ECG interpretation

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Electrocardiogram interpretation skill is an indispensable skill to nurses and clinicians. Its importance is marked by a host of approaches which are used to teach it to healthcare practitioners around the country. According to Keller et al (n.d. a), there are many causes tailored to teach healthcare practitioners how to interpret electrocardiograms. However, these causes have different shortcomings. Where some are too brief, some are hopelessly detailed. UW Madison self study manual presented a different approach. Its module provides a self study manual and workshops for learning. The direct applicability of the course content makes it more successful. In the module I learnt the following three concepts, which will have a great impact on my future practice.

The first concept was on the waves: P wave, QRS and T wave. Each one of these waves represents different phenomena. P wave indicates depolarization of the atria; QRS indicated depolarization of the ventricle while T waves indicate repolarization of the Ventricle (Keller et al n.d. b). It is these waves that are used to determine the state of the patient. The size, the length and the intervals between the wave con be inferred to deliver varied information about the patient. By grasping the concept of the waves: there appearance, length, sequence, interval and the meaning of each wave. The basic pattern of the wave is P wave, and then QRS, then T wave as indicate on the ECG paper in fig. 1 bellow with their basic intervals. The time interval between P waves can be used to determine arterial rate. The time between the beginning of the P wave and that of the QRS is the P-R interval. on the other hand, the ventricular rate can be determined using the intervals between QRS complexes. Between the QRS and the T wave is the ST segment or the Isoelectric period which can also be used to diagnose ailments such as hypoxia and ventricular ischemia. The T wave comes next representing ventricular repolarization. Occasionally, a little U wave may appear after the wave, this is ventricular repolarization remnants (Klabunde, 2007). The period between ventricular depolarization and repolarization is the Q-T interval. The ability to note variations in the pattern, durations, interval and distortion of the shapes of the wave will enable me to properly diagnose the patient’s conditions in future.

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Fig 1.( Klabunde, 2007)

The second concept I grasped from the module is, cardiac muscle cell depolarize with a postive wave of depolarization, the repolarize to a negative charge intracellularly (Keller et al, n.d. b). This waves are not confined to the heard but spread to the rest of the body from where they can easily be picked (Klabunde, 2007). This wave are picked form the body by skin “leads” also known as electronic which have both positive and negative ends. The ECG machine simply traces the wave as they are picked from the body by the positive and negative electrodes. In my practice, I will be able to understand the functioning of the patient heart by inferring the information picked and trace on the ECG paper to the patient condition and understanding what is happening at a particular time.

An observation of the tracing of the waves on the ECG paper reveals typical common reading and abnormal reading or finding by the ECG machine. These reading all contribute to understanding of the patient conditions. Normal reading involves a P wave that is 0.08-0.10 seconds and QRS that is 0.06-0.10 seconds. The P-R interval is 0.12-020seconds while the QT complex is ≤ 0.44 seconds. These intervals and the sequence P, QRS, T form the normal rhythm. Deviations create an abnormal rhythm, which is also known as arrhythmia. Arrhythmia can be well by studying out of place pace makers. One of the most common arrhythmia is sinus arrhythmia (Keller, n.d. b). This anomaly occurs when the P waves and the PR interval are not identical. Since this wave originates from the sinus node, the anomaly will mean that the sinus rate is fluctuating a lot. The trace by the ECG will show two P Waves before and after every QRS wave as shown in the slip blow (Keller, n.d. c):

There are several things that can cause this arrhythmia. They include seizure, sleep, intrinsic disease of the SA node, effects of drugs, Hypothyroidism among others. The patient may show signs of dizziness or lightheadedness.

The third and final concept is was on the ECG paper. The paper has 1 millimeter little squares and as a result the depth of the height of the waver is measured using millimeters. 10mmillimeters are equivalent to 1.0mVolt (Keller et al, n.d.). On this paper the horizontal axis represents time. 1 small box, which is equivalent to 1mm, represents 0.04 second and one large box, which is a total of five small ones, is equivalent to 0.02 seconds. It is against this paper that the waves are measured and interpreted. In this regard each small square or 1mm is equivalent to 0.04 sec in time and 0.1mV in voltage. Understanding the calibration in terms of time and voltage will also help me understand what is happening to the patient at any particular time. I will be able to detect anomalies in the wave using these calibrations and give a proper repot on the patient’s status.

Indeed, this concepts, presented by the module have enhance, my knowledge of the ECG. Understanding how to use the ECG is critical. This understanding will enable me be of great service to patient. With this knowledge I will be able to diagnose the patients’ conditions using the wave traces on the ECG paper. Each abnormal pattern in the rhythm is an indication of a critical condition to the patient. Such conditions include Escape (late) beats and premature (early) beats, Rapid ectopic (out of place) rhythms, atrioventricular heart blocks, and Irregular rhythms. Each one of this is indicate by different pattern of wave on the ECG slip and bear different implications for the patient. Ability to identify these patterns and interpret their implications will enable me help patient achieve good health.

References

Keller, D., Zakowski, L., & Hambrecht, M. A. (n.d. a). Introduction to ECG Interpretation. Retrieved from http://www.fammed.wisc.edu/medstudent/pcc/ecg/ecg.html

Keller, D., Zakowski, L., & Hambrecht, M. A. (n.d. b). Primer on Basic Concepts. Retrieved from http://www.fammed.wisc.edu/medstudent/pcc/ecg/ecg.html

Keller, D., Zakowski, L., & Hambrecht, M. A. (n.d. c). Group 1 Irregular rhythms. Retrieved from http://www.fammed.wisc.edu/medstudent/pcc/ecg/rhythm.group1.html

Klabunde, .R. E. (2007). Cardiovascular Physiology Concepts: Electrocardiogram (EKG, ECG). Retrieved from http://www.cvphysiology.com/Arrhythmias/A009.htm