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ECG NOTES
What is your Nursing Management?

Electrical System of the Heart

Pulmonary Embolism

Atrial Fibrillation
Assess the patient.
What is the Drug of choice?
Atropine Sulfate

Sinus Tachycardia at 129 beats/min

Causes:

Basic ECG Interpretation and

NursingManagement

Normal Sinus Rhythm at 70 beats/min

Atrial Rate of 400 600 beats per minute

No identifiable P Wave
Underlying heart disease
Alcoholism
Infection
Stress

Causes:
Exercise, pain, fever, hypotension
Myocardial Ischemia, CHF, Anemia Hyperthyroidism,
Theophylline , Epinephrine, Caffeine

What is its significance?

Embolus formation
High risk for?
Pulmonary Embolism

What is your Nursing Management?

What are the Treatments?

Find First the cause

What is the Drug of Choice?
Beta Blockers

Atrial Flutter
All the measurement are within the normal range
Understanding your Normal Rhythm is very Important.
Doing a quick Count, The rhythm of the Patient is 70 beats/ min

Cardioversion- synchronizes electric cardioversion

IV ibutilide (corvert)- chemical cardioverion
Catheter ablation

What are the drugs to be given?

Verapamil,( vasodilation, prolonged AV node

conduction time)

Diltiazem,( slows AV node, Decrease contractility)

Digoxin, (Slows AV node conduction)

Heparin, (warfarin) blood thinner

Sinus Bradycardia at 55 beats/ min

What if the PRI is prolonged?

What are the causes of atrial flutter?

Causes:
Parasympathomimetic drug
Increase Intracranial pressure
Myocardial Infarction (inferior)
Normal with trained athletes
P-R Interval 0.12- 0.20 sec.
QRS
- Less than 0.10 sec.
Q-T interval Under 38 sec.

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Saw-tooth flutter waves

Atrial rate of 240 400 beats per minute
No identifiable P wave

Significance:
Decrease Cardiac Output
Decrease Blood Pressure
Angina
Change Level of consciousness

Answer. Coronary artery disease,

Hypertension,
Mitral valve disorder
Cardiomyopathy
Cor Pulmonale
Pulmonary heart disease
What is its significance?
Embolus formation
High risk for?

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Heart Block. A- V Block

Can occur as a results of structural changes in the

conduction system.
Prolonged PR interval
Normal PR interval ( 0.12 - 0.20 Sec. )

Causes:

Tumors
Myocardial Infarction
Coronary Artery Disease,
Infections of the heart
Toxic effect of Digitalis

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ECG NOTES

Digitalis Toxicity

o
o

Irregular heart beat

Asymptomatic

2nd degree block (2:1) Wenckebach

Associated with heart blocks

Check Pulse Rate (Toxicity Rate)
< 60 bpm for adult
< 80 bpm for child
< 100 bpm for neonatal
Evaluation of Digitalis Level

Therapeutic level
0.9-1.2 ng/mL

Spike is the term use and can be seen at the ECG

For the use of Pacemaker

Treatment of choice for

2nd and 3rd degree AV block
Pacemaker ( Spike )
Atrial pacing

(2:1) 2 Pwave for every 1 set of QRS

2nd degree block (2:1, 3:1)

Toxic level
2.0 ng/mL

100% Ventricular-paced rhythm

Nausea, vomiting and seeing Halos around eyes (yellowGreen), Diplopia, Blurred Vision
Photophobia, Headache Drowsiness

(2:1 , 3:1) more than 2 Pwaves for every 1 set of QRS

Check potassium level (3.5 5.5 meq/L)

Hypokalemia can cause Digitalis toxicity
Give Potassium I.V or orally
Give Isuprel and Atropine Increase Heart Rate
High Fiber Diet ( constipation contributes to digitalis
toxicity )

3rd degree Complete Block

(unidentifiable)

Second degree AV- Block

is a block in which impulse reach
the ventricles but others do not

The results of this heart block

Hypotension
Siezure
Cerebral ischemia
Cardiac arrest

( unidentifiable ) The P wave has no correlation with the QRS )

st

1 degree block (1:1)

An increased irritability of the ventricles

Early ventricular Complexes

Life threatening PVCs

What are the symptoms of digitalis toxicity?

