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Cardiac Rhythm Intrepretation
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General Priniciples
 
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Electrocardiogram - A graphic recording of the electrical activity prduced by the heart muscle. This recording may be printed on specially produced graph paper or viewed in real time on an ocilliscope screen.
 
Normal electrical conduction - The impulse is generated by the SinoAtrial Node (SA NODE) travels across the upper chambers of the heart  (the Atria) to the Atrioventricular Junction (AV NODE) along the Bundle of HIS (bundle branches) .
 
HEART RATES
 
NORMAL SINUS RHYTHM    60 - 100 beats/min
JUNCTIONAL RHYTHM        40 - 60 beats/min
VENTRICULAR RHYTHM      20 - 40 beats/min
 
ELECTRODE PLACEMENT
 
white lead - right shoulder
black lead - left shoulder
red lead - left lateral chest wall on lower margin of rib cage
green lead  - right lateral chest on lower margin of rib cage
brown lead - center of chest near xiphoid process
 
LEAD DEFINITION
 
Limb Leads
Lead I        RA (white) neg to LA (black) pos
Lead II       RA (white) neg to LL (red) pos
Lead III      LA (black) neg  to LL (red) pos
Lead MCL1  LA (black) neg to 4th IC Space{r side} (brown) pos
 
Chest Leads
 
The chest leads (V1 -V6) record the depolarization of the ventricles (QRS)
 
LEAD       View                         Location
 
V1        Right Ventricle              Right side of sternum  
                                             just below intramammary line 
V2        Right Ventricle              Left side of sternum just below
                                             intramammary line
V3        Intraventricular septum  lower margin of
                                             rib cage to Left of xiphoid process
V4        Left Ventricle               under Left nipple
V5        Left Ventricle               curve of rib cage
V6        Left Ventricle               Left side of rib cage level with V5
 
ECG RECORDING PAPER
 
LARGE BLOCK = 0.20 SEC LENGTH BY 5 MM HEIGHT
SMALL BLOCK = 0.04 SEC LENGTH BY 1 MM HEIGHT
 
STEPS OF EKG ANALYSIS
Strip should be at least 6 seconds in length.
 
1. look at strip and do an initial survey
2. examine "P" wave - presence, shape, length, size
3. measure "PR" interval - normal 0.12 - 0.20 sec (< 1 large box)
4. measure "QRS" interval - normal 0.06 - 0.10 sec(< 2 small boxes)
5. determine in regular or irregular - measure R to R interval
6. determine rate - 
                R to R interval
                    # of large squares/300 or
                    # of small squares/1500 or
                    # of R waves on a 6 second strip x 10
  
7. Intrepret Strip
 
DESCRIPTION OF WAVES
 
P wave - generated in SA node represents depolarization (or firing) of the atria. The repolarization of the artia is buried inthe QRS complex.
 
QRS complex represents ventricular depolarization.
 
ST segment and T wave depict ventricular repolarization

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