Electrophysiology_of_the_Heart

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Electrophysiology of the Heart : 

EMSP 2544 Cardiology Lesson Four Electrophysiology of the Heart by Rory Prue 2008 Galveston College Paramedic Class

Slide 2: 

EMSP 2544 Cardiology Lesson Four What is an EKG?

Slide 3: 

EMSP 2544 Cardiology Lesson Four EKGs are graphic representations of electrical activity within the heart.

EKG : 

EMSP 2544 Cardiology Lesson Four EKG EKGs reflect electrical activity, not mechanical activity. To evaluate mechanical function, assess blood pressure and peripheral pulses.

EKG : 

EMSP 2544 Cardiology Lesson Four EKG EKG can tell about electrical function: Rhythm disturbances Conduction disturbances

EKG : 

EMSP 2544 Cardiology Lesson Four EKG EKG cannot tell about mechanical function: Structural disorders Perfusion disorders

Initiation of Electrical Flow : 

EMSP 2544 Cardiology Lesson Four Initiation of Electrical Flow Polarization “Ready” state Depolarization “Discharge” state Repolarization “Recovery” state

Electrical Conduction System : 

EMSP 2544 Cardiology Lesson Four Electrical Conduction System

Inherent Rates : 

EMSP 2544 Cardiology Lesson Four Inherent Rates Sinus Node 60-100 beats/min AV Junction 40-60 beats/min Ventricles 10-40 beats/min

Pacemaker Rule : 

EMSP 2544 Cardiology Lesson Four Pacemaker Rule Pacemaker site with the fastest rate will generally control the heart.

Irritability : 

EMSP 2544 Cardiology Lesson Four Irritability A site along the conduction pathway becomes irritable and speeds up, thus overriding higher pacemaking sites for control of the heart.

Escape Mechanism : 

EMSP 2544 Cardiology Lesson Four Escape Mechanism The normal pacemaker slows down or fails, and a lower pacing site assumes pacemaking responsibility.

Electrocardiographic Monitoring : 

EMSP 2544 Cardiology Lesson Four Electrocardiographic Monitoring The Electrocardiogram Positive and Negative Impulses The Isoelectric Line Artifact Muscle tremors Shivering Patient movement Loose electrodes 60-hertz interference Machine malfunction

Artifact: Muscle Tremors : 

EMSP 2544 Cardiology Lesson Four Artifact: Muscle Tremors

Artifact: Patient Movement : 

EMSP 2544 Cardiology Lesson Four Artifact: Patient Movement

Artifact: Loose Electrode : 

EMSP 2544 Cardiology Lesson Four Artifact: Loose Electrode

Artifact: 60-Cycle Interference : 

EMSP 2544 Cardiology Lesson Four Artifact: 60-Cycle Interference

Rule of Electrical Flow : 

EMSP 2544 Cardiology Lesson Four Rule of Electrical Flow

Rule of Electrical Flow : 

EMSP 2544 Cardiology Lesson Four Rule of Electrical Flow

Rule of Electrical Flow : 

EMSP 2544 Cardiology Lesson Four Rule of Electrical Flow Electricity flowing toward positive electrode produces an upright pattern.

Rule of Electrical Flow : 

EMSP 2544 Cardiology Lesson Four Rule of Electrical Flow Electricity flowing toward negative electrode produces an inverted pattern.

The Electrocardiogram (1 of 19) : 

EMSP 2544 Cardiology Lesson Four The Electrocardiogram (1 of 19) ECG Leads Bipolar (Limb) Einthoven’s Triangle Leads I, II, III Augmented (Unipolar) aVR, aVL, aVF Precordial V1 – V6

Electrode Placement for Monitoring Lead II : 

EMSP 2544 Cardiology Lesson Four Electrode Placement for Monitoring Lead II

Graph Paper : 

EMSP 2544 Cardiology Lesson Four Graph Paper

Graph Paper : 

EMSP 2544 Cardiology Lesson Four Graph Paper

The Electrocardiogram (2 of 19) : 

EMSP 2544 Cardiology Lesson Four The Electrocardiogram (2 of 19) Routine Monitoring Information from a single lead shows: Rate and regularity Time to conduct an impulse A single lead cannot: Identify/locate an infarct Identify axis deviation or chamber enlargement Identify right-to-left differences in conduction Show the quality or presence of pumping action

The Electrocardiogram (3 of 19) : 

EMSP 2544 Cardiology Lesson Four The Electrocardiogram (3 of 19) ECG Paper Speed Amplitude and Deflection Calibration

Each cardiac cycle should produce a pulse. : 

EMSP 2544 Cardiology Lesson Four Each cardiac cycle should produce a pulse.

