Discussion on EKG

Discussion on EKG

Nurse practitioners can order a variety of diagnostic tests to arrive at a definite diagnosis for their patients. Mostly, the choice of the test is determined by the patient’s signs and symptoms that suggest the likelihood of a certain pathology based on the complaints reported. Some diseases may present with similar symptoms, but their management and pathology are different. They are termed differential diagnoses. Evading misdiagnosis of the patient justifies the prescription of diagnostic tests.

For this discussion, I chose to review the EKG video and discuss the electrocardiogram (ECG) test. This test is done to monitor the functioning of the heart through electric waves. There are three types of ECG. The first type is the resting ECG, which is done when the patient is lying still on their back. The second is the exercise ECG, which is done when the patient is physically active. The third is the Holter monitor, which is done for 24 hours (Institute for Quality and Efficiency in Health Care, 2019). From the EKG video reviewed, the electrical waves are obtained by attaching the patient to four categories of lead: inferior made up of II, III, Avf, the lateral category made up of I, Avl, V5, V6, the anterior category made up of V1, V2, and septal category made up of V3, V4. All these leads are connected to the patient’s arms and trunk (Dirty Medicine, 2019).

The electrical waves form rhythms that are interpreted to determine the pathology of the heart’s conduction. These waves are called sinus rhythms. It takes six seconds to create a complete normal sinus rhythm, which has a P-wave of 0.11 seconds observed through leads II and V1. It precedes a QRS complex, a T-wave, and a U-wave. The normal parameters of a sinus rhythm are a heart rate of 60-100 b/min, regular P-R interval of 0.12-0.20 secs, and QRS duration of 0.04 to 0.12 secs. Any deviation from these parameters signifies a problem in heart conduction (Soos & McComb, 2020).

Notably, the S-T segment elevation marks STEMI in the inferior leads. Atrial fibrillation has no P-wave and is irregular. The atrial flutter has no P-wave but differs from atrial fibrillation since it has a ‘sawtooth’ pattern. Pulmonary embolism is characterized by S1Q3T3 observation. S1-deep s-wave in lead I, Q3-deep Q–wave on lead III, and T3-inverted T-wave on lead III. A prominent U-wave signifies hypokalemia ( low potassium levels) while a peaked T-wave reflects hyperkalemia (high potassium levels). A prolonged QRS complex signifies TCA toxicity, which is treated by bicarbonate. Diffuse ST-elevation and PR depression indicate pericarditis. Lastly, as Dirty Medicine (2019) indicates, three or more different P-waves signify multifocal Atrial Tachycardia, commonly associated with lung disease.

References

Dirty Medicine. (2019, April 22). Electrocardiograms (ECG) made easy! [Video]. YouTube. https://www.youtube.com/watch?v=XNXVGAneSyk

Institute for Quality and Efficiency in Health Care. (2019). What is an electrocardiogram (ECG)? In www.ncbi.nlm.nih.gov. Institute for Quality and Efficiency in Health Care (IQWiG). https://www.ncbi.nlm.nih.gov/books/NBK536878/

Soos, M. P., & McComb, D. (2020). Sinus arrhythmia. PubMed; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK537011/

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Discussion Prompt
This week’s content addresses common techniques and testing that can be prescribed by the Nurse Practitioner. Please review ONE of the following resources and discuss what you have learned this week after reviewing.

Discussion on EKG

Review one of the following resources on EKG rhythms or Chest X-ray interpretation:
• Skillstat
• EKG Video
• Chest X-ray: Introduction & Approach

Expectations
Initial Post:
• Length: A minimum of 250 words, not including references
• Citations: At least one high-level scholarly reference in APA from within the last 5 years