12-Lead EKG Interpretation for the Primary Care Provider
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1 21 st Annual Southwestern Regional Nurse Practitioner Symposium July 26, Lead EKG Interpretation for the Primary Care Provider Fran Stier MSN, ANP-BC, ACNP-BC Heart Health Care LLC Show Low, AZ (Part 3 of 3 parts)
2 12-Lead EKG Interpretation for the Primary Care Provider, Fran Stier, ANP
3 12-Lead EKG Interpretation for the Primary Care Provider, Fran Stier, ANP
4 12-Lead EKG Interpretation for the Primary Care Provider, Fran Stier, ANP
5 12-Lead EKG Interpretation for the Primary Care Provider, Fran Stier, ANP
6 12-Lead EKG Interpretation for the Primary Care Provider, Fran Stier, ANP
7 Antiarrhythmic Agents 12-Lead EKG Interpretation for the Primary Care Provider, Fran Stier, ANP
8 12-Lead EKG Interpretation for the Primary Care Provider, Fran Stier, ANP
9 CAST ( ) Encanide (Enkaid) Flecainide (Tambocor) Moricizine (Ethmozine) 12-Lead EKG Interpretation for the Primary Care Provider, Fran Stier, ANP
10 Class IA Phase 0: slow conduction by blocking sodium flow. Use: Supraventricular or ventricular Proarrhythmic: Moderately High ECG: Prolong QRS & QT intervals Agents: quindine, norpace, procainamide 12-Lead EKG Interpretation for the Primary Care Provider, Fran Stier, ANP
11 Class IB Agents: lidocaine, mexiletine, tocainide, dilantin. Use: ventricular arrhythmias. Proarrhythmic: relatively low. ECG: no effect on AV, does not widen QRS 12-Lead EKG Interpretation for the Primary Care Provider, Fran Stier, ANP
12 Class IC Agents: flecainaide, propafenone (Rythmol) Use: Supraventricular. Rythmol for both supraventricular & ventricular. Proarrhythmic: High ECG: Prolong PR, QRS, & QT. 12-Lead EKG Interpretation for the Primary Care Provider, Fran Stier, ANP
13 Class II Phase 4: decrease conduction thru AV node & dec. myocardial automaticity. Agents: Beta Blockers Use: Supraventricular & ventricular. ECG: Bradycardia, prolong PR. 12-Lead EKG Interpretation for the Primary Care Provider, Fran Stier, ANP
14 Class III Phase 3: Potassium channel blocker, prolongs relative refractory, causes coronary vasodilatation. Agents: Amiodarone, Sotalol, Dofetilide-pure Class III, no BB activity Use: primarily ventricular, but also atrial fibrillation & flutter. ECG: Amiodarone - prolongs PR & QT, prominent U wave. Sotalol - prolongs PR & QT, torsades de pointes. Dofetilide prolongs QT, may cause polmorphoric VT. 12-Lead EKG Interpretation for the Primary Care Provider, Fran Stier, ANP
15 Class IV Phase I & IV: depress automaticity SA node, slows AV conduction. Agents: Verapamil, Diltiazem Use: Supraventricular arrhythmias Proarrhythmic: relatively low ECG: Decrease SR, prolong PR Contraindications: wide QRS tachycardia, WPW. 12-Lead EKG Interpretation for the Primary Care Provider, Fran Stier, ANP
16 Unclassified Agent: Adenosine ( Adenocard) Use: PSVT, SVT Proarrhythmic: moderate ECG: Transient inc. PR interval: 1st, 2nd, & 3rd degree heart block. Asystole. Note: bradycardia refractory to atropine. 12-Lead EKG Interpretation for the Primary Care Provider, Fran Stier, ANP
17 Antiarrhythmics: Nursing Implications Monitor for Proarrhythmia Assess patient symptoms. Observe ECG changes. 12-Lead EKG Interpretation for the Primary Care Provider, Fran Stier, ANP
18 Electrolyte Effects on EKG Agents that Prolong QT 12-Lead EKG Interpretation for the Primary Care Provider, Fran Stier, ANP
19 Drug-Induced QT Prolongation 12-Lead EKG Interpretation for the Primary Care Provider, Fran Stier, ANP
