Cardiac catheterization and ECG


Cardiac catheterization
Pre – operative :
1- fasting 8-12 hrs.
Post – operative :
1- observe puncture sites, hematoma, peripheral pulses, every 15 minutes for 1 hr. then every 1-2 hrs until stable.
2- color of exterimities, pain, numbness.
3- observe cardiac monitor for dysrhythmias
4- nausea + vomiting , ↓ Bp.
5- supine position 2 head 30 degrees with leg straight.
6- analgesic medication, and report any chest pain.
9] Echocardiography:
Non invasive procedure ultrasound test used to examine the size + shape, useful in diagnosis of the heart murmur (turbulent flow of blood + the cause is narrowed valve, which allow regurgitation blood flow, can be heard at the apex or chest).
ECG is a pictorial representation of the electrical activity occurring within the heart
Electrocardiograph (ECG)
•    Electrical impulse stimulates the heart to contract
•    A small amount of electricity spreads on the body surface
•    This electricity can be measured and recorded on the ECG

“PQRST” Waves
P wave represents depolarization (contraction) of the atrium

QRS wave represent the depolarization of the ventricles

“PQRST” Waves

•    PR interval represents the impulses for the time it leave the SA node through the delay at the AV node and its arrival at purkinje fibers (heart muscle fibers that help carry the electric signals that control heart contractions).
•    P – R interval:- the time required for atrial depolarization.

–    Recording of hearts electrical activity.
–    Allows the physician or nurse to evaluate the hearts:
–    Rate
–    Rhythm
–    Certain cardiac problems
–    quick – safe inexpensive and non invasive
ECG leads
For standard 12
lead ECG, We have 6 Limb leads and 6 Chest leads, 10 electrodes (six on the chest and four on the limbs) are placed on the body.
Four Limbs: RA, LA, RL and LL.
Chest leads: from V1 to V6
V1   4th intercostal space  just to the right of the sternum
V2   4th intercostal space just to the left of the sternum
V3   Halfway between V2 and V4
V4   5th intercostal space in the left mid-clavicular line
V5   On same horizontal as V4 in anterior axillary line
V6   On same horizontal as V4,V5 in mid axillary line


Analysis of ECG


•     P wave: 2.5 millimeter squares [mm] or less and 0.11 second or less on duration
•    QRS : less than  0.12 second,  less than 5 mm
•    U wave :- the same size as P wave . 2.5 mm.
•    P – R interval: Normal interval .12 to .2 second 3 – 5 mm
Estimating Heart Rate
    Heart rate determination for a regular rhythm: 1500 divided by the number of small boxes between two R waves.
    Or Count numbers of large boxes between R-R and divide that into 300
•    Example: Heart rate: regular rhythm 1500
•    The number of small boxes between two R= 13
•    HR:  1500/13= 115 bpm
•    If two large box: HR: 300/2= 150 bpm

Estimating Heart Rate
•    Heart rate determination if the rhythm is irregular, count the number of RR interval in 6 seconds and multiply the number by 10.


Sinus Bradycardia


Sinus Tachycardia

Premature Atrial Complexes (PAC)
•    Occurs when an electrical impulses starts in the atrium before the next normal impulses of the sinus node.
•    Ventricular and atrial rhythm: irregular due to P waves, creating a PP interval that is shorter than the others. Sometimes followed by longer than normal PP.
•    Causes: caffeine, anxiety, hypokalemia and nicoton.

Atrial flutter
•    Occur in the atrium and create impulses at an atrial rate between 250 – 400, because the atrial rate is faster than the AV node can conduct, not all atrial impulses are conducted into the ventricule.
•    Rhythm: regular or irregular.
•    P wave: atrial flutter is characterized by a series of identical P waves, they described as having the appearance of the Saw toothed shape
•    T wave: present but may be hidden by flutter waves.
Atrial fibrillation
•    Atrial fibrillation causes rapid, disorganized and uncoordinated twitching of atrial musculature, it is the most common dysrhythmia, may occur for a very short time (paroxysmal) or it may be chronic.
•    Rate: 350 – 600 beats /min
•    P wave: no visible P wave ( P wave greater than QRS)
•    P-R: interval cannot be measured.
•    Rhythm: irregular + usually rapid.

Premature ventricular contraction [PVC]
•     Is an impulses that starts in a ventricle and is conducted through the ventricles before the next normal sinus impulses.
•    PVC originates in one ventricle which their for depolarizes before the other, so the deflection from a P.V.C are very tall + deep.
•    PVC have greater deflection than normal QRS complexes.

Ventricular Bigeminy
•    When a P.V.C becomes coupled with a normal beat, this is called Bigeminy.
•    Every other complex is a PVC
Ventricular Trigeminy


•    When a P.V.C coupled with two normal beat, this is called Trigeming.
•    A rhythm in which every third complex is a PVC
Ventricular Quadriageming
•    P.V.C coupled with three normal beats.
•    A rhythm in which every fourth complex is a PVC.
Ventricular tachycardia (V.T)
Ventricular tachycardia
•    It is a three or more PVCs in a row.
•    Patient is usually unresponsive and pulseless.
•    P wave: hidden in the QRS complex
•    Increased myocardial irritability.
•    Rate ventricular: 100 – 200 beats/min.
•    It is extremely dangerous + consider an emergency.
•    Immediate defibrillation is the action of choice.
Ventricular Fibrillation
•    No audible heart sound.
•    Ineffective quivering of the ventricles
•    No palpable pulse.
•    No respiration.
•    Extremely irregular.
•    Ventricular fibrillation is not corrected immediately cardiac arrest + death will be happened.
•    P wave: not seen.
•    QRS: rapid + irregular.
•    Rx: defibrillation.
Ventricular Asystole
Ventricular ASystole
•    Called Flatline, [ condition in which the heart no longer beats ]
•    No QRS complexes
•    No heart beat
•    No palpable pulse
•    No respiration
•    Without any treatment ventricular A Systole is fetal.
•     Rx: CPR is necessary
Conduction abnormalities
1st – degree AV block

•    Heart blocks may occur in any one of the three areas, the SA Node, AV Node or the Bundle Branches.
•    Note : you must measure the P – R interval on every ECG, if the P – R interval is longer than one large square, an AV block is present.
•    A first  degree AV block is present when P – QRS – T sequence is normal but the P – R interval is prolonged.

2nd degree AV block

•     A second degree AV block is present when it takes 2 or more atrial impulses to stimulate the ventricular response.
•    Two or more P waves before each QRS 2 : 1 or 3 : 1
•    Rate : 30 – 55

3rd degree heart block

•    In 3rd degree block the AV block is complete that is no atrial impulses get through to the AV node [that mean no ventricular  contraction ]
•    In this case there is an atrial rate + independent ventricular rate .
•    3rd . Av block called AV dissociation.
•     Note : in 3rd block the ventricular rate may be so slow that the blood flow to the brain is diminished, so the patient may lose consciousness.
•    [ strokes – adams syndrome] : A state of sudden fainting. It is caused by incomplete heart block

•    Device used to produce and maintain normal heart rate in patients who have heart block it consist of a battery that stimulates the heart through an electrode wire attached to the surface of the ventricle epicardium or endocardium .
•    A method of restoring the normal Rhythm of the heart [ terminate dysrhythmias ] by giving D/C shock through electrode placed on the chest.

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Posted in Adult Health Nursing, Cardiovascular

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