An electrocardiogram is an important part of the initial evaluation of a patient who is suspected to have a heart related problem. There are 12 small sticky electrodes that applied to the patient’s chest, arms and legs. However, with some systems, the electrodes may be applied to the chest, shoulders and the sides of the lower chest, or hips. The wires are used to connect the patient to the electrocardiogram machine. The patient will be asked to remain very still while a nurse or technician records the EKG. The electrical activity created by the patient’s heart is processed by the EKG machine and then printed on a special graph paper. This is then interpreted by your physician. It takes a few minutes to apply the EKG electrodes, and one minute to make the actual recording. The EKG is extremely safe and there is no risk involved. In rare cases, some people may develop skin irritation from the electrode adhesive, but no serious allergic reactions have been reported. The EKG can provide important information about the patient’s heart rhythm, a previous heart attack, increased thickness of heart muscle, and signs of decreased oxygen delivery to the heart, and problems with conduction of the electrical current from one portion of the heart to another.
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What Is EKG?
The basic importance of electrocardiogram are diagnosing irregularities in the heart, record changes in the heart, and establish baseline for other EKG by using the electrocardiogram machine. An electrocardiogram (ECG or EKG) is a quick, painless test that records the electrical activity of the heart. It may be taken at rest or during exercise. It is the standard clinical tool for diagnosing arrhythmias (abnormal rhythms) and to check if your heart is getting enough blood or if areas of your heart are abnormally thick. Small patches called electrodes are placed on different parts of the body. Different tracings of the heart’s electrical activity can be made and permanently recorded on paper or in a computer. Three major waves of electric signals appear on the ECG. Each one shows a different part of the heartbeat. The P wave records the electrical activity of the atria. The QRS wave records the electrical activity of the ventricles, and the T wave records the heart’s return to the resting state. Doctors study the shape and size of the waves, the time between waves and the rate and regularity of beating.
Importance of Electrocardiogram
There are many importance of EKG but these are the main importance, diagnose irregularities in the heart, record changes in the heart, and establish baseline for other electrocardiogram. Diagnose irregularities in the heart means to provide what need to be done in the heart. It is important to know because there are different types of importance that need to be done in order to know the right heart record during the electrocardiogram testing. Some patient base on their history because a lot of their family’s having failure heart problem too. This means that they need more exercise and eat more good meals. “Arrhythmias may be seen on 12- leads ECG’s strips of one more leads”. This means that everything is required for the EKG test. It also improves the patient development because the doctor may tell the patient what is right or wrong.
Condition Determined by EKG
The condition determined by electrocardiogram are previous heart attack, Heart blocked, Enlarged heart muscle, Rhythm disturbances. It takes a few minutes to apply the EKG electrodes, and one minute to make the actual recording. The EKG is extremely safe and there is no risk involved. In rare cases, some people may develop skin irritation from the electrode adhesive, but no serious allergic reactions have been reported. The EKG can provide important information about the patient’s heart rhythm, a previous heart attack, increased thickness of heart muscle, and signs of decreased oxygen delivery to the heart, and problems with conduction of the electrical current from one portion of the heart to another. Most of the Electrocardiogram physician and basically the one who help other people that has complaining about slow heart beat, fast heart beat, irregular heart beat or any symptom that they may encountered whatever they doing. It is very important to see the physician right away for check up before the heart beat will become severe problem and this will cause them to death.
Junctional Tachycardia
Junctional Tachycardia is believed to be caused by enhanced automaticity and is commonly the result of digitalis toxicity (Shade & Wesley, 2005). Another cause includes myocardial ischemia or infraction. It can also occur at the any age without a patient history of underlying heart disease. The patient will also complain to palpitations, nervousness, anxiety, vertigo, and syncope frequently accompany with dysrhythmia. When the patient get junctional tachycardia they may also sustained with rapid ventricular rates and retrograde depolarization in their atria because the ventricular filling is not as complete during diastole, leading to compromised cardiac output and the patient may occur heart disease. The rate of the person who has junctional tachycardia is 100 to v180v beats per minute and de P waves inverted may immediately precede, occur during the absent or follow the QRS complex” (Shade & Wesley, 2005).
Myocardial Infraction
Myocardial infarction is the death of injured myocardial cells. This may occur when the person has a sudden decrease or total cessation of blood flow through the coronary artery. It is also commonly occurs when the intimacy of a coronary artery ruptures, exposing the atherosclerotic plaque to the blood within the artery. The area of the heart normally supplied by the blocked artery goes through a characteristic sequence of events describe as zones of ischemia, injury and infraction. There are also three key EKG indicators of myocardial ischemia, injury, and infarction; they are changes in the T wave, changes in the ST segment, and Enlarged Q waves or appearance of new Q waves. This means that means that anyone of this changes maybe present without anyone of the others.
