

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interrupted baseline

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