Download - ECG ARTIFACTS AND PITFALLS
![Page 1: ECG ARTIFACTS AND PITFALLS](https://reader035.vdocument.in/reader035/viewer/2022062902/58efd02d1a28ab0f7a8b45c1/html5/thumbnails/1.jpg)
ECG ARTIFACTS AND PITFALLS
DR PADMANABH KAMATHADDITIONAL PROFESSSOR
DEPT OF CARDIOLOGYKMC
MANGALORE
![Page 2: ECG ARTIFACTS AND PITFALLS](https://reader035.vdocument.in/reader035/viewer/2022062902/58efd02d1a28ab0f7a8b45c1/html5/thumbnails/2.jpg)
STANDARD POSITION OF LEADS
![Page 3: ECG ARTIFACTS AND PITFALLS](https://reader035.vdocument.in/reader035/viewer/2022062902/58efd02d1a28ab0f7a8b45c1/html5/thumbnails/3.jpg)
10 COMMANDMENTS1. YOU SHALL NOT REVERSE THE ARM ELECTRODES2. YOU SHALL NOT TREAT THE ECG,TREAT PATIENT3. SHALL NOT REVERSE LG ELECTRODES4. SHALL NOT REVERSE PRECORDIAL ELECTRODES5. PATIENT CALM AND QUIET6. TURN OFF MOBILE PHONE7. DO NOT PLACE ELECTRODE ON TORSO8. DO NOT PLACE TELEMETRY ELECTRODES ON ECG ELECTRODES9. DO NOT REVERSE ARM AND LEG ELECTRODES10. PATIENT SHOULD BE LYING DOWN
![Page 4: ECG ARTIFACTS AND PITFALLS](https://reader035.vdocument.in/reader035/viewer/2022062902/58efd02d1a28ab0f7a8b45c1/html5/thumbnails/4.jpg)
CLASSIFICAION OF ARTIFACTS
INTERNAL(PHYSIOLOGICAL)1) MUSCULAR2) MOTION
EXTERNAL(NON PHYSIOLOGICAL)1. ELECTROMAGNETIC INTERFERENCE Light Electrocautery Electrical devices2. CABLE AND ELECTRODE MALFUNCTION Insufficient gel Inappropriate filter Loose connection Misplaced leads Accumulation of static energy
![Page 5: ECG ARTIFACTS AND PITFALLS](https://reader035.vdocument.in/reader035/viewer/2022062902/58efd02d1a28ab0f7a8b45c1/html5/thumbnails/5.jpg)
LIMB LEAD REVERSAL
![Page 6: ECG ARTIFACTS AND PITFALLS](https://reader035.vdocument.in/reader035/viewer/2022062902/58efd02d1a28ab0f7a8b45c1/html5/thumbnails/6.jpg)
RA LA LEAD REVERSAL(COMMONEST)(Technical Dextrocardia)
![Page 7: ECG ARTIFACTS AND PITFALLS](https://reader035.vdocument.in/reader035/viewer/2022062902/58efd02d1a28ab0f7a8b45c1/html5/thumbnails/7.jpg)
TECHNICAL DEXTROCARDIA
• R wave positive in lead avR• Extreme axis eviation• Reverse polarity in all normal deflection in
lead I and avL• DIFFERENTIAL IS DEXTROCARDIA• In dextrocardia precordial R wave progression
is reversed• In technical dextrocardia it is normal.
![Page 8: ECG ARTIFACTS AND PITFALLS](https://reader035.vdocument.in/reader035/viewer/2022062902/58efd02d1a28ab0f7a8b45c1/html5/thumbnails/8.jpg)
RA AND RL REVERSAL(pseudoasystole pattern)
![Page 9: ECG ARTIFACTS AND PITFALLS](https://reader035.vdocument.in/reader035/viewer/2022062902/58efd02d1a28ab0f7a8b45c1/html5/thumbnails/9.jpg)
LEFT ARM AND LEFT LEG REVERSAL(abdollah sign)
![Page 10: ECG ARTIFACTS AND PITFALLS](https://reader035.vdocument.in/reader035/viewer/2022062902/58efd02d1a28ab0f7a8b45c1/html5/thumbnails/10.jpg)
REVERSAL OF PRECORDIAL LEADS(Tall R in V1and deep S in V6)
![Page 11: ECG ARTIFACTS AND PITFALLS](https://reader035.vdocument.in/reader035/viewer/2022062902/58efd02d1a28ab0f7a8b45c1/html5/thumbnails/11.jpg)
TREMOR ARTIFACT(Pseudo flutter waves)
When in doubt look at lead II
![Page 12: ECG ARTIFACTS AND PITFALLS](https://reader035.vdocument.in/reader035/viewer/2022062902/58efd02d1a28ab0f7a8b45c1/html5/thumbnails/12.jpg)
ERROR OF COMPUTER AVERAGING(HI TECH ARRHYTHMIAS)
![Page 13: ECG ARTIFACTS AND PITFALLS](https://reader035.vdocument.in/reader035/viewer/2022062902/58efd02d1a28ab0f7a8b45c1/html5/thumbnails/13.jpg)
PSEUDO VENTRICULA TACHYCARDIA(SINUS SIGN,SPIKE SIGN,NOTCH SIGN)
![Page 14: ECG ARTIFACTS AND PITFALLS](https://reader035.vdocument.in/reader035/viewer/2022062902/58efd02d1a28ab0f7a8b45c1/html5/thumbnails/14.jpg)
Differentiating an Artifact from Ventricular tachycardia
• Huang et al also described 3 signs that may help in differentiating a tremor-induced pseudo-ventricular tachycardia from true ventricular tachycardia. Presence of any of these signs is suggestive of pseudo-ventricular tachycardia:
• "Sinus" sign: One of the frontal leads (I, II and III) may present with sinus rhythm showing normal P, QRS, and T waves. The reason is that one of the upper limbs may be free off tremor.
