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EKG Interpretation Basics: King County Course

Learn cardiac rhythm basics, cardiac terminology, and rhythm identification. Pass exams with 70% score. Understand primary patient obligations and common heart rhythms. Study heart anatomy, conduction system, and EKG paper details.

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EKG Interpretation Basics: King County Course

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  1. EKG Interpretation Just the beginning

  2. King County • Introduction • Cardiac monitoring has been routinely used in the Fire Service for many years • Not without some liability • Intent of this course is to provide the basics in cardiac rhythm interpretation

  3. Introduction cont. • This course is not intended to teach diagnosis of heart disease • Lead II is not sufficient for EKG diagnosis • Recognition of the cardiac cycle will aid in the understanding of EKG’s • In order to remain proficient it is necessary to commit time to ongoing training in EKG interpretation

  4. Objectives • Understand basic cardiac terminology • Describe the anatomy of the heart • Identify the electrical conduction system • Identify abnormal electrical cardiac activity

  5. Objectives • Identify common cardiac rhythms • Identify and effect appropriate therapy for the patient on a monitor

  6. Course Completion • Participants are expected to pass a written exam and achieve a 70% score • Practical exam will include correct interpretation of static rhythms, 70% passing score

  7. Primary Obligation • It cannot be overemphasized that the primary obligation for non-cardiac arrest patients is: ABC’s & • Attention to the patient’s symptoms • Vital Signs, physical exam • Any necessary treatment with application of the monitor only when basic life support has been completed

  8. Anatomy & Physiology • Heart is a muscle • Divided into four chambers • Receives blood from the body via the inferior and superior vena cavae • Chambers separated by valves • Coronary arteries supply blood to the myocardium

  9. Electrical Conduction System • Specialized system of interconnected cells spread throughout the entire heart • Provides and conducts the signal to the heart muscle to contract in a coordinated fashion

  10. Sinoatrial (SA) Node • Collection of electrical tissue that is the normal point of origin of electrical activity • Named because it is located in the sinus part of the atria • Generates “P” waves

  11. Atrioventricular (AV) Node • A way station that receives the impulses from the atria • Named because it is located between the atria and the ventricles • Actually used to slow impulses from the atria to the ventricles

  12. Bundle of His • Receives impulses from the AV node and passes them through the left and right bundle branches in the ventricular septum

  13. Purkinje Fibers • Last receiving point of the electrical impulses • Fibers located in the ventricular musculature • Rapidly conducts impulses causing ventricular contraction

  14. Automaticity • Any portion of the conduction system or heart muscle may initiate an electrical impulse • When the AV Node fails to generate an impulse, another cell/area of the heart will initiate electrical activity

  15. Secondary Pacemakers • Any portion of the heart may initiate an electrical impulse and becomes a secondary pacemaker • Determining the location of a secondary pacemaker will become clearer as we proceed through this curriculum

  16. Electrocardiographic paper

  17. EKG paper • Grid of standard dimensions • Simply used as a measurement of time • Each small box represents 0.04 seconds • Larger bolded boxes are .20 seconds • Important to remember these values as they aid in the identification of virtually all EKG strips

  18. The Cardiac Cycle • P wave- indicates atrial “depolarization” • PR interval- the interval from the beginning of the P wave to the beginning of the QRS complex • PR interval represents the time from atrial depolarization to the beginning of ventricular repolarization

  19. Cardiac Cycle • Normal PR interval should not exceed 0.2 seconds or one large bolded square on the EKG paper • QRS complex- represents electrical depolarization of the ventricle • Normal duration of the QRS complex is from 0.08-0.10 seconds (2 to 3 small boxes on the EKG paper

  20. Cardiac Cycle • T wave- represents repolarization of the myocardium

  21. Normal Sinus Rhythm • Characteristics- • P wave for each QRS • PR interval normal, <0.20 seconds • QRS complex is normal, <0.10 seconds • Uniform in shape • Rate is regular and is between 60-100

  22. Normal Sinus Rhythm • Most common rhythm seen in acute MI • Does not indicate that the patient is stable or that there is an absence of heart disease • Indicates that the origin of the impulse is from the SA Node • Indicates normal function of the electrical system

