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At ECG, Lili focuses on service line strategic planning, business planning for new and expanded clinical programs, and the development of hospital-provider affiliations.

She dedicates a substantial portion of her work to helping oncology programs design better offerings to meet the needs of the communities they serve.

Her experience in this area encompasses capabilities such as identifying strategic options for program differentiation, conducting strategic and operational program reviews to ensure long-term performance, and developing financial feasibility models and business plans for new oncology programs and service offerings.

Prior to joining ECG, Lili was a healthcare management consultant with Milliman, where she focused on operational consulting to improve functionality and efficiency for a wide range of healthcare organizations, including health insurance companies and accountable care organizations.

In this role, she designed and implemented numerous quality-management programs, assessed medical management functions against best practice recommendations, and conducted benchmark analyses to help organizations understand and manage healthcare cost and utilization trends.

This session will offer practical guidance for cancer providers and administrators, outlining what o. To build a properly designed and constructed cancer center, it is necessary to explore the four main.

On July 10, CMS released a proposed rule for an advanced payment model for radiation oncology servic. Without proactive physician succession planning, hospitals and medical groups may find themselves un.

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In this webinar on. Contact lthay ecgmc. ECG manager Lili Hay is speaking about the update on regulatory change. Certain rhythms are known to have good cardiac output and some are known to have bad cardiac output.

Ultimately, an echocardiogram or other anatomical imaging modality is useful in assessing the mechanical function of the heart. Like all medical tests, what constitutes "normal" is based on population studies.

The heartrate range of between 60 and beats per minute bpm is considered normal since data shows this to be the usual resting heart rate.

Interpretation of the ECG is ultimately that of pattern recognition. In order to understand the patterns found, it is helpful to understand the theory of what ECGs represent.

The theory is rooted in electromagnetics and boils down to the four following points:. Thus, the overall direction of depolarization and repolarization produces positive or negative deflection on each lead's trace.

For example, depolarizing from right to left would produce a positive deflection in lead I because the two vectors point in the same direction.

In contrast, that same depolarization would produce minimal deflection in V 1 and V 2 because the vectors are perpendicular, and this phenomenon is called isoelectric.

Normal rhythm produces four entities — a P wave, a QRS complex, a T wave, and a U wave — that each have a fairly unique pattern.

Changes in the structure of the heart and its surroundings including blood composition change the patterns of these four entities.

The U wave is not typically seen and its absence is generally ignored. Atrial repolarisation is typically hidden in the much more prominent QRS complex and normally cannot be seen without additional, specialised electrodes.

ECGs are normally printed on a grid. The horizontal axis represents time and the vertical axis represents voltage.

The standard values on this grid are shown in the adjacent image:. The "large" box is represented by a heavier line weight than the small boxes.

Not all aspects of an ECG rely on precise recordings or having a known scaling of amplitude or time. For example, determining if the tracing is a sinus rhythm only requires feature recognition and matching, and not measurement of amplitudes or times i.

An example to the contrary, the voltage requirements of left ventricular hypertrophy require knowing the grid scale. In a normal heart, the heart rate is the rate in which the sinoatrial node depolarizes since it is the source of depolarization of the heart.

Heart rate, like other vital signs such as blood pressure and respiratory rate, change with age. In adults, a normal heart rate is between 60 and bpm normocardic , whereas it is higher in children.

A complication of this is when the atria and ventricles are not in synchrony and the "heart rate" must be specified as atrial or ventricular e.

In normal resting hearts, the physiologic rhythm of the heart is normal sinus rhythm NSR. Generally, deviation from normal sinus rhythm is considered a cardiac arrhythmia.

Thus, the first question in interpreting an ECG is whether or not there is a sinus rhythm. Once sinus rhythm is established, or not, the second question is the rate.

For a sinus rhythm, this is either the rate of P waves or QRS complexes since they are 1-to If the rate is too fast, then it is sinus tachycardia , and if it is too slow, then it is sinus bradycardia.

