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Understanding the Normal ECG rd 23 September 2022 @Lwnurses #LWN #LearnWithNurses Joanne Haws RN MSc Clinical Director, Learn With Nurses Independent Nurse Consultant & Specialist in Cardiovascular Disease Non-Executive Director, National Association of Primary Care Clinical Consultant, National CLEAR Programme Nurses & Allied Health Professionals Working Party Member, British & Irish Hypertension Society @jojohawsUsing Medall To get slidesMedall.org getting certificates/slidesClosed FB group & Page What are we looking at? • Iso-electric line (baseline) • There are three lead systems that make up the standard ECG: • Standard Limb Leads (Bipolar): I, IlI & III • Augmented Limb Leads (Unipolar): aVR, aVL & aVF • Precordial Leads: V1- V6 • Impulses towards the positive (+ve) electrode are seen as positive or upward deflections in that lead • Impulses away from the positive (+ve) electrode are seen as negative or downward deflection in that lead4 electrodes → 6 “leads”6 electrodes → 6 “leads” Clavicle The Society for Cardiological Science and Technology Consensus Guideline (2010) Recording a standard 12 lead electrocardiogram Chest leads Limb leads aVR aVL V6 I V5 V1 V3 V4 V2 III aVF II The Society for Cardiological Science and Technology lead electrocardiogram010) Recording a standard 12Cardiac Conduction SystemECG Waves and Intervals • P wave: the sequential activation (depolarization) of the right and left atria • QRS complex: right and left ventricular depolarization (normally the ventricles are activated simultaneously) • ST-T wave: ventricular repolarization Step by Step analysis • Rhythm • Rate • P Wave • P- R interval • QRS complex • ST segment • T waves • Q-T interval Rhythm Interpretation • Is it regular? • What’s the rate? Check paper speed is 25mm/sec • Regular Rhythm Divide 300 by number of large squares between 2 QRS complexes • Irregular Rhythm count number of complexes in 30 large squares (=6 seconds) and multiply by 10 Hampton J & Hampton J (2019) The ECG Made Easy V9.Elselvier Rhythm Interpretation P waves: • ? Present • ? Visible • ? Normal contour • ? Inverted • ? Related to the QRS • ? Look the same Hampton J & Hampton J (2019) The ECG Made Easy V9.Elselvier Rhythm Interpretation PR Interval: • Time taken from beginning of P wave to beginning of QRS complex • 0.12 secs – 0.20 secs (3-5 small squares) Hampton J & Hampton J (2019) The ECG Made Easy V9.Elselvier Rhythm Interpretation QRS Complex: • ? Normal Contour • 0.08 secs – 0.12 secs (2-3 small squares) ST Segment: • Return to baseline? • Positive deflection? Hampton J & Hampton J (2019) The ECG Made Easy V9.Elselvier Rhythm Interpretation QT Interval: • Time from start of QRS to end of T wave 0.33 secs – 0.43 secs (8-11 small squares) • PR/QT intervals can vary with heart rate Hampton J & Hampton J (2019) The ECG Made Easy V9.ElselvierTwelve Lead ECG In summary • Preparation is key to obtaining a good quality ECG • Ensure correct lead placement • Think about what you are looking at • Don’t believe the auto-interpreter • Don’t forget to look at the patient! Become a PCCS MembWhat does PCCS Membership give you? Register here: Membership is free and gives you access to our members only CVD academy Receive monthly newsletters and updates from the Council Potential involvement in Cardiovascular Advisory Committees Updates on latest guidance Access to high quality education OR SIGN UP AT www.pccsuk.org PCCS educational events and CVD Academy sessions at nationals meetings
