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Basics of EKG: SA Node, Pacemaker, Interatrial Pathways, AV Node, His-Purkinje System

Learn about the fundamentals of Electrocardiography (EKG) including the SA node, pacemaker, interatrial pathways, AV node, and the His-Purkinje system. Understand the principles of P waves, QRS complex, T and U waves, and how to determine heart rate and axis. Explore various sinus and atrial arrhythmias.

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Basics of EKG: SA Node, Pacemaker, Interatrial Pathways, AV Node, His-Purkinje System

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  1. اصول EKG

  2. اصول EKG

  3. SA node Pacemaker 60-100 bpm P waves up in I, II, aVF Internodal Pathways AVN; RA contraction Interatrial Pathways LA to depolarize سیستم هدایتی

  4. AV node Delays impulse by .1s PR segment AV junction AV node & His 40-60 bpm Purkinje/bundles Ventricular depol 20-40 bpm سیستم هدایتی

  5. سیستم هدایتی

  6. سیستم هدایتی • Repolarization • Direction is same as depolarization • Autonomic Nervous System (ANS) • Sympathetic Nervous System (SNS) • Parasympathetic Nervous System (PNS)

  7. اصول EKG

  8. Normal Width < .11 secs Height .5 to 2.5 mm Morphology Flat Biphasic Absent اصول EKG: موج P

  9. Abnormal Inversions Amplitude P-Pulmonale > 2.5 mm Duration P-Mitrale > .1 sec (or 2 ½ boxes) Absence اصول EKG: موج P

  10. اصول EKG: موج QRS • Impulse travels quicker down the left bundle branch (LBB) than the right bundle branch (RBB). Septum depolarizes L to R resulting in a downward deflection • Both ventricles are activated simultaneously. Since the RV is smaller, depolarizes quicker resulting in the downward deflection • LV depolarizes resulting in the R wave

  11. اصول EKG: موج QRS

  12. 6 ویژگی موج QRS • Duration: .05 - .12 Secs • Amplitude: > 5mm; < 20 mm in limb, < 25 in anterior leads • Presence of Q waves < 0.04 msec and < 2 mm normal in I, aVL, aVF, V5 • Axis • Progression: Zone of transition V3-V4 • Configuration

  13. اصول EKG: موج T و U • T waves occur in • Same direction as QRS • Height: < 5 mm in limb leads, <10 mm in anterior leads • U waves • After T wave • Best seen in lead III • Hypothermia/hypokalemia

  14. اصول EKG

  15. لیدهای قفسه سینه

  16. EKGاستاندارد • 12 leads and rhythm strip • Limb leads • I, II, III, aVR, aVL, aVF • Anterior leads • V1-V6 • Speed = 25 mm/sec • Height = 10 mm

  17. Source Age, Sex Body weight Chest configuration Heart position Food intake Temperature, Exercise Smoking, Hyperventilation Position of precordial leads متغیرهای نوار قلب

  18. Ideal time for EKG Bayes’ Theorem Normal hearts have abnl EKGs Normal EKG does not r/o heart disease متغیرهای نوار قلب

  19. رویکرد منظم • Rate • Rhythm • Axis • Wave Morphology • P, T, and U waves and QRS complex • Intervals • PR, QRS, QT • ST Segment

  20. تعیین ریت قلب • On 6 sec strip, count QRS complexes, X 10 • QRS on dark line of tracing, count large boxes, ÷ into 300

  21. تعیین ریت قلب

  22. تعیین ریت قلب

  23. دپلاریزاسیون

  24. دپلاریزاسیون

  25. اصول EKG

  26. موج P در لید II

  27. دپلاریزاسیون بطن ها در لید قفسه سینه

  28. محور قلب • Find the quadrant • Isolate the isoelectric lead • Smallest QRS voltage • Isolate the perpendicular lead • Isolate the vector • Double check your findings

  29. پیدا کردن ربع

  30. پیدا کردن ربع 1. 3.

  31. پیدا کردن لید ایزوالکتریک

  32. پیدا کردن محور

  33. پیدا کردن محور

  34. پیدا کردن محور

  35. پیدا کردن محور

  36. ریتم/ آریتمی • Sinus • Atrial • Junctional • Ventricular

  37. P waves upright in I, II, aVF Constant P-P/R-R interval Rate Narrow QRS complex P:QRS ratio 1:1 P-R interval is normal and constant آریتمی سینوسی: معیار و انواع

  38. Normal Sinus Rhythm Sinus Bradycardia Sinus Tachycardia Sinus Arrhythmia آریتمی سینوسی: معیار و انواع

  39. Normal Sinus Rhythm • Rate is 60 to 100

  40. Sinus Bradycardia • Can be normal variant • Can result from medication • Look for underlying cause

  41. Sinus Tachycardia • May be caused by exercise, fever, hyperthyroidism • Look for underlying cause, slow the rate

  42. Sinus Arrhythmia • Seen in young patients • Secondary to breathing • Heart beats faster

  43. P waves inverted in I, II and aVF Abnormal shape Notched Flattened Biphasic Narrow QRS complex آریتمی دهلیزی: معیار و انواع

  44. Premature Atrial Contractions Ectopic Atrial Rhythm Wandering Atrial Pacemaker Multifocal Atrial Tachycardia Atrial Flutter Atrial Fibrillation آریتمی دهلیزی: معیار و انواع

  45. Premature Atrial Contraction • QRS complex narrow • RR interval shorter than sinus QRS complexes • P wave shows different morphology than sinus P wave

  46. Ectopic Atrial Rhythm • Narrow QRS complex • P wave inverted

  47. Wandering Atrial Pacemaker • 3 different P wave morphologies possible with ventricular rate < 100 bpm

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