20 Normal QTi:.40 sec +.04 sec Heart rate 60 < 100: QTi is < ½ R-R interval QTc = QT R-R 12-Lead EKG Interpretation for the Primary Care Provider, Fran Stier, ANP
21 12-Lead EKG Interpretation for the Primary Care Provider, Fran Stier, ANP
22 Prolong QT Resources Lead EKG Interpretation for the Primary Care Provider, Fran Stier, ANP
23 EKG changes Hyperkalemia Peaking of T wave P waves flatten PR prolongs Widening of QRS: looks like RBBB w/lah ST disappears into T wave VF or standstill may occur 12-Lead EKG Interpretation for the Primary Care Provider, Fran Stier, ANP
24 EKG Effects Hypokalemia Flatten T wave Prominent U wave Prolong PR: 1 st degree Block Wenckebach Slight ST depression Dig Toxicity 12-Lead EKG Interpretation for the Primary Care Provider, Fran Stier, ANP
25 12-Lead EKG Interpretation for the Primary Care Provider, Fran Stier, ANP
26 Maintains intracellular Potassium Na/K/ATPase pump Intracellular enzymes Glucose metabolism Protein synthesis Neuromuscular sedative Magnesium 12-Lead EKG Interpretation for the Primary Care Provider, Fran Stier, ANP
27 Peaked T waves Prominent U wave Prolong QRS ST depression QU prolongation EKG Changes Hypomagnesemia 12-Lead EKG Interpretation for the Primary Care Provider, Fran Stier, ANP
28 Indications for Mg ++ Replacement Ventricular arrhythmias Torsades Contraindicated in Heart Block 1-2 gms IV, <1.5ml/min Watch for toxicity: hypotension, drowsiness, weakness, dec. DTRs 12-Lead EKG Interpretation for the Primary Care Provider, Fran Stier, ANP
29 EKG Changes Hypocalcemia Elongates QT prolong QT Symmetrical T wave 12-Lead EKG Interpretation for the Primary Care Provider, Fran Stier, ANP
30 EKG Changes Hypercalcemia Shortens QT interval T wave prolongs Increase sensitivity to digitalis 12-Lead EKG Interpretation for the Primary Care Provider, Fran Stier, ANP
31 12-Lead EKG Interpretation for the Primary Care Provider, Fran Stier, ANP
32 EKG Samples 12-Lead EKG Interpretation for the Primary Care Provider, Fran Stier, ANP
33 12-Lead EKG Interpretation for the Primary Care Provider, Fran Stier, ANP
34 12-Lead EKG Interpretation for the Primary Care Provider, Fran Stier, ANP
35 12-Lead EKG Interpretation for the Primary Care Provider, Fran Stier, ANP
36 12-Lead EKG Interpretation for the Primary Care Provider, Fran Stier, ANP
37 12-Lead EKG Interpretation for the Primary Care Provider, Fran Stier, ANP
38 12-Lead EKG Interpretation for the Primary Care Provider, Fran Stier, ANP
39 12-Lead EKG Interpretation for the Primary Care Provider, Fran Stier, ANP
40 12-Lead EKG Interpretation for the Primary Care Provider, Fran Stier, ANP
41 12-Lead EKG Interpretation for the Primary Care Provider, Fran Stier, ANP
42 12-Lead EKG Interpretation for the Primary Care Provider, Fran Stier, ANP
43 12-Lead EKG Interpretation for the Primary Care Provider, Fran Stier, ANP
44 12-Lead EKG Interpretation for the Primary Care Provider, Fran Stier, ANP
45 12-Lead EKG Interpretation for the Primary Care Provider, Fran Stier, ANP
46 12-Lead EKG Interpretation for the Primary Care Provider, Fran Stier, ANP
47 12-Lead EKG Interpretation for the Primary Care Provider, Fran Stier, ANP
48 12-Lead EKG Interpretation for the Primary Care Provider, Fran Stier, ANP
49 Questions??? 12-Lead EKG Interpretation for the Primary Care Provider, Fran Stier, ANP
50 Thank you
ACLS Cardiac Arrest Algorithm Neumar, R. W. et al. Circulation 2010;122:S729-S767
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