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BASIC ECG

BASIC ECG. NITMED TUTORIALS INC. GOALS OF THE LECTURE. At the end of this lecture, the students should be able to ; Understand basic definitions and principle Determine the heart rate Identify common ECG abnormalities. DEFINITIONS. Electrocardiography Electrocardiogram Electrogram

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BASIC ECG

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  1. BASIC ECG NITMED TUTORIALS INC

  2. GOALS OF THE LECTURE • At the end of this lecture, the students should be able to ; • Understand basic definitions and principle • Determine the heart rate • Identify common ECG abnormalities

  3. DEFINITIONS • Electrocardiography • Electrocardiogram • Electrogram • Electrocardiograph

  4. CARDIAC ELECTRICAL SYSTEM • Sinoatrial Node – the Pacemaker • Internodal fibres & intraatrial pathway • Atrioventricular node • Bundle of His • Bundle branches • Fascicles • Purkinje system

  5. The Pacemaker • The Sinoatrial Node is the Pacemaker. • First described in 1907 in the countryside of Kent (UK) by Arthur Keith and his laboratory assistance; Martin Flack (a young medical student). • As such it s also called Keith –Flack Node • SAN has P cells with special property: automaticity

  6. INTRACARDIAC ELECTRICAL SYSTEM

  7. Ionic Basis of Cardiac Electrical Impulses • Ionic movement across the cell membrane • Major ions ; Sodium, Potassium • Cycles of depolarisation and repolarisation

  8. THE ELECTROCARDIOGRAM PAPER

  9. ECG Denotations • P wave • QRS complex • T wave • PR interval • QT interval • RR interval • ST segment • J junction • U wave

  10. P wave – 0.12s • QRS wave – 0.1-0.12s • PR interval – 0.12-0.2s • QT interval : depends on age and sex • RR interval : 0.6-1s • T wave – 0.1-0.25s

  11. ELECTROCARDIOGRAPH(ECG MACHINE)

  12. ELECTRODES • 10 Electrodes ; 4 limb and 6 chest electrodes.

  13. Standard 12-Lead System • Standard bipolar limb leads: I,II & III • Augmented limb leads: aVF,aVL & aVR • Chest or precordial leads: V1-V6

  14. Chest Electrode Placement • V1-4th intercostal space, right sternal edge • V2-4th intercostal space, left sternal edge • V3-midway between V2 & V4 • V4-5th intercostal space, left midclavicular line • V5-5th intercostal space, left anterior axillary line • V6-5th intercostals space, left mid-axillary line

  15. Chest Electrodes

  16. Limb Electrodes

  17. Heart Rate Estimation Regular RR Interval HR = 300/x or 1500/y where x and y are no of big and small squares within RR interval respectively Irregular RR interval Use long rhythm strip method

  18. Sinus Tachycardia

  19. Sinus Tachycardia • Sinus rhythm • Heart rate > 100bpm • Common causes • Fever -Shock • Anaemia -Pulmonary Embolism • Pain -Shock • Hyperthyroidism -Sympathomimetics like adrenaline • Treatment: B blockers, Digoxin, CCB

  20. Sinus Bradycardia

  21. Sinus Bradycardia • Sinus rhythm • Heart rate < 60bpm • Common causes • Hypothermia -physical fitness • Hypothyroidism • Drugs like beta blockers • Vasovagal syncope • Treatment : atropine, isoprenalin, cardiac pacing

  22. Atrial fibrillation

  23. Atrial Fibrillation • No discrete P wave • Fibrillary waves • Irregular RR interval • Common causes: • Hyperthyroidism -Alcohol Abuse • Hypertension -Pulmonary embolism • Valvular Hear disease • Cardiomyopathy

  24. Atrial fibrillation • Treatment: B blockers, digoxin, CCBs, amiodarone, cadioversion, anticoagulant

  25. Atrial Flutter

  26. Atrial flutter • No discrete P waves • Saw tooth appearance • Causes are same as atrial fibrillation • Treatment : cardioversion, B blockers

  27. Paroxysmal Supraventricular Tachycardia

  28. Paroxysmal Supraventricular tachycardia • Narrow QRS complex • Occurs in paroxysms • Heart rate: 150-250bpm • P waves may not be seen • Treatment : Adenosine, esmolol, digoxin, cardioversion

  29. STEMI & NSTEMI

  30. STEMI • Initial treatment: Morphine Oxygen Nitroglycerine Aspirin • Definitive treatment: PCI and thrombolysis(streptokinase)

  31. NSTEMI • Initial Treatment: MONA • Definitive : B blockers, ace inhibitors, angiography and PCI

  32. Thank You

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