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11/13/23, 6:23 PM Prophecy Foundations of ECG Interpretation 1© Copyright Clinical Assessments by Prophecy, a Division of Advanced Practice Strategies
FI: 1
Foundations of ECG Interpretation
INTRODUCTION
The heart is central to the success of all body systems. It has its own unique electrical system to
stimulate the heart to contract in an orderly fashion. When there are complications with the electrical
conduction system, this can result in an arrhythmia.
about:blank 1/61
,11/13/23, 6:23 PM Prophecy Foundations of ECG Interpretation 1
© Copyright Clinical Assessments by Prophecy, a Division of Advanced Practice Strategies
FI: 1
Foundations of ECG Interpretation
INTRODUCTION
The heart is central to the success of all body systems. It has its own unique electrical system to
stimulate the heart to contract in an orderly fashion. When there are complications with the electrical
conduction system, this can result in an arrhythmia.
There can be many causes for arrhythmias including but not limited to electrolyte imbalances, heart
disease, congenital anomalies, and substance abuse. Depending on the type and severity of arrhythmia,
it could mean a life or death situation.
Technological advances have made it possible for cardiac monitors to actually identify a cardiac rhythm.
However, it is the licensed clinician’s responsibility to confirm that the interpretation is accurate.
Therefore, it is imperative for clinicians to understand how to properly interpret a cardiac rhythm with
accuracy so appropriate treatment can be administered.
Clinical knowledge of basic rhythm interpretation begins with understanding the basic anatomy and
physiology of the heart and the electrical conduction system. Understanding each of the components of
a cardiac rhythm and how it corresponds to the mechanisms of the heartbeat is critical to the proper
analysis and treatment of an arrhythmia.
PURPOSE/OVERALL GOAL
The purpose of this module is to serve as a review for individuals who have previously completed a
formal ECG interpretation course.
This module is not intended to replace any formal training, nor is the primary focus on interventions.
Rather, it is to serve as a review of the fundamental components for properly interpreting cardiac
rhythms in the provision of safe and effective care.
To protect content integrity, the learner will be unable to print this module.
All strips in this module are six seconds in length.
COURSE OBJECTIVES
After completing this module, the learner should be able to:
1. Identify basic components of the electrical conduction system on the ECG
2. Identify and correlate the electrical conduction system to the cardiac cycle
3. Describe two ways to properly measure rhythm
4. Describe the basic steps to rhythm interpretation
FI: 2
OVERVIEW OF HEART FUNCTION
The heart is made up of four chambers: two atria and two ventricles, which are identified by right and
left. During one cardiac cycle:
Blood is emptied from the right atria into the right ventricle and is then pumped into the
pulmonary vascular system
At the same time, blood from the left atria empties into the left ventricle and is then pumped
into the peripheral circulatory system
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,11/13/23, 6:23 PM Prophecy Foundations of ECG Interpretation 1
FI: 2
OVERVIEW OF HEART FUNCTION
The heart is made up of four chambers: two atria and two ventricles, which are identified by right and
left. During one cardiac cycle:
Blood is emptied from the right atria into the right ventricle and is then pumped into the
pulmonary vascular system
At the same time, blood from the left atria empties into the left ventricle and is then pumped
into the peripheral circulatory system
The heart’s ability to pump can only occur with electrical stimulation. This stimulation is the cardiac
impulse of the heart through the electrical conduction system.
The cardiac conduction system is part of the complex autonomic nervous system made up of two
branches:
The sympathetic (or adrenergic)
The parasympathetic (or cholinergic)
The sympathetic or adrenergic system releases two hormones: epinephrine and norepinephrine. These
hormones:
Speed up the heart rate
Increase the force of the heart’s contraction
Increase blood pressure
Sympathetic activation is well known for its flight or fight response. Conversely, the parasympathetic or
cholinergic response releases acetylcholine and actually decreases the heart rate.
FI: 3
THE CARDIAC ELECTRICAL CONDUCTION SYSTEM
Basic steps to rhythm interpretation start with reviewing each component of the ECG complex.
ECGs (electrocardiograms) are a measure of electricity (voltage on the y-axis) over the time it takes for
the impulse to travel through the heart fibers (milliseconds on the x-axis).
An electrical impulse travels from the SA (sinoatrial node), located in the right atrium, through
the walls of the atria which causes them to contract
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, 11/13/23, 6:23 PM Prophecy Foundations of ECG Interpretation 1
FI: 3
THE CARDIAC ELECTRICAL CONDUCTION SYSTEM
Basic steps to rhythm interpretation start with reviewing each component of the ECG complex.
ECGs (electrocardiograms) are a measure of electricity (voltage on the y-axis) over the time it takes for
the impulse to travel through the heart fibers (milliseconds on the x-axis).
An electrical impulse travels from the SA (sinoatrial node), located in the right atrium, through
the walls of the atria, which causes them to contract.
The impulse travels through the AV node, which is also located between the atria and ventricles,
and then travels down through the bundle branches located in the ventricles.
The contraction of muscles fibers in a normal fashion is called depolarization.
Repolarization is the resting state, or relaxation phase, of the myocardium.
Any delays in the electrical activity could indicate the presence of damage to the fibers in the
conduction pathway such as in a myocardial Infarction or electrolyte imbalances, for example.
FI: 4
It’s important to understand the relationship between the electrical system of the heart and what we
see on the cardiac monitor.
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