Ecg 12 Lead Introduction Essay

1440 words - 6 pages

An Introduction to the
12 lead ECG
& Acute MI changes
a lecture for student nurses

Dr Kofi Amu-Darko
MB. ChB. DRCOG. DFFP. MRCGP. PgDip. LLM
Family Physician
Charles Curtis Memorial Hospital
October 2008
1

By the end of this lecture, you will be able
to:
• Understand the 12 lead ECG in relation to
the coronary circulation and myocardium
• Perform an ECG recording
• Identify the ECG changes that occur in the
presence of an acute coronary syndrome.
• Begin to recognize and diagnose an acute
MI.

2

What is a 12 lead ECG?
 Records the electrical activity of the heart
(depolarization and depolarization of the myocardium)
 Views the surfaces of the left ventricle ...view middle of the document...

17

Surfaces of the Left
Ventricle
 Inferior - underneath
 Anterior - front
 Lateral - left side
 Posterior - back

18

Inferiorand avF look UP from below to the inferior
Surface
 Leads II, III
surface of the left ventricle
 Mostly perfused by the Right Coronary Artery

19

Inferior Leads
II
III
aVF

20

Anterior Surface
 The front of the heart viewing the left ventricle and the
septum
 Leads V2, V3 and V4 look towards this surface
 Mostly fed by the Left Anterior Descending branch of the
Left artery

21

Anterior Leads
 V2
 V3
 V4

22

Lateral Surface

 The left sided wall of the left ventricle
 Leads V5 and V6, I and avL look at this surface
 Mostly fed by the Circumflex branch of the left artery

23

Lateral Leads
V5, V6,

I, aVL

24

Posterior Surface
 Posterior wall infarcts are rare
 Posterior diagnoses can be made by looking at the anterior
leads as a mirror image. Normally there are inferior
ischaemic changes
 Blood supply predominantly from the Right Coronary
Artery

25

RIGHT

LEFT

Inferior
II, III, AVF

Antero-Septal
V1,V2, V3,V4

Posterior
V1, V2, V3

Lateral
I, AVL, V5,
V6
26

ECG Waveforms

 Normal cardiac axis is downward and to the left
 ie the wave of depolarisation travels from the right
atria towards the left ventricle
 when an electrical impulse travels towards a positive
electrode, there will be a positive deflection on the
ECG
 if the impulse travels away from the positive electrode,
a negative deflection will be seen

27

ECG Waveforms
 Look at your 12 lead ECG’s
 What do you notice about lead avR?
 How does this compare with lead V6?

28

An Introduction to the
12 lead ECG
Part II

29

Basic electrocardiography


Heart beat originates in the
SA node
Impulse spreads to all parts of
the atria via internodal
pathways
ATRIAL contraction occurs
Impulse reaches the AV node
where it is delayed by
0.1second
Impulse is conducted rapidly
down the Bundle of His and
Purkinje Fibres
VENTRICULAR contraction
occurs
30

•The P wave represents atrial depolarisation
•the PR interval is the time from onset of atrial activation to onset of
ventricular activation
•The QRS complex represents ventricular depolarisation
•The S-T segment should be iso-electric, representing the ventricles
before repolarisation
•The T-wave represents ventricular repolarisation
•The QT interval is the duration of ventricular activation and recovery.
31

ECG Abnormalities
Associated with ischaemia

32

Ischaemic Changes





S-T segment elevation
S-T segment depression
Hyper-acute T-waves
T-wave inversion
Pathological Q-waves
Left bundle branch block

33

ST ST segment represents period between ventricular
Segment
 The
depolarisation and repolarisation.
 The ventricles are unable to receive any further stimulation
 The ST...

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