Are those Tombstones real?

Many of the providers that we encounter in the hospital are always looking to be more educated on the ins and outs of cardiology. A repeated question is regarding cardiac dysrhythmias and the interpretation of the ischemic patient. Have you ever had a patient in your office that complains of chest pain? Did you get an EKG and have difficulty interpreting it? Did you send them to the ER and wonder what the next steps were once they arrived there? First, you have to be able to evaluate a normal ECG and understand what you are looking at and the physiology behind it. Once you understand normal, then you can begin to investigate the abnormal.
The normal ECG runs with a 12 lead system. There are three standard limb leads (I, II,III), the augmented leads (aVR, aVL, aVF), and six precordial leads (V1-V6). As we look at the leads, they exhibit the electrical currents in varying patterns and depict certain regions of the heart. On each lead, there is a P wave, QRS, and a T wave. Each one of those waves represents different depolarizations of the heart. We then move into the abnormal ECG. As we have an interruption of the normal conductions throughout the heart muscle, the wave before will change their pattern, and we can detect an ischemic or rhythm disorder based on that change. For example, the patient that is in your office that experiences chest pain. An ECG is obtained, and it is different compared to an old one. After interviewing the patient regarding the pain, you decide to send the patient to the ER. The patient continues to have chest pain; ECG looks like there are ST-segment elevations. We start thinking the could be an Acute MI. You may have just saved your patient’s life. We will discuss these scenarios, outcomes, and more at the GAPA conference this summer. Hope to see you there!

See Jason Lucas, PhD, PA-C speak at the GAPA 2020 Summer Conference in Sandestin, FL.

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