ECG
Transcript: When T wave inversion is normal: Inversion in V1 is common--but compare with previous ECG Inversion after STEMI this is EXPECTED and is a sign of reperfusion ST Elevation V2-V6, lead 1 and aVL with reciprocal depression in lead 2, 3, aVF. Hyperacute T waves Normal Knowing which part of the heart each lead sees can help identify where a problem is occurring http://3.bp.blogspot.com/-d5LHPGVUKLU/TzBuiZ4uYTI/AAAAAAAABMY/vbLRI5oGN-4/s1600/Initial+ECG.jpg http://www.publicsafety.net/image/precord_view.gif http://cardiophile.org/wp-content/uploads/2009/02/lateral-wall-ischemia-small.jpg UP! Objectives Can appear horizontal, up or down slopping off of ST segment http://lifeinthefastlane.com/wp-content/uploads/2012/01/AMI-ST-elevation-3.png EITHER! Arrows show which direction the QRS should be pointing primarily if depolarization is normal Lead 1 through AVF: "Up, always, sometimes, never, either, up" Precordial leads should progress downward to upward Lead placement is important http://i.istockimg.com/file_thumbview_approve/2436356/2/stock-photo-2436356-pink-gerbera-flower-from-3-different-angles.jpg Represents supply and demand ischemia Slightly asymmetrical Upright V2-V6 ALWAYS subordinate to QRS BLUE: part of the heart each lead capture RED: vessels located in this area Contingent leads: same background color 12 Lead ECG Analysis ALWAYS! (up) This chart is located by the original monitors at the front desk for your reference Bundle Branch Block QRS 0.12 sec or greater Review V1 and V6 for differentiation RBBB- V1 up, V6 up LBBB- V1 down, V6 up T wave inversion Electrode placement is IMPORTANT! T Wave Review of PESI Healthcare course "ECG Interpretation: Essential Skills & Treatment Protocols" by Cynthia Webner DNP, RN, CCNS, CCRN-CMC and Karen M. Marzlin DNP, RN, CCNS, CCRN-CMC Elevation http://www.ecglibrary.com/ecgs/norm.gif Summary and Application ST depression can indicate: ischemia reciprocal change to ST elevation ST depression can be visible in reciprocal leads to those with ST elevation *If you see depression, double check reciprocal leads for elevation Normal http://www.emedu.org/ecg/images/cond_2a.jpg SOMETIMES! (up) Normal Sinus Rhythm UP! Use contingent leads to help confirm suspicions RBBB Anatomical placement of leads makes a difference in the picture you are taking. Example: You see ST depression in leads 1 and aVL. Look at leads 2,3, AVF for ST elevation. Abnormal LBBB ST Depression Associate correct lead placement with ECG accuracy Use provided chart to identify: each lead's view of the heart lead normals contingent leads Associate lead views with appropriate bedside monitor primary lead choice Analyze ECG by following given steps rSR' pattern example Same example as earlier, but note ST depression in leads 2, 3, aVF with ST elevation in the reciprocal leads of I and AVL. http://nl.ecgpedia.org/images/thumb/d/d4/12leadLBTB.png/800px-12leadLBTB.png Infarction http://emj.bmj.com/content/17/1/40/F10.medium.gif Reciprocal http://12leadecg.com/intro/images/ECG/12841_01_0561A.gif Break Down http://3.bp.blogspot.com/_ES0GyVWZYyw/SZb-xYqlM0I/AAAAAAAAAEU/6LZQ9zaIVZQ/s1600/Second%2BEKG%2Bnow%2Bwithout%2BST%2Bdepression.png Use these steps for thorough ECG analysis Familiarizing with norms can help with abnormal identification http://lifeinthefastlane.com/wp-content/uploads/2011/12/normal-sinus-rhythm.jpg Apply when choosing a primary lead on the bedside monitor that is most appropriate for your patient's condition Abnormal You can use this chart to identify: where in the heart the lead is showing contingent leads QRS norms leads to identify BBB http://ecg.utah.edu/img/items/ST%20segment%20depression%20morphologies.jpg http://static.memrise.com/uploads/mems/7914000110501182002.gif http://12leadecg.com/intro/images/ECG/12841_01_0559A.gif NEVER (up)! T wave inversion can signal NSTEMI with positive trops or unstable angina (ischemia) with negative trops QRS Hyperacute T waves (sharp angulation) can be an early sign of STEMI ST elevation requires immediate reperfusion Normal Sinus Rhythm Represents a need for reperfusion with a cath or lytic http://ars.els-cdn.com/content/image/1-s2.0-S0147956311005553-gr2.jpg 12 Lead ECG Evaluation http://ars.els-cdn.com/content/image/1-s2.0-S0147956311005553-gr2.jpg ST elevation V1-V5, slight lead 1 and aVL.