1. Electrical Flow of the Heart
NRSG450
Module Two
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2. Background of Electrical Flow of the Heart
The flowing electricity is summarized to give a general direction. This is called the vortex.
The vortex is the electrical direction viewed on the monitor.
Electrical flow toward a positive electrode gives a upward deflection. Flow away from the positive electrode gives a downward deflection.
Lead II - +
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3. Background of Electrical Flow of the Heart
The electrical activity of the heart is examined from several different views or directions, commonly called leads.
The common leads are six limb leads and six chest leads. Many more leads are possible and are used in special situations.
Most patients with a non-cardiac condition are monitored in Lead II.
Cardiac patient monitoring is based on the expected problems, usually MCL1 &/ MCL 5/6

5. Reading Electrical Flow of the Heart
12 Lead EKG
V4 or MCL4
VI or MCLI I
AVR
V5 or MCL5
AVL
V2 or MCL2 II II
V6 or MCL6
III
V3 or MCL3
AVF
Lead II monitoring strip

6. Reading the Electric Flow of the Heart
The EKG Rhythm Strip

7. Reading the Electrical Flow of the Heart
A straight line is called the isoelectric line. It is seen when no electrical flow is detected in the heart.

8. Reading the Electrical Flow of the Heart
The electrical activity of the heart is picked up be electrodes, travels through the wires to a heated stylus and transferred to specially designed EKG paper.

9. Reading the Electrical Flow of the Heart
EKG is recorded on graph paper traveling at 25mm per second
The horizontal axis is time.
1 small block=1mm=0.04 sec
5 small blocks= 1 big block = 5mm = 0.2 sec
5 big blocks = 1 second
30 big blocks = 6 seconds
The vertical axis is voltage.
1 small block = .01 mv
10 small blocks=2 big blocks = 1 mv

10. Reading the Electrical Flow of the Heart
One heart beat or an electrical wave propagation
Depolarization wave
Heart muscle contraction

11. Reading the Electrical Flow of the Heart
San Diego Paramedics
San

12. Reading the Electrical Flow of the Heart
Putting it together!

13. DRAG LABELS TO CORRECT LOCATION AND REBUILD THE CHART
THIS SLIDE WILL SHOW A FLASH DRAG AND DROP QUIZ
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14. Anchoring the Information
qrs
Label the waves. T p
qrs
qrs
qrs
qrs
qrs p T p p T p T T p T
pr = 0.20
QRS = o.o4 p p p T T
qrs
qrs
qrs p T p p T p T
qrs
qrs
qrs p T p pr
= 0.12
QRS = .06
pr = 0.44
QRS = o.o6

15. DRAG LABELS TO CORRECT LOCATION AND REBUILD THE CHART
THIS SLIDE WILL SHOW A FLASH DRAG AND DROP QUIZ
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16. Reading the Electrical Flow of the Heart
p wave = atrial depolarization
Accounts for the time electrical stimulation moves across the atria.
Duration 0.06 – 0.12 sec (2 small blocks> 4 small blocks)
Located before QRS complex
Height 2-3 mm ( mv)
Shape rounded & positive (upright)
Normal
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17. Reading the Electrical Flow of the Heart
PR interval involves the atrial and nodal depolarization
Measure from beginning of p wave to the beginning of the QRS
Duration 0.12 – 0.20 sec

18. Reading the Electrical Flow of the Heart
Ventricular depolarization is represented by the QRS complex
Normal
location
Location follows the PR interval.
Duration seconds
Amplitude dependent on Lead (~5-30 mm)
Configuration dependent on Lead
Deflection usually a combination of negative
and positive, varies with leads
Schwimmin

19. Reading the Electrical Flow of the Heart
ST segment from the end of the S wave to the beginning of T wave
Usually isoelectric,
May be from mm from the isoelectric line

20. Reading the Electrical Flow of the Heart
T wave is ventricular repolarization
Normal
Location follows the s wave
Configuration is round & smooth
(looks like a big p wave)
Deflection is usually positive

21. Reading the Electrical Flow of the Heart
QT segment is measured from the beginning of the QRS complex to the end of the T wave.
Duration is rate dependent
Not routinely measured

22. Reading the Electrical Flow of the Heart
Wave Summary