Bullets

Life Threatening Dysrhythmias

Premature Ventricular Contraction

Third Degree Heart Block( Complete Heart Block )

erratic heart rates where SA and AV
are beating independently

If there are more than 6 PVCs in one full minute

Multiform / multifocal PVC
R on T phenomena
Couplet ( Two Consecutive PVC )
Triplet ( Three consecutive PVC )
Chest Pain with increased Frequency of PVC

What is the first thing you need to do?

Pacemakers

P: Patients identification, Medic Alert Card

A: Aware your dentist
C: Check for signs of hiccups
E: Electric Machine are avoided
M: MRI are avoided
A: Avoid driving for the first 6 months
K: Keep a record of Pulse Rate.
E: Educate the patient in taking Pulse Rate 1 full
minute.
R: Report signs of dizziness, faintness fever,
Redness, swelling, soreness, blackouts or
Increase Pulse Rate
S- Stand Clear

Notify the Physician.

What Electrolyte you need to check?
Potassium ( hypokalemia can cause PVC ).
What do you need to prepare for Wide and Chaotic PVC?
Prepare Lidocaine.
What if it is a Narrow PVC (hypoxic PVC)?
Give Oxygen.

Failure to Sense
The rate set by the pacemaker has not reacted.

(1:1) 1 P wave for every 1 set of QRS

First degree AV-Block

SA continues to function but the

transmission of impulse fails

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Failure to Capture
There is no response after a spike
( impulse given by the pacemaker)
Failure to Discharge
Battery Failure, dislodge leads, wire fracture

During the Exam

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ECG NOTES
Answer. Epinephrine

Ventricular Tachycardia

Ventricular Fibrillation (Course)

Ventricular Fibrillation (Fine)

It is a repititve Firing of an irritable Ventricular Ectopy.
140 250 beats / minute or greater
Prepare for this question..

( elective procedure )
Awake/ Alert/ oriented
Informed Consent
Synchronized
10- 200 joules
Biphasic50- 100 joules
Monophasic
100- 200

You can use cardioversion with:

Is there a Pulse? Yes

Prepare oxygen, antidysrhythic drugs and prepare for a

synchronized cardioversion
Is there a Pulse? No

Electrical therapy
Cardioversion

no discernible waves or complexes to measure

the heart is fibrillating
no cardiac output

What are your interventions?

Prepare for Defibrillation and CPR

Answer. Assess the patient

Activate the EMS
Perform continues CPR
Defibrillation
Give Adrenalin and Antidysrhythmic Therapy

Torsades de Pointes

What is the drug of choice for ventricular fibrillation?

Answer. Epinephrine

Asystole

Atrial Tachycardia,
A.Flutter,
A.Fibrillation,
Ventricular Tachy. With pulse
PSVT, WPW

Defibrillation

Emergency procedure
Unconscious
Check for DNR
Asynchronized
300j CPR Assess rhythm360j CPR Assess rhythm360j CPR- Assess rhythm-

Common Interpretation that is being ask in

examination:
Prominent U wave:
Flat or inverted T wave:

Hypokalemia
Hypokalemia

Peak T Wave:
Widened QRS:

Hyperkalemia
Hyperkalemia

Prolong ST interval:
Shortened ST segment:

Hypocalcemia
Hypercalcemia

Wide and Chaotic QRS:

Prolong PRI:
Shortened PRI:

PVC
AV Block
Junctional

Inverted T wave:
Hypoxia
Presence of Q wave:
Necrosis
S-T elevation:
Myocardial Injury

You can use defibrillation with:

Another type of ventricular tachycardia

Irregular rhythm with fast heart beat.

What is the main reason of Torsades de Pointes?

Answer. Hypomagnesaemia
What is the expected drug to be given?
Answer. Magnesium Sulfate

Ventricular Fibrillation
Ventricular Tachycardia (pulseless )
Pulses Electrical Activity

Cardiac Arrest
No cardiac movement
No rhythm

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What is your first intervention?

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Answer. Assess the patients responsiveness before

checking the machine

Emir Kahn R. Bautista R.N.

(Review Specialist)

Are you allowed to defibrillate the patient?

Answer. No! You cannot shock a shocked heart
What is the drug of choice?

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