2. ECG, EKG, Electrocardiogram  The ECG is easy to understand  The abnormalities happen for a reason

3. CONSTANT VIGILANCE !!!

4. The electricity of the heart

5. What to expect from the ECG  Essential monitor  Rate, rhythm, propagation of the excitation wave, heart position, muscle hypertrophy, regional ischemia  NO information about pump function

6. 3-lead system

10. Lead Selection Lead II is the same as standard lead two as seen in a 12 lead ECG. It is the most common monitoring lead. It is not the optimal monitoring lead.

11. Lead Selection V5 = the best lead to detect ST-T change Move the LA lead to V5 position Monitor lead I

12. The shape of the ECG P P T T QRSQRS Q R S

13. Normal ECG

14. ECG interpretation 1.Rate 2.Rhythm 3.Intervals 4.QRS complexes 5.ST segments & T waves

15. Abnormal Normal

16. ECG abnormalities  Myocardial ischemia / infarction  arrhythmias

17. Myocardial ischemia / infarction  ST depression (0.1mv)  ST elevation (0.2mv)  T wave inversion  Abnormal Q

18. Myocardial ischemia / infarction

19. Condition associated with perioperative dysrhythmias Electrolyte disturbances (hypokalemia, hypocalcemia, hypomagnesemia) Hypothermia Medications such as digitalis, theophylline, anesthetic agents Metabolic alkalosis Presence of indwelling central venous or pulmonary artery catheters Sympathetic stimulation (hypoxia, hypercarbia, surgical or anesthetic stimulation) Parasympathetic stimulation (distention of bladder or bowel)

20. Bradyarrhythmias

21. Bradyarrhythmias

22. Bradyarrhythmias

23. Bradyarrhythmias : 2 nd degree AVB

25. Bradyarrhythmias : 3 rd degree AVB

26. Tachyarrhythmias : Premature complexes

28. Tachyarrhythmias

29. Tachyarrhythmias

30. Tachyarrhythmias

31. Tachyarrhythmias

32. Tachyarrhythmias

33. Tachyarrhythmias

34. Asystole