ECG Interpretation: Types of Heart Block

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The heart is a pump that is made up cardiac muscle tissue. The way the heart pumps is controlled by a conduction system that causes the heart muscles to contract when electrical impulse passes through it. The sinoatrial node (SAN) is where impulse is generated. It is the pacemaker of the heart. The impulse generated frequently is about 60-100 beats per minute (Gandelman G, 2013). The SAN is located in the right atrium and as impulse leaves, the left atrium conducts it by way of Bachmann’s bundle. Impulse travel to the AV node and are briefly delayed so contracting atria can empty all the blood into the ventricles. The impulse travels to the bundle of His, to the bundle branches and Purkinje fibers (Gandelman G, 2013).

An ECG is a test that records the rhythm and activity of the heart through the use of electrodes on the skin and it is graphically displayed. 10 electrical cables are placed on the body; one to each limb (4cables) and the other six across the chest (Ashley EA, 2004).

Lead- The word lead has two meaning in the ECG terms:

- a cable that helps the ECG recorder to be attached to an electrode.

-from anyone arrangement of the electrodes the electrical view of the heart.

When an ECG is carried out: the patient undresses to the waist and lay down, excess hair is removed if required, the limb leads are fixed anywhere on the limb and the chest leads are attached as follows:

V1 and V2 – 4th intercostals space to the right and left of the sternum respectively

V3 – midway between V2 and V4

V4 – on the heart apex

V5 and V6 – anterior axillary and mid axillary at the same line as V4

Ask patient to stay calm and push record button (Rautaharju PM, 1987).

The 10 electrical cables have 12 electrical views and this is how a standard ECG reading is taken. The angles the electrodes “look” at the heart are reflected by these different views and the heart’s electrical depolarization direction (Ashley EA, 2004). (Dr Kavanagh Sean, 2013)

The pacemaker of the heart is the sino atrial node (SAN).

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