Electrocardiography

Electrocardiography Definition Electrocardiography is a commonly used, noninvasive procedure for recording electrical changes in the heart.
The record, which is called an electrocardiogram (ECG or EKG), shows the series of waves that relate to the electrical impulses that occur during each beat of the heart. The results are printed on paper and/or displayed on a monitor to provide a visual representation of heart function. The waves in a normal record are named P, Q, R, S, and T, and follow in alphabetical order. The number of waves may vary, and other waves may be present. Purpose Electrocardiography is a starting point for detecting many cardiac problems, including angina pectoris, stable angina, ischemic heart disease, arrhythmias (irregular heartbeat), tachycardia (fast heartbeat), bradycardia (slow heartbeat), myocardial infarction (heart attack), and certain congenital heart conditions. It is used routinely in physical examinations and for monitoring a patient's condition during and after surgery, as well as in the intensive care setting. It is the basic measurement used in exercise tolerance tests (i.e., stress tests) and is also used to evaluate symptoms such as chest pain, shortness of breath, and palpitations. Description The patient disrobes from the waist up, and electrodes (tiny wires in adhesive pads) are applied to specific sites on the arms, legs, and chest. When attached, these electrodes are called leads; three to 12 leads may be employed for the procedure. Muscle movement may interfere with the recording, which lasts for several beats of the heart. In cases where rhythm disturbances are suspected to be infrequent, the patient may wear a small Holter monitor in order to record continuously over a 24-hour period. This is known as ambulatory monitoring. Special training is required for interpretation of the electrocardiogram. To summarize in the simplest manner the features used in interpretations, the P wave of the electrocardiogram is associated with the contraction of the atriathe two chambers of the heart that receive blood from the veins. The QRS series of waves, or QRS complex, is associated with ventricular contraction, with the T wave coming after the contraction. The ventricles are the two chambers of the heart that receive blood from the atria and that send the blood into the arteries. Finally, the PQ or P-R interval gives a value for the time taken for the electrical impulse to travel from the atria to the ventricle (normally less than 0.2 seconds). Diagnosis/Preparation Patients are asked not to eat for several hours before a stress test . Before the leads are attached, the skin is cleaned to obtain good electrical contact at the electrode positions and, occasionally, shaving the chest may be necessary. Heart problems are diagnosed by the pattern of electrical waves produced during the EKG, and an abnormal rhythm can be called dysrhythmia. The cause of dysrhythmia is ectopic beats. Ectopic beats are premature heartbeats that arise from a site other than the sinus node commonly from the atria, atrioventricular node, or the ventricle. When these dysrhythmias are only occasional, they may produce no symptoms or simply a feeling that the heart is turning over or "flip-flopping." These occasional dysrhythmias are common in healthy people, but they also can be an indication of heart disease.
The varied sources of dysrhythmias provide a wide range of alterations in the form of the electrocardiogram. Ectopic beats display an abnormal QRS complex. This can indicate disease associated with insufficient blood supply to the heart muscle (myocardial ischemia). Multiple ectopic sites lead to rapid and uncoordinated contractions of the atria or ventricles. This condition is known as fibrillation. When the atrial impulse fails to reach the ventricle, a condition known as heart block results. . Clinical Indications: Known or Suspected Cardiac Patient Known or Suspected Tricyclic Overdose Electrical Injuries Syncope
Procedure: a. b. Assess patient and monitor cardiac status. Administer oxygen per patient condition as tolerated.
c. If patient is unstable, definitive treatment is the priority. If the patient is stable or stabilized after treatment, perform a 12-lead ECG. d. e. f. g. v v v v v v v v Prepare ECG monitor and pre-cordial lead cables. Enter patient demographic data. Expose the chest and prep as necessary. Modesty should be considered. Apply chest leads and limb leads as follows: RA----right arm LA----left arm RL----right leg LL----left leg V1----4th intercostal space at right sternal border V2----4th intercostal space at left sternal border V3----Directly between V2 and V4 V4----5th intercostal space at midclavicular line
v v h. i.
V5----Level with V4 at the left anterior axillary line V6----Level with V5 at the left midaxillary line Instruct patient to remain still. Press the 12 lead acquisition button on the monitor.
j. If the monitor detects a problem, such as loose leads, bad connection, noisy data, the monitor will alarm. The EMT-P should address the problem. k. l. m. n. o. Once acquired, transmit to the appropriate receiving facility. Contact the receiving facility to notify them of the patient and the incoming 12-lead. Monitor and reassess the patient enroute and continue treatment protocol. Attach a copy of the 12-lead with the patients record at the hospital. Document the procedure, time, results and findings on the ACR.
Certification Requirements:
Successfully complete an annual skill evaluation including the indications, contraindications, technique, and possible complications of the procedure. Aftercare To avoid skin irritation from the salty gel used to obtain good electrical contact, the skin should be thoroughly cleaned after removal of the electrodes.
ELECTROCARDIO GRAM ( ECG )
Research by; Ms ; Buan , Joan Marie S. Retern Demo; Ms; Agbunag , Rachellyn Ms; Basas , Charllote

Electrocardiography

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Electrocardiography Definition Electrocardiography is a commonly used, noninvasive procedure for recording electrical changes in the heart.

ELECTROCARDIO GRAM ( ECG )

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