Placing leads on the client and setting machine control
This are the steps they physician need to do before hooking up the EKG leads and electrodes to the patient. First wash hands, assemble the equipment like the EKG machine with electrodes, electrodes pad, alcohol wipes or skin cleansing agent, bath and blanket or sheet, and the patient grown. The physicians need also to identify the patient to make sure they have the right patient. Explain what you are doing, and reassure patient that this procedure is painless but the electrodes are sticky and its little bit cold and the patient need to avoid applying lotion before the test. Position the patient on bed or treatment table in a supine position with are relaxed beside their body. Covers the patient with a blanket leaving the arms and legs exposed to provide privacy. Wipe the skin with a cleansing agent to remove oils, scaly skin, or perspiration and the physician are now ready to apply the 12 electrodes. The patient needs to arrive 15 minutes before the test. There is no pain during the test and the result of the test will send it to your doctor and they will share the result with the patient in 2 weeks. There are 12 leads that will be place in the the body which is the arm, legs, and chest.
What is Pacemaker?
An electronic pacemaker is a small device use to control the heart rhythm. The Pacemaker electrical device use to prompt the pulses of the irregular heartbeat to a normal heartbeat. Pacemaker is people who have bradycardia.” Cardiac pacing is a recognized and widely used treatment for patients presenting with bradycardia. Physicians expect patients to return to normal activities almost immediately post implantation. However, patients themselves may perceive interference to pacemaker function by various routine activities and devices, and hence continue to lead restricted, disabled lives. The aim of this study is to determine if routine activities are perceived by pacemaker patients to interfere with their device function “(Pacemaker, 2008). This means that most of the patient who needs to have pacemaker is the old people because they starting to have a slow heartbeat and they need the pacemaker in order to help them breathing. The Pacemaker contains two parts the generator and the parts. “The generator is tiny, hermetically sealed computer” (Fogoros, 2003). This generator is roughly the size of a 50-cent piece, and approximately three times as thick. The battery life of most pacemaker generators today is 5 to 8 years.
EKG interpretation
Electrocardiograms are diagnosing irregularities in the heart record changes in the heart. The patient needs to arrive 15 minutes before the EKG test. Avoid using lotion around the chest, arms, and legs because the electrodes pads are sticky. For the women they may have to use gown in the hospital to avoid privacy and for the men if they have hairy hair in their chest the physicians may have to shaved if so that the 12 electrodes can hook up good. There are 12 electrodes that need to be connected during the EKG test (Electrocardiogram, 2005). The physician needs to know if the patient has a normal heart beat or irregular heart that why it’s very important to go see the doctor right away when people have problems about the heart. It is very important because most of the people who having symptoms are just taking any kind types of medication. When the patient taking the wrong medication without the doctor prescription the body will affect and the body will become perilous. Horizontal lines measure time (1mm square- 0.04 secs), the vertical lines measure voltage (1mm square- 0.01 mV), and the tic mark will identify 6 sec strip intervals. Heart rate computation has the identify rate which measure ventricular rate unless otherwise specified and it’s also measure the R-wave. They choose to method to determine or make sure that the rate has six second method box and box method. The six second method count the number of QRS complexes occurring within 6 seconds and multiply the number by 10. During the Holter monitoring or electrocardiogram testing make sure that the V3 leads is under the right nipple if the patient is under 15 years old and if it’s older than 15 they can hook it up like adult. During the hook up of the Holter monitoring the first step they need to do is to take out the battery compartment and place AA battery, then insert the flashcard with the lip facing downward. Second, push the enter key twice, they will hear the beep sound, then you will be able to enter the social security of the patient by scrolling the up down side to side keys then select ok button. Third, scroll across the top check the channels 1-3 to make sure all the hook ups are all working and good. Fourth, they should also check the first time by scrolling across the date and time. Fifth, check the duration of the scan and pacer detector by going to the settings then go to start and press the enter button. Lastly, issue the patient what they need to do after 24 hours. The physician needs to hand his/her a log sheet for their activities and symptoms.
Electrocardiogram Rhythm
Sinus Rhythm is a regular normal rhythm of the heart set by the natural pacemaker of the heart called the sinoatrial node or sinus node. It is located in the right atrium and refers to the normal increase in heart rate that occurs during inspiration when they breathe. “It’s also a small, slow variation of the R-R interval variation of the normal sinus heart rate respiration” (Medical, n.d.). There is also sinus tachycardia which means the sinus rhythm is 100 beats per minute. “The QT interval decreases as the rate increases. The maximum rate in sinus rhythm is usually 220-age” (Medical, n.d.). The sinus bradycardia or slow heart beat is 60 beats per minute and this may due to parasympathetic dominance at rest” (Cardiac, n.d.). The premature ventricular complexes are observed in 60 percent of healthy adults in monitoring. This means that the patient can take home the Holter monitoring and they have a log sheet and they have to write the time and what are they doing. The sheet also is very important because it will record all the information that the physicians need it. The Holter monitor is the recording the heart beat the every time the patient realize of feel that they having a funny heart beat they may need to press the middle button of the Holter monitor.
Atrial fibrillation is when human has two upper chambers and the two low chambers. The upper chambers are called the left atrium and the right atriums are the plural of atrium in the atria. When the two lower chambers contact at the excessively high rate, and it’s an irregular way, the patient has atrial fibrillation. (What, n.d.)