  23. Normal Sinus Rhythm

  24. Normal Sinus Rhythm

  25. Sinus Tachycardia • Characteristics- • P wave for each QRS • PR interval is normal, < 0.20 seconds • QRS complex is narrow, < 0.10 seconds • Uniform in shape • Rate is regular, > 100/minute

  26. Sinus Tachycardia • Accelerated discharge of electrical impulses from the sinus node • Treatment is “attention to symptoms” • Underlying cause is the concern • Causes include; shock, stimulants, acute MI where decrease in cardiac output causes heart rate increase

  27. Sinus Tachycardia

  28. Sinus Tachycardia

  29. Supraventricular Tachycardia • P waves may not be seen due to accelerated rate • QRS complex is narrow, < 0.10 seconds • Uniform in shape • Rate is regular, > 150/ minute • Patient’s heart rate is too fast

  30. Supraventricular Tachycardia

  31. Supraventricular Tachycardia

  32. Sinus Bradycardia • Characteristics- • P wave for each QRS • PR interval is normal, < 0.20 seconds • QRS complex is normal, < 0.10 seconds • Uniform in shape • Rate is regular, < 60/ minute

  33. Sinus Bradycardia • Transmission of impulses from the SA node is slowed to < 60/ minute • Heart rates less than 50/ minute should never be considered to be normal • Beta blockers, digoxin, hypoxia, being athletic or with history of a slow heart rate can be the cause • Patient’s heart rate is too slow

  34. Sinus Bradycardia

  35. Sinus Bradycardia

  36. Premature Ventricular Contractions • Characteristics- • Early occurring beats that have a characteristic “compensatory pause” • Premature QRS complex that is wide and bizarre, conduction time > 0.10 seconds • Same shape except when from different focus in the heart

  37. Premature Ventricular Contractions • Can occur in a healthy individual • Viewed with caution in the patient who presents with cardiac symptoms • Significant if: occur in 2’s (couplets), 3’s (triplets),run of 4 is Ventricular Tachycardia • Frequent occurring with syncope be cautious

  38. Premature Ventricular Contractions

  39. Ventricular Tachycardia • Characteristics- • P waves are usually present but are obscured by wide, rapidly occurring QRS complex • QRS complex is wide > 0.10 and bizarre • Uniform in shape typically • Rate is regular and > 150/ minute

  40. Ventricular Tachycardia • Life threatening arrythmia • Rapid rate decreases cardiac output • Place patient supine, anticipating shock • Cause can be electrical and not always acute MI • If patient unconscious and pulseless is a a shockable rhythm

  41. Ventricular Tachycardia

  42. Ventricular Tachycardia

  43. Idioventricular Rhythm • Characteristics- • P waves typically obscured or follow the QRS complex • QRS complex is wide, > 0.10 seconds • Sometimes uniform in shape • Rate is irregular, most often seen with rate < 40/minute

  44. Idioventricular Rhythm • Observed after defibrillation & can be endpoint in arrest resuscitation attempt • Conduction system above the ventricles fails to generate an electricle impulse • Inherent rate of 30-40/minute • Will likely be in cardiac arrest • If unconscious and B/P <60, initiate CPR

  45. Idioventricular Rhythm

  46. Ventricular Fibrillation • Characteristics- • P waves are absent • QRS complex absent • Baseline wavy, chaotic and inconsistent • Rhythm irregular • Rate is not countable

  47. Ventricular Fibrillation • Sudden death & cardiac arrest immediately follow the onset • Immediately defibrillate with 200 joules and proceed with standing orders • Remember that we now do CPR for 2 minutes between shocks

  48. Asystole • Characteristics- • P waves are not present • QRS complex is not present • Absence of any complexes indicate complete cessation of electrical activity • The heart is motionless

  49. Asystole

  50. Pacemakers • Characteristics- • P waves sometimes are visible but are not associated • QRS complex of times is wide, > 0.10 seconds • Preceded by a small spike with either a negative or positive deflection

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