Electrocardiogra

m (ECG)
By:

Jay Aries T. Gianan

EMT-B, RM, RN, LPT, MAN
Objectives:
• What are related concepts?
• Conduction system of the heart
• How to interpret ECG result?
• Basic ECG reading
• How to attach the ECG lead?
What are the conduction system of the heart?
Conduction system of the heart
• Sino-atrial Node (SA node)
• Found in the R atrium of the heart
• Natural pacemaker, beginning of conduction
take place
• 60 – 100 BPM
• Atrio-ventricular node (AV Node)
• Found at the border of R atrium & R ventricle
of the heart
• Gate keeper (get to decide what impulse to
get thru)
• 40 – 60 BPM
• Bundle of His
• 40 – 60 BPM
• Bundle branches (left & right)
• 20 – 40 BPM
• Purkinje Fibers
• 20 – 40 BPM
How to interpret ECG result?
Electrocardiogram (ECG, EKG)

• Electrocardiography is the
process of producing an
electrocardiogram.

• It is a graph of voltage versus

time of the electrical activity of
the heart using electrodes
placed on the skin.
 • Where is atrial repolarization?
• Found in QRS complex, this is
Parts of ECG because ventricles tend to
contract stronger than atria, they
tend to mask the atrial
• P wave repolarization
• Represents atrial depolarization • Takes after P wave & can be found
• 2 atria are contracting w/in QRS complex
• QRS complex
• Ventricular depolarization
• 2 ventricles are contracting
• T wave
• Ventricular repolarization
• Ventricular relaxation
ECG Strip
• 1 small box = 0.04 seconds

• 1 big box = 0.2 seconds

 6 step method of Basic EKG interpretation
1. Identify & examine the P waves
• N: P waves – present & upright
• If P waves = absent/inverted, it could
indicate junctional rhythm
2. Measure the PR interval (PRI)
• The beginning of P wave & the
beginning of QRS complex (count the
small box multiply by 0.04
• N: PRI = 0.12 – 0.20 seconds
• >0.20 could indicate dysrhythmias
such as heart blocks
6 step method Basic EKG interpretation
3. Measure the QRS complex
• Measure the small boxes b/w the
QRS complex.
• N: 0.06 – 0.12 seconds
• >0.12 sec denotes PVC
4. Identify the rhythm
• It could be regular or irregular
• Measure the distance between R’s
• Can use index card, caliper or
ruler, regular if R’s distance is the
same length
 6 step method Basic EKG interpretation
5. Determine the heart rate
• Make sure that the strip is 6 sec strip.
• Remember
• 1 small box = 0.04 sec
• 1 big box = 0.2 sec
• 30 big box = 6 second.
• Best for irregular rhythm: Then count
the R waves in 6 sec strip multiplied
by 10 (6 sec method)
• Best for regular rhythm: Divide 300
by the small boxes b/w 2 Rs (Big box
Method)
6. Interpret strip
Example:
Example:
How to attach the ECG lead?
 Activity Read about dysrhythmias.
• You are caring for a 40-year-old man who
recently had an AV sequential pacemaker
inserted, with the rate set at 72 bpm. When
taking his pulse, you note that his heart rate is
66 bpm. Describe the possible causes of this
difference in heart rate and the nursing actions
that are needed. The patient’s wife tells you
that her husband has informed her that now
that he has a pacemaker, they must get rid of
their microwave oven.
• What would you say to the wife and patient about
this?
• What other education would you provide to them
about safety in relation to the pacemaker?
• What is the evidence base that supports this
education?
• Discuss the strength of the evidence and the criteria
used to evaluate the strength of the evidence.