The Cardiac Cycle and The ECG Carson Vandiver This template can be used as a starter file for presenting training materials in a group setting. Sections Sections can help to organize your slides or facilitate collaboration between multiple authors. On the Home tab under Slides, click Section, and then click Add Section. Notes Use the Notes pane for delivery notes or to provide additional details for the audience. You can see these notes in Presenter View during your presentation. Keep in mind the font size (important for accessibility, visibility, videotaping, and online production) Coordinated colors Pay particular attention to the graphs, charts, and text boxes. Consider that attendees will print in black and white or grayscale. Run a test print to make sure your colors work when printed in pure black and white and grayscale. Graphics, tables, and graphs Keep it simple: If possible, use consistent, non-distracting styles and colors. Label all graphs and tables.

Einthovens Triangle

The Normal ECG

Sinus Rhythms The Impulse is Originating in the SA node (Sinus Node) Characterized by: One P wave for Every QRS Complex Rhythm is Normally Spaced out Regularly PR interval is between .12-.20 Seconds QRS is less than .12 Seconds Classified by Rate

Normal Sinus Rhythm Rate is Between 60-100

Sinus Bradycardia Rate is less than 60 beats per minute

Sinus Tachycardia Rate is between 100 and 150

Sinus Arrhythmia Impulse is still originating in SA node but QRS complexes are spaced out unevenly (Usually related to breathing pattern)

Wandering Atrial Pacemaker Has all the characteristics of sinus Arrhythmia but P waves have different Morphology

AV Blocks AV blocks means that there is an issue with the conduction of the Impulse through the AV node Characterized by: By an Abnormal PR interval Or More than 1 P wave associated with Every QRS

First Degree AV Block Impulse is being held for too long at AV Node Usually Benign (Very Common in Elderly)

Second Degree Type 1 AV Block PR Interval gets longer until QRS is Dropped Commonly associated with Myocardial infarctions (Heart Attack) or infections of the heart such as myocarditis

Second Degree Type 2 AV Block Impulse is blocked at AV Node Commonly associated with extensive damage to the bundle branches usually caused by an anteroseptal Myocardial infarction (heart attack)

Third Degree AV Block Total disassociation between the electrical activity in the Atria and Ventricles Very critical requires immediate intervention because they are normally hypotensive and Bradycardic

Junctional Rhythms Av Junction is the secondary pacemaker site for the heart if the impulse fails to start in the SA node the AV junction will start firing Junctional Rhythms are Characterized by: The Absence of a P wave Regularly spaced out QRS Complexes QRS that is less than .12 seconds in length The are classified by Rate Can be caused by drug toxicity from Digoxin, Myocardial infarctions and a number of other physiological issues

Junctional Escape Rhythm Rate is 40-60 Beats per Minute

Accelerated Junctional Rhythm Rate 60-100 Beats per Minute

Junctional Tachycardia Rate is between 100-150 beats per minute

Atrial Arrhythmias Impulse is originating in the SA node Characterized by QRS that is less than .12 seconds Can be benign or life threatening

Atrial Fibrillation (A-Fib) No organized atrial contraction Atria is Fibrillating (Pulsating)

Atrial Flutter Well defined pacemaker within atria firing at a rate of 250-350 times

Suparventricular Tachycardia (SVT) Occurs when a Pacemaker site develops within the Atria and fires very quickly (Greater than 150 beats per minute) Life Threatening

Ventricular Dysthymias Caused by a pacemaker site developing somewhere in the Ventricles Characterized by: QRS complex that is greater than .12 Can Be life threatening

Ventricular Tachycardia (V-tach) Caused by a pacemaker site originating in the ventricles and beating very fast (100-250 beats per minute) Life Threatening requires intervention

Cardiac Arrest Rhythms With these rhythms the patient does not have a pulse Very life threatening If the person does not have a pulse you should be doing CPR Depending on the rhythm these patients require drugs and defibrillation to correct

Ventricular Fibrillation (V-Fib) No organized electrical rhythm Ventricles are Fibrillating (Pulsating)

Pulseless electrical activity (PEA) The lights are on but no one is home The heart is still experiencing organized electrical activity but there is no mechanical activity ie. The person does not have a pulse

Asystole No electrical activity

Ectopic Beats An Ectopic beat is premature heart beat They are broken down by the origin of the electrical impulse Most of the time they are benign

Premature Atrial Contraction

Premature Junctional Contraction A beat originates in the AV Junction early

Premature Ventricular contraction

Bundle Branch Block There is a block in the transmission of the electrical impulse somewhere in the ventricles Can be found within any other rythm

12-Lead ECG Much more complicated to read Used in the pre-hospital setting to Identify ST elevation Myocardial Infarctions Used in the hospital setting to aid in the diagnosis various cardiac related conditions Uses the 4 limb leads plus 6 precordial leads to take pictures of the heart from different angles

12-Lead ECG patches placement

12-Lead ECG