• "Spike" sign: Presence of regular or irregular tiny spikes among wide-QRS complexes.
• "Notch" sign: Notches superimposed in the wide-QRS-like complex artifact, coinciding with the cycle length when sinus rhythm was recorded.
![Page 15: ECG ARTIFACTS AND PITFALLS](https://reader035.vdocument.in/reader035/viewer/2022062902/58efd02d1a28ab0f7a8b45c1/html5/thumbnails/15.jpg)
WANDERING BASELINE ECG
![Page 16: ECG ARTIFACTS AND PITFALLS](https://reader035.vdocument.in/reader035/viewer/2022062902/58efd02d1a28ab0f7a8b45c1/html5/thumbnails/16.jpg)
WANDERING BASELINE
• CAUSES:EXAGGERATED RESPIRATORY MOVEMENTS USUALLY SEEN IN
PATIENTS IN RESPIRATORY DISTRESS .
• SOLUTION:AVOID PLACING ELECTRODE IN AREAS WHERE
MOVEMENTS OF THE ACCESSORY MUSCLES ARE MOST EXAGGERATED . PLACE THE ELECTRODES ON THE TOP OF THE SHOULDERS.
![Page 17: ECG ARTIFACTS AND PITFALLS](https://reader035.vdocument.in/reader035/viewer/2022062902/58efd02d1a28ab0f7a8b45c1/html5/thumbnails/17.jpg)
Baseline drift• The amplifier in the ECG machine has to re-find the 'mean'.
This often occurs right after lead connection and after electric cardioversion.
![Page 18: ECG ARTIFACTS AND PITFALLS](https://reader035.vdocument.in/reader035/viewer/2022062902/58efd02d1a28ab0f7a8b45c1/html5/thumbnails/18.jpg)
ELECTROMAGNETIC INTERFERENCE(CELL PHONES)
![Page 19: ECG ARTIFACTS AND PITFALLS](https://reader035.vdocument.in/reader035/viewer/2022062902/58efd02d1a28ab0f7a8b45c1/html5/thumbnails/19.jpg)
Differentiating an Artifact from Ventricular tachycardia
Sometimes, EKG changes may mimic specific arrhythmias like ventricular tachycardia and atrial flutter or fibrillation. It is important to differentiate these, as misdiagnosis can lead to inadvertent use of medications and procedures in such a patient.
Characteristics that can help in differentiate an artifact from ventricular tachycardia include:
• Absence of hemodynamic deterioration during the event.• Normal QRS complexes within the artifact.• An unstable baseline on the EKG before the event, after the event, or
both.• Association with bodily movement.
![Page 20: ECG ARTIFACTS AND PITFALLS](https://reader035.vdocument.in/reader035/viewer/2022062902/58efd02d1a28ab0f7a8b45c1/html5/thumbnails/20.jpg)
ELECTRICAL INTERFERENCE
![Page 21: ECG ARTIFACTS AND PITFALLS](https://reader035.vdocument.in/reader035/viewer/2022062902/58efd02d1a28ab0f7a8b45c1/html5/thumbnails/21.jpg)
ELECTRICAL INTERFERENCE• CAUSES:
PATIENT USING ELECTRICAL EQUIPMENT IMPROPERLY GROUNDED EQUIPMENT LOOSE ELECTRICAL CONNECTIONS OR EXPOSED WIRING.
• SOLUTIONS:(A) IF PATIENT IS USING ELECTRICAL EQUIPMENT, TO PUT OFF THE EQUIPMENT.PROBLEM IS TRANSIENT AND WILL CORRECT ITSELF.
(B) IF PATIENT IS NOT USING ELECTRICAL EQUIPMENT
UNPLUG ALL EQUIPMENT NOT IN CONTINOUS USE REMOVE FROM SERVICE AND USE BATTERY CONNECTION ASK THE ELECTRICAL ENGINEER TO CHECK THE WIRING.
![Page 22: ECG ARTIFACTS AND PITFALLS](https://reader035.vdocument.in/reader035/viewer/2022062902/58efd02d1a28ab0f7a8b45c1/html5/thumbnails/22.jpg)
CALM PATIENT!!!!!!
![Page 23: ECG ARTIFACTS AND PITFALLS](https://reader035.vdocument.in/reader035/viewer/2022062902/58efd02d1a28ab0f7a8b45c1/html5/thumbnails/23.jpg)
![Page 24: ECG ARTIFACTS AND PITFALLS](https://reader035.vdocument.in/reader035/viewer/2022062902/58efd02d1a28ab0f7a8b45c1/html5/thumbnails/24.jpg)
THANK YOU