Professional Documents
Culture Documents
Cardiac Circulation
Cardiac Conduction
Sinoatrial (SA)Node
Intaatrial Nodal
Pathways
Atrioventricular
(AV) Node
Bundle of His
Left Bundle Branch
Right Bundle Branch
Purkinje Fibers
Action Potentials
The heart’s electrical activity results from
ion shifts across the cell membrane.
Polarized
Resting State: no electrical activity take place
Normal ionic balance – slightly negative inside the
cell.
Depolarization
Creating a positive charge within the cell
The electricity gets “turned on”…like a large
wave…..contraction of the myocardium….Lub Dub !!
Repolarization
Inside the cell returning to a negative charge;
returning to the resting state.
Cardiac Pacemakers
SA Node
“Normal” pacemaker
Intrinsic rate 60-100
beats/min
AV Node
Intrinsic rate 40-60
beats/min
Purkinje Fibers
Intrinsic rate 20-40
beats/min
Electrocardiography
Abbreviated as EKG or ECG
Depicts the electrical activity of the
heart
Shows Dysrhythmias
Conduction Abnormalities
Electrolyte Imbalances
Chamber Abnormalities (i.e. hypertrophy)
Drug effectiveness
Myocardial Ischemia or Infarction
Bedside Monitoring
Lead Placement
Three Leadwire System
White: Right Arm (RA)
2nd intercostal
space, right
midclavicular line
Black: Left Arm (LA)
2nd intercostal
space, left
midclavicular line
Red: Left Leg (LL)
Placed on the left
lower rib cage
8th intercostal
space, left
midclavicular line
Bedside Monitoring Cont.,
Lead Placement
Five Leadwire Systems
White: Right Arm (RA)
Black: Left Arm (LA)
Red: Left Leg (LL)
Green: Right Leg (RL)
Placed at the 8th
intercostal
space, Right
midclavicular line
Brown: chest lead (C)
Usually placed 4th
intercostal space,
right sternal border
Components of ECG / EKG
Complexes / Waves
P wave
QRS complex
T wave
Intervals
Measured including a wave
PR interval
QT interval
Segments
Measured between waves
ST segment
P Wave
Indicates atrial
depolarization, or
contraction of the
atrium.
First positive deflection
Simultaneous
contraction of the
atria forces blood
through the AV valves
(tricuspid and mitral)
between the atria and
ventricles.
PR Interval
Represents the time
required for atrial
depolarization, the impulse
delay through the AV node
and travel time to the
Purkinje fibers.
Duration time is 0.12 to
0.20 seconds
Measured from the
beginning
of the P wave
to the beginning
Indicates
ventricular
repolarization or
resting of the
ventricles
Positive Deflection
QT Interval
Indicates total time
required for
ventricular
depolarization and
repolarization.
Sinus Bradycardia
Sinus Tachycardia
Sinus Arrhythmia
Sinus Bradycardia ++
Rate:
Atrial: 250-400 beats/min & Ventricular: 60-150
beats/min
Rhythm: Both Atrial & Ventricular Regular
Pacemaker: Ectopic Atrial Focus / AV block
P wave: “Sawtooth” pattern (F waves)
PR Interval: Difficult to Determine
QRS Complex: Normal
P to QRS Ratio: 2:1, 3:1 or 4:1
Atrial Fibrillation (A-Fib)+
Rate:
Atrial: 350-600 beats/min & Ventricular: 100-200
beats/min
Rhythm: Both Atrial & Ventricular Irregular
Pacemaker: Numerous Ectopic Atrial Foci
P wave: No Identifiable P waves
PR Interval: Unable To Determine
QRS Complex: Normal
P to QRS Ratio: Many:1
Junctional Dysrhythmias
Bigeminy
PVC every other
beat
Trigeminy
PVC every third beat
PVC: Configurations Cont,
Couplet*
Two PVC’s in a row
Triplet*
Three PVC’s in a row
AKA “Run of V-Tach”
* More dangerous !!
PVC: More Dangers
R on T Phenomenon *
The superimposition of an ectopic beat on
the peak of the preceding T wave, which
could result in ventricular tachycardia or
ventricular fibrillation.
PVC: Configurations Cont.,
Unifocal PVC
PVC’s are identical (same shape)
Multifocal PVC*
PVC’s with different shapes; more dangerous
!!
Ventricular Tachycardia (VT) +
Fine
“late”
Rate: NONE
Rhythm: NONE
Pacemaker: NONE
P wave: NONE
QRS Complex: NONE
Treatment (ACLS):
Immediate Cardiopulmonary resuscitation (CPR)
Medications: i.e. epinephrine, atropine
Emergency cardiac pacing
Treat or remove underlying cause !!
Pacemaker Strips
Atrial Pacemaker
Ventricular Pacemaker
Nursing: Temporary Pacemakers
Nursing Considerations
Potential for microshock and infection
Nursing Education
Explain device & why it is needed
Care of Device
Notify nurse if dressing is loose or wet
Minimize lead handling
Symptoms to Report
i.e. SOB or lightheadedness
Thank you