If it is not a sinus rhythm, then determining the rhythm is necessary before proceeding with further interpretation. Some arrhythmias with characteristic findings:.

The heart has several axes, but the most common by far is the axis of the QRS complex references to "the axis" imply the QRS axis.

Each axis can be computationally determined to result in a number representing degrees of deviation from zero, or it can be categorized into a few types.

The QRS axis is the general direction of the ventricular depolarization wavefront or mean electrical vector in the frontal plane.

It is often sufficient to classify the axis as one of three types: normal, left deviated, or right deviated. The normal QRS axis is generally down and to the left , following the anatomical orientation of the heart within the chest.

An abnormal axis suggests a change in the physical shape and orientation of the heart or a defect in its conduction system that causes the ventricles to depolarize in an abnormal way.

All of the waves on an ECG tracing and the intervals between them have a predictable time duration, a range of acceptable amplitudes voltages , and a typical morphology.

Any deviation from the normal tracing is potentially pathological and therefore of clinical significance. The animation shown to the right illustrates how the path of electrical conduction gives rise to the ECG waves in the limb leads.

Recall that a positive current as created by depolarization of cardiac cells traveling towards the positive electrode and away from the negative electrode creates a positive deflection on the ECG.

Likewise, a positive current traveling away from the positive electrode and towards the negative electrode creates a negative deflection on the ECG.

The magnitude of the red arrow is proportional to the amount of tissue being depolarized at that instance. The red arrow is simultaneously shown on the axis of each of the 3 limb leads.

Both the direction and the magnitude of the red arrow's projection onto the axis of each limb lead is shown with blue arrows.

Then, the direction and magnitude of the blue arrows are what theoretically determine the deflections on the ECG. For example, as a blue arrow on the axis for Lead I moves from the negative electrode, to the right, towards the positive electrode, the ECG line rises, creating an upward wave.

As the blue arrow on the axis for Lead I moves to the left, a downward wave is created. The greater the magnitude of the blue arrow, the greater the deflection on the ECG for that particular limb lead.

Frames 1—3 depict the depolarization being generated in and spreading through the Sinoatrial node. Frames 4—10 depict the depolarization traveling through the atria, towards the Atrioventricular node.

During frame 7, the depolarization is traveling through the largest amount of tissue in the atria, which creates the highest point in the P wave.

Frames 11—12 depict the depolarization traveling through the AV node. This creates the flat PR segment.

Frame 13 depicts an interesting phenomenon in an over-simplified fashion. It depicts the depolarization as it starts to travel down the interventricular septum, through the Bundle of His and Bundle branches.

After the Bundle of His, the conduction system splits into the left bundle branch and the right bundle branch. Interestingly, however, the action potential starts traveling down the left bundle branch about 5 milliseconds before it starts traveling down the right bundle branch, as depicted by frame This causes the depolarization of the interventricular septum tissue to spread from left to right, as depicted by the red arrow in frame In some cases, this gives rise to a negative deflection after the PR interval, creating a Q wave such as the one seen in lead I in the animation to the right.

Depending on the mean electrical axis of the heart, this phenomenon can result in a Q wave in lead II as well. Following depolarization of the interventricular septum, the depolarization travels towards the apex of the heart.

This is depicted by frames 15—17 and results in a positive deflection on all three limb leads, which creates the R wave. Frames 18—21 then depict the depolarization as it travels throughout both ventricles from the apex of the heart, following the action potential in the Purkinje fibers.

This phenomenon creates a negative deflection in all three limb leads, forming the S wave on the ECG. Repolarization of the atria occurs at the same time as the generation of the QRS complex, but it is not detected by the ECG since the tissue mass of the ventricles is so much larger than that of the atria.

Ventricular contraction occurs between ventricular depolarization and repolarization. During this time, there is no movement of charge, so no deflection is created on the ECG.

This results in the flat ST segment after the S wave. Frames 24—28 in the animation depict repolarization of the ventricles.

