Identify signs of ischemia, injury, and infarct on a lead EKG strip and demonstrate an understanding of underlying pathology. Complete each of the three examinations given in the course. No make up examinations will be given!!! Each examination, with the exception of Exam III will be worth points.
Exam III is comprehensive and is worth pts. Each CD homework assignment is worth 5 pts. Take home EKG interpretation assignment is worth 75 points.
Rapid ECG Interpretation
No late assignments will be accepted. Additions or deletions to this outline may be made by the instructor as deemed necessary. QRS complexes wide or narrow?
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General pattern — regular, regularly irregular or irregularly irregular? Axis The ECG electrodes record the average direction of flow of electrical current within the heart. Lead I is the zero reference point, any axis lying below is deemed positive while those lying above are deemed negative.
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When the wave of depolarization begins, any lead that views this wave as moving towards it will record this as a positive deflection on the ECG paper. Assessment of P Wave Axis: Atrial depolarization begins at the sinus node in the right atrium and follows a right to left and inferior direction. Assessment of QRS Complex Axis: As the wave of depolarization moves through the interventricular septum the current moves in a left to right direction.
As a result of the increased size of the left ventricle in comparison to the right, the remainder of the QRS complex vector of flow is directed leftward and is demonstrated as the positively deflected R wave in most left lateral and inferior leads. The aVR lead will record a deep negative deflection based on the direction of flow being away from this lead.
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Common Arrhythmias 1 1. Clinical Symptoms: palpitations, shortness of breath, dizziness.
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Possibly induced by alcohol, caffeine or extreme excitement. Atrial Flutter P waves bpm Atrial depolarization occurs so rapidly that discrete P waves are indiscernible. Leads II and III demonstrate a prominent saw-tooth AV node cannot handle the number of atrial impulses therefore there is an unequal number of P waves to QRS complexes — some electrical impulses from the sinus node bump into a refractory node and go no further, this is called AV Block. Clinical Symptoms: shortness of breath, angina type discomfort.
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No true P waves are discernible, AV node allows occasional impulses to pass through to the ventricles, creating an irregularly irregular ventricular rate often in the range of bpm. Clinical Symptoms: some patients experience no symptoms, others experience shortness of breath, chest pain, palpitations and dizziness.
Premature Ventricular Contractions Most common ventricular arrhythmia. Wide QRS of at least 0. Often occur randomly and rarely require treatment unless an isolated PVC is noted in the setting of acute MI as it may trigger ventricular tachycardia or ventricular fibrillation. Prolonged ventricular tachycardia is an emergency requiring immediate treatment to prevent cardiac arrest.
May be uniform or polymorphic, uniform being more closely associated with healed infarctions and polymorphic waveforms more commonly associated with acute coronary events.
Rapid ECG Interpretation : M. Gabriel Khan :
Ventricular Fibrillation Spasmodic tracings or coarse ventricular fibrillation or fine ventricular fibrillation without any true QRS complexes. Heart generates no cardiac output, CPR and defibrillation are required immediately.
Most common arrhythmia in adults who experience sudden death. Andrade, J. ECG Guide [Mobile application software]. Tampa, Fla.