Atrial flutter is when a patient complaining about their heartbeat. Most of the patient that has atrial flutter heartbeat has stop beating, and they can’t realize any feeling. There are also times that when the patient is lying down they may experience fast heart beat. Most old people have experiencing this because of their age. They may need to stop drinking coffee, soda, lemonade or any drinks that has acid because this will may affect their heart beats. For the patient that has atrial flutter they have to go to emergency room right away and make sure the doctors take x-rays of the patient’s heart and lungs. To prevent this people need to exercise and eat healthy food. Ventricular Tachycardia is very rapid tachycardia. The causes are cardiomyopathy and heart failure can occur without heart disease.
Ventricular Fibrillation:
Right and Left Main Coronary Artery
The right main coronary artery originates from the side of the aorta and passes along the antrioventricular sulcus between the right atrium and the ventricle. They divided into two branches, the marginal artery and the posterior interventricular artery. The portion of the myocardium supplied by the right coronary artery includes the right atrium, right ventricle, inferior and posterior wall of the left ventricle and the one third posterior of the intarventricular septum. The right coronary artery supplies blood to the SA node in about 60 percent of the population and to the AV node about 90 percent of the population. Also the posterior-inferior fascicle of the left bundle branch. The left coronary artery originates from the left side of the aorta. It divides into the anterior descending and circumflex branches. The anterior descending artery perfuses the anterior surface and part of the lateral surface of the left ventricle and the anterior two thirds of the intraventricular septum. The branches of the anterior descending artery, the diagonal artery and the septal perforators, help supply blood to the lateral walls of the left ventricle. The circumflex artery supplies the left atrium, anteriolateral, poster lateral, and the posterior wall of the left ventricle. The heart needs its own blood supply because the demand for oxygen in the myocardial cells is extremely high. The coronary arteries provide a continuous supply of oxygen and nutrients to the myocardial cell. The heart works constantly to pump blood to the body, so the oxygen consumption of the heart is greater than that of single organs. The terminal branches of the arteries have many interconnections, forming an extensive vascular network.
Reciprocal Changes
The reciprocal changes are the mirror image that occurs when you have two leads viewing the same myocardial infarction from opposite angles. The infracted zone is electrically neutral, so the lead directly over the heart registers only an unopposed vector moving away from it. This cause the waveform to be negative. The T wave is flipped because of depolarization abnormalities generated by the areas ischemia and injury. The concept is important to relate while looking at the EKG traces because it shows the different areas of the heart. Reciprocal change was noted in all patients with inferior infarction. This means that the ST segment depression is higher. If the Electrocardiogram traces are change the heart will detect the symptom right away or the ST segment will change.
Anatomy and Physiology of EKG
“The heart is a hollow muscular organ that lies in the middle of the thoracic cavity behind the sternum, between the lungs and just above the diaphragm” (Pre-reading). The blood enters to the heart for the major veins of the body. The superior vena cava feed the right atrium and the left atrium. The left ventricle supply the left atrium and the right ventricle are in the middle to return blood in the middle. The heart beat consist of two contractions, when the atriums contract the blood is squeezed simultaneously from the right atrium through the tricuspid valve and when the ventricles contract the blood squeeze from the right ventricle through the pulmonary valve and to the lungs. There are also two major veins that deliver blood all over the areas of the body especially in the right atrium. They called this superior vena cava and anterior vena cava. They divides directly in the heart and have different construction.
Different Waves
P-waves moves in a compression motion similar to the motion of a slinky, while the S waves move in a shear motion perpendicular to the direction of the wave that is travelling. P-wave is basically electrical signature of the current that cause atrial contraction. It is also the portion of the electrocardiogram tracing that represent the depolarization of the myocardium. It’s depolarized in the left atrium and reflects to the right depolarization. QRS complex is the portion of the EKG tracing that represents depolarization in the myocardium and the ventricle are activated simultaneously. T-wave is deflection of the normal electrocardiogram following QRs complex and it represent repolarization or recovery of the ventricle.
Sinus Arrest
A rhythm can also appear irregular when a SA node fails to initiate an impulse. This can be called sinus arrest and is seen as the pause in the electrocardiogram rhythm. They rhythm leading up to the pause looks normal. Sometimes there is also suddenly absence of the P wave as well as the QRS complex and T wave. These are one who’s creating gap or pause of the heartbeat. If a SA node fails to fire, then the escape pacemaker from the atria call AV injunction will initiates and impulses. Irregularity may also cause by premature ventricular heartbeat during the electrocardiogram test and the rhythm making R-R interval pause. The rhythm leading up to the pause looks normal if the EKG test is no irregular. A slightly rhythm is where the P-P intervals and R-R intervals vary. The changes of the pacemaker from site to site can lead to this type of irregularities. A cause of the slightly irregular rhythm is when initiation of the heartbeat changes from site to site of each beat. Each of the heart beat is initiates to other area. The QRS ventricle depolarize and it will become larger muscle mass. The ST segment is normally isoelectric and gently blends into upslope of T wave. The point where the ST segment is located will takes off from the QRS ventricle and it goes to the J point.