The epicardium is the first layer of the ventricles to repolarize, followed by the myocardium. The endocardium is the last layer to repolarize.

The plateau phase of depolarization has been shown to last longer in endocardial cells than in epicardial cells. This causes repolarization to start from the apex of the heart and move upwards.

Since repolarization is the spread of negative current as membrane potentials decrease back down to the resting membrane potential, the red arrow in the animation is pointing in the direction opposite of the repolarization.

This therefore creates a positive deflection in the ECG, and creates the T wave. It may also affect the high frequency band of the QRS.

The earliest sign is hyperacute T waves, peaked T waves due to local hyperkalemia in ischemic myocardium.

Over a period of hours, a pathologic Q wave may appear and the T wave will invert. Over a period of days the ST elevation will resolve.

Pathologic Q waves generally will remain permanently. The left anterior descending LAD artery supplies the anterior wall of the heart, and therefore causes ST elevations in anterior leads V 1 and V 2.

An ECG tracing is affected by patient motion. Some rhythmic motions such as shivering or tremors can create the illusion of cardiac arrhythmia.

Distortion poses significant challenges to healthcare providers, [47] who employ various techniques [49] and strategies to safely recognize [50] these false signals.

Improper lead placement for example, reversing two of the limb leads has been estimated to occur in 0. Numerous diagnoses and findings can be made based upon electrocardiography, and many are discussed above.

Overall, the diagnoses are made based on the patterns. For example, an "irregularly irregular" QRS complex without P waves is the hallmark of atrial fibrillation ; however, other findings can be present as well, such as a bundle branch block that alters the shape of the QRS complexes.

ECGs can be interpreted in isolation but should be applied — like all diagnostic tests — in the context of the patient. For example, an observation of peaked T waves is not sufficient to diagnose hyperkalemia; such a diagnosis should be verified by measuring the blood potassium level.

Conversely, a discovery of hyperkalemia should be followed by an ECG for manifestations such as peaked T waves, widened QRS complexes, and loss of P waves.

The following is an organized list of possible ECG-based diagnoses. The word is derived from the Greek electro , meaning related to electrical activity; kardia , meaning heart; and graph , meaning "to write".

From Wikipedia, the free encyclopedia. Not to be confused with other types of electrography or with echocardiography. Main article: Cardiac electrophysiology.

Main article: Electrocardiography in myocardial infarction. Lexico Dictionaries. Retrieved 20 January Archived from the original on 2 October Retrieved 11 February Basic arrhythmias 7th ed.

Philadelphia: Saunders. ECG Medical Training. Retrieved 24 June Textbook of veterinary medical nursing. Oxford: Butterworth-Heinemann.

Preventive Services Task Force recommendation statement". Annals of Internal Medicine. Federal Aviation Administration.

Retrieved 27 December World Health Organization. Retrieved 1 August MIT Technology Review. Retrieved 1 April Retrieved 25 August Stanford Health Care.

Journal of the American College of Cardiology. Society for Cardiological Science and Technology. Retrieved 21 October Retrieved 24 May Retrieved 27 May Nurses Learning Network.

Cables and Sensors. Retrieved 11 July Pediatric and Fundamental Electrocardiography. Developments in Cardiovascular Medicine. BioMed Research International.

Retrieved 15 August Archived from the original on 22 March December Advances in Physiology Education.

Bibcode : BpJ Indian Pacing and Electrophysiology Journal. J Electrocardiol. Estonian Journal of Engineering. Clinical Cardiology.

Tex Heart Inst J. Hodder Education. Simple Cardiology. Retrieved 20 October CV Physiology. Retrieved 22 October Joe; Hillis, J. Stanley; Rothbaum, Donald A.

Kenneth; Hall, W. Dallas; Hurst, J. Willis eds. January Circulation Research. Journal of Cardiovascular Pharmacology and Therapeutics.

J Am Coll Cardiol.

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