Gimme an E! Gimmie a K! Gimmie a G!

I got a really nice email from a doctor today! He’s an Electrophysiologist, a doctor trained in finding and combating abnormal heart rhythms. He had some nice comments about the Funky Heart blog (Thanks, doc!) and he also commented on this EKG strip. If it doesn’t look familiar, it is a strip generated when the artificial pacemaker is working but the heart isn’t responding. The most common cause is  a fractured (broken) pacer wire; more than likely, this patient will be back in the Operating Room soon.

The best way to learn what an EKG strip is supposed to look like is to study them, of course. Some heart defects can be detected by EKG readings – but how do you learn what those strips look like? You study them, of course… but there are 35 different heart defects, and variations of each. How do you study the EKGs of the more obscure combinations?

The trick isn’t memorization – no one is going to hold up a series of EKG flash cards and expect you to say “Coarctation! Hypoplastic Left Heart! PDA! Tricuspid…no… I don’t know that one! Maybe it’s Dry Rot!”

The EKG tracing is usually drawn on graph paper, and that grid is very important – the paper moves through the machine at a pre-determined rate and each grid is a measurement of time. Each section of a heartbeat – normal hearts beat in a certain sequence, which can be detected – is labeled and the distance (time) between segments is important. You just don’t glance at an EKG strip and see if it “looks right” – its an exacting science.

The first segment that the doctors look for is the P Wave. This little “hump” is the electrical activity created when the natural pacemaker inside the Atrium activates.  Reading the P wave can tell you if an Atrium is enlarged.

The large “spike” in the middle is the QRS complex, when the ventricles begin to function. This one is pretty important: You can detect several different things by timing the QRS complex, especially trouble in the heart’s electrical conduction system.

And the last segment is the T wave, when the Ventricles begin to recover from their pumping and “reset” for the next heartbeat. And not only is the P – QRS – T pattern important, experts can find problems based on the amount of time between certain actions in the heart. So even though the pattern looks good to the untrained eye, there are still plenty of opportunities for a potential problem to show up – and hopefully be corrected.

If you know how to read it, each section of the EKG graph tells you a story.

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