Slide 29: 

EMSP 2544 Cardiology Lesson Four

The Electrocardiogram (4 of 19) : 

EMSP 2544 Cardiology Lesson Four The Electrocardiogram (4 of 19) Relationship of the ECG to Electrical Events in the Heart ECG Components P Wave QRS Complex T Wave U Wave

The Electrocardiogram (5 of 19) : 

EMSP 2544 Cardiology Lesson Four The Electrocardiogram (5 of 19)

The Electrocardiogram (6 of 19) : 

EMSP 2544 Cardiology Lesson Four The Electrocardiogram (6 of 19)

The Electrocardiogram (7 of 19) : 

EMSP 2544 Cardiology Lesson Four The Electrocardiogram (7 of 19)

The Electrocardiogram (8 of 19) : 

EMSP 2544 Cardiology Lesson Four The Electrocardiogram (8 of 19)

The Electrocardiogram (9 of 19) : 

EMSP 2544 Cardiology Lesson Four The Electrocardiogram (9 of 19)

The Electrocardiogram (10 of 19) : 

EMSP 2544 Cardiology Lesson Four The Electrocardiogram (10 of 19)

The Electrocardiogram (11 of 19) : 

EMSP 2544 Cardiology Lesson Four The Electrocardiogram (11 of 19)

The Electrocardiogram (12 of 19) : 

EMSP 2544 Cardiology Lesson Four The Electrocardiogram (12 of 19) Time Intervals PR Interval (PRI) or PQ Interval (PQI) 0.12–0.20 seconds QRS Interval 0.08–0.12 seconds ST Segment QT Interval 0.33–0.42 seconds

The Electrocardiogram (13 of 19) : 

EMSP 2544 Cardiology Lesson Four The Electrocardiogram (13 of 19) Refractory Periods Absolute Relative

Slide 40: 

EMSP 2544 Cardiology Lesson Four

Slide 41: 

EMSP 2544 Cardiology Lesson Four

The Electrocardiogram (14 of 19) : 

EMSP 2544 Cardiology Lesson Four The Electrocardiogram (14 of 19) ST Segment Changes Associated with Myocardial Infarctions Ischemia Injury Necrosis

Various QRS Configurations : 

EMSP 2544 Cardiology Lesson Four Various QRS Configurations

The Electrocardiogram (15 of 19) : 

EMSP 2544 Cardiology Lesson Four The Electrocardiogram (15 of 19) Lead Systems and Heart Surfaces

The Electrocardiogram (16 of 19) : 

EMSP 2544 Cardiology Lesson Four The Electrocardiogram (16 of 19) Interpretation of Rhythm Strips Basic Criteria Always be consistent and analytical. Memorize the rules for each dysrhythmia. Analyze a given rhythm strip according to a specific format. Compare your analysis to the rules for each dysrhythmia. Identify the dysrhythmia by its similarity to established rules.

The Electrocardiogram (17 of 19) : 

EMSP 2544 Cardiology Lesson Four The Electrocardiogram (17 of 19) Five-Step Procedure Analyze the rate. Analyze the rhythm. Analyze the P waves. Analyze the PR interval. Analyze the QRS complex.

The Electrocardiogram (18 of 19) : 

EMSP 2544 Cardiology Lesson Four The Electrocardiogram (18 of 19) Analyzing Rate Six-Second Method Heart Rate Calculator Rulers RR Interval Triplicate Method Analyzing Rhythm Regular Occasionally Irregular Regularly Irregular Irregularly Irregular

The Electrocardiogram (19 of 19) : 

EMSP 2544 Cardiology Lesson Four The Electrocardiogram (19 of 19) Analyzing P Waves Are P waves present? Are the P waves regular? Is there one P wave for each QRS complex? Are the P waves upright or inverted? Do all the P waves look alike? Analyzing the PR Interval Analyzing the QRS Complex Do all the QRS complexes look alike? What is the QRS duration?

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