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P-waves that are notched
P-waves that are notched and widened between the notch of .04 seconds are seen with with atrial abnormality. P-waves may be peaked or biphasic in some leads and are considered atrial hypertrophy.
P-waves that are inverted
P-waves that are inverted are usually called Junctional or Nodal in origin.
P-waves that look like saw tooth
P-waves that look like saw tooth are seen in Atrial Flutter.
P-waves that are not seen
P-waves that are not seen or are after the QRS are considered Junctional.
P-waves that are of chaotic origin
P-waves that are of chaotic origin and R-waves that do not walk are seen in Atrial Fibrillation.
P-waves of varying shapes
P-waves of varying shapes are usually seen in Wandering Pacemaker.
Prolonged PR-Interval
First degree heart block or any block in the AV-Node area (Ex. Wenchebach, CHB or 3rd degree degree heart block, 2nd degree heart block.
Short PR-Interval
Short PR-Interval is seen with pre-excitation syndrome (Ex. LGL, WPW)
QRS complex if the Q-wave is widened
QRS complex-if the Q-wave is widened or deep with an amplitude of 1/3 the height of the R-wave or .04 seconds in duration- this may be an indication of a Myocardial Infarction (MI).
QRS complex with a notch R-wave
QRS complex with a notch R-wave or a S and S wave is a sign of Bundle Branch Block- look in the chest leads for which Bundle Branch Block it is.
QRS complex of .11 seconds
QRS complex of .11 seconds is of Intra Ventricular Conduction Delay.
QRS complex that is wide and bizarre in configuration
QRS complex that is wide and bizarre in configuration is usually a PVC if it appears early in the cycle or possible Idioventricular Rhythm is present.
If the QRS is not present after the P-wave
If the QRS is not present after the P-wave this maybe Ventricular Standstill.
ST-elevation
ST-elevation of 2mm or more is an indication of Myyocardial injury or possible Repolarization abnormalities.
ST-depression
ST-depression may be an indication of Myocardial injury or Myocardial Ischemia. It can be seen in digitalis patients and may have a concave appearance if patient is digitalis toxic.
T-waves that are pointed or notched
T-waves that are pointed or notched in some adult patients can be a sign that pericarditis or a myocardial infarction has occurred.
Tall T-waves are seen in patients
Tall T-waves are seen in patients that are possibly having a myocardial infarction or elevated serum potassium level.
T-waves that are inverted
T-waves that are inverted in leads I,II,V3 to V6 is an indication of myocardial ischemia.
QT-Prolongation
QT-Prolongation is a sign of prolonged ventricular recovery or repolarization.
QT-Shortening
QT-Shortening can be a result from hypercalcemia or digitalis toxicity.
U-wave
U-wave is seen usually on patients with potassium loss, digitalis toxicity and hypercalcemia.
Basic MI Leads Inferior or Diaphragmatic
Leads II,III,AVF
Basic MI Leads Lateral
Leads I,AVL,V5,V6
Basic MI Leads Anterior
Leads V2,V3,V4, (V1)
Basic MI Leads Posterior
Leads V1,V2,V3-look for tall R-waves, St depression, and T waves being elevated.
Basic MI Leads Apical
Leads V3,V4,V5,V6
Basic MI Leads Anterior Lateral
Leads I,AVL,V4,V5,V6
Basic MI Leads Anterior Septal
Leads V1,V2,V3
MI develops in 3 basic ways Hyperactive
Hyperactive start of MI the T-wave inverts and show's ischemia has set in.
MI develops in 3 basic ways Acute
Acute-ST segment elevates showing that injury has occurred.
MI develops in 3 basic ways Evolving
Evolving-Q-waves now appear and shows a fully evolved MI.
Chest lead placement V1
V1 is located in the fourth intercostal space, right sternal border
Chest lead placement V2
V2 is located in the fourth intercostal space, left sternal border
Chest lead placement V3
V3 is halfway between V2 and V4
Chest lead placement V4
V4 is located in the fifth intercostal space, at the midclavicular line.
Chest lead placement V5
V5 is located in the fifth intercostal space, at the anterior axillary line.
Chest lead placement V6
V6 is located in the fifth intercostal space, at the mid axillary line.
EKG controls speed
The speed control regulates how fast or slow the paper or data run the EKG procedure. Common setting is 25 mm/sec.
EKG controls gain
The gain control regulates the output or height of the EKG waveform. Common setting 10mm/mv.
EKG controls artifact
Forty HZ is normally used to reduce artifact or abnormal marks on the EKG tracing due to muscle tremors & slight patient movement.
Standard leads
I,II,III and they are bipolar because they measure the flow of electrical current in two direction.
Augmented leads
AVR,AVL,AVF and they are unipolar because they measure the flow of electrical current in one direction.
Precordial leads (Chest leads)
V1-V6 and they are located in front of the heart across the chest.
Right arm (RA)Color
White
Left arm (LA) Color
Black
Left leg (LL) Color
Red
Right leg (RL) Color
Green
Polarization
The state of cellular rest is know as polarization and is the ready phase of the heart.
Depolarization
Depolarization is a state of cellular stimulation which precedes contraction. This is the most important electrical event in the heart-it causes the heart to contract & pump blood to the body.
Repolarization
Repolarization is a state of cellular recovery, which follows each contraction.
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