basic ekg reviewr2
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ARHYTHMIA INTERPRETATION
REVIEW
2007
Susan Eade RN&
Vicki Clavir RN
Cardiac Anatomy
PHYSIOLOGY
Electrical vs. Mechanical
“Contraction”
Contraction“Atrial kick”
ELECTRICAL CONDUCTION
Coronary Arteries
EKG STRIP
Sinus Rhythms
• P is usually upright lead II
• Rhythm regular
• 1 P wave before each QRS – PRI -.12-.20
• QRS’s normal width .04-.10
• SR rate 60-100
• SB rate < 60
• ST rate >100
SINUS RHYTHM
Rate ____, R or I____, PR ____, QRS_____
Interpretation __________________
78 R .16 .08
SINUS BRADYCARDIA
Rate _____, R or I____ PR ____, QRS_____
Interpretation __________________
52 .16-.18 .08R
Sinus Tachycardia
Rate ____, R or I____, PR ____, QRS_____Interpretation __________________ QT________
125 R .16 .06
.34
Sinus ArrestRhythm - Irregular—the pause is of undetermined length
(more than one PQRST complex is omitted) and is not the same distance as other P-P intervals
Sinus Exit BlockRhythm - Irregular due to the pause's caused by the SA block—the pause is the same as (or an exact multiple of) the distance between two other P-P intervals
Junctional Rhythms
• AV node intrinsic heart rate 40-60• P waves may occur before (usually
inverted), during or after the QRS• PRI less than .12 • QRS- normal width• Junctional- 40-60• Accelerated Junctional >60• Junctional Tach- >100
JUNCTIONAL
Rate ____, R or I_____ PR ____, QRS_____Interpretation __________________
53 R .10 -.12 .08
FYI: P can precede, be imbedded in, or after the QRS
Junctional Rhythms
Accelerated Junctional
Junctional Tach
Atrial Rhythms • Atrial Fibrillation
– Very Irregular (Irregularly Irregular)
– No discernable P waves- fibrillatory waves- wavy baseline (atrial rate >300)
– No PRI– Normal QRS
• Atrial Flutter
– Hallmark “Sine Waves" or pattern
– May or may not be regular– No PRI– Atrial rate >200
ATRIAL FIBRILLATION
Rate _____, R or I____ PR ____, QRS_____Interpretation __________________ QT______
75-136 I none .04Unable to determine
ATRIAL FLUTTER
Rate _____, R or I____ PR ____, QRS_____Interpretation __________________
100 R none .06
Saw tooth flutter waves
Atrial rate: 300
1st ° HB 2nd ° HB T 1 2nd ° HB T 2 3rd ° HB
Just like sinus rhythm only PR interval is > .20 seconds
More P waves than QRS’s.
More P waves than QRS’s
More P waves
than QRS’s some are hidden
PR interval is constant.
PR intervals are not constant & they gradually lengthen until QRS is dropped
PR intervals are constant
PR intervals will
vary and do not
have a set
pattern.
R-R interval is regular
R-R intervals irregular (clustering or grouping of QRS’s)
R-R interval will be regular or irregular. QRS usually wide
R-R intervals will be regular. Ventricular rate much slower than atrial rate. QRS usually wide
P-P interval is regular (P waves will march out).
P-P interval is regular (P waves will march out).
P-P interval is regular (P waves will march out).
P-P interval is regular (P waves will march out).
No extra P’s One extra P at the end of each grouping.
Ratio of QRS to P waves usually will vary
No relationship between P waves and QRS’s.
1st DEGREE AV BLOCK
Rate _____, R or I___ PR ____, QRS_____Interpretation __________________
62 R .32 .08Prolonged PR
2nd DEGREE TYPE I
Rate _____, R or I____ PR ______, QRS_____Interpretation __________________
45-68 I
Lengthening
.20-.28 - .32 .08
R to R interval same
Atrial rate: 80
2nd DEGREE TYPE II
Rate ____, R or I____ PR ____, QRS_____Interpretation __________________
I(Fixed) .16 .08-.10
Dropped QRS
Atrial rate: 80
28-78
3rd DEGREE AV BLOCK
Rate _____, R or I____ PR ____, QRS_____Interpretation __________________
50 R
Changes each beat, Varies .16
Atrial rate:
78
Atria and ventricles beat Independently of each other
P PPPPP P
Ventricular Rhythms
• Intrinsic rate of ventricles is 20-40• QRS .12 or greater, wide and oddly shaped• T wave often opposite direction from QRS• Idioventricular – rate 20-40 (escape
rhythm)• Accelerated Idioventricular - >40- <100• Ventricular tachycardia - >100
IDIOVENTRICULAR RHYTHM
Rate _____, R or I____ PR ____, QRS_____Interpretation __________________
35 R none .16-.18
SR with PVC’S
Rate _____, R or I___ PR ____, QRS_____Interpretation __________________
50 I .16 .08
PVC PVC PVCunifocal
PVC rules –1.Come early2. Wide and bizarre3. T wave opposite deflection
4. Compensatory pause5. QRS wider than .12
BIGEMINY
Rate _____, R or I____ PR ____, QRS_____Interpretation __________________
PVC PVC PVC PVC
40 R .16 .08
Every other beat
SR with PVC’s to VT
Rate _____, R or I____ PR ____, QRS_____Interpretation __________________
42 .18I .06
PVC PVC PVC PVC’smultiformed
R R R
PVC QRS -.14
VTACH
Rate _____, R or I____ PR ____, QRS_____Interpretation __________________
188 R none .22
Is there a pulse?
NO PULSE = DEAD RHYTHM
VTACH to VFIB
Rate _____, R or I___ PR ____, QRS_____Interpretation __________________
none188 .22R to I
VENTRICULAR FIBRILLATION
Rate _____, R or I___ PR ____, QRS_____Interpretation __________________
none none none none
DEAD RHYTHM
ASYSTOLE
Rate _____, R or I___ PR ____, QRS_____Interpretation __________________
none none none none
Check pulse Check leads
DEAD RHYTHM
May have just P waves
TORSADES de POINTES
Rate _____, R or I___ PR ____, QRS_____Interpretation __________________
300+ I none UTD
Twisting of points
VENTRICULAR PACEMAKER
Rate _____, R or I___ PR ____, QRS_____Interpretation __________________
75 R none .18
Pacer spike
Dual Pacemaker
Pacemaker Identification Codes
P =
Pacing (antitachycardia)
P = Simple
programmability (rate and/or
output
T =
Triggers pacing
A =
Atrium
A =
Atrium
D = Dual (pacing &
shock)
C = Communication
R = Rate responsive
D = Dual (triggers & inhibits pacing)
D =
Dual chamber (atrium & ventricle)
D =
Dual chamber (atrium & ventricle)
S =
Shock
M = Multi-
programmable
I =
Inhibits pacing
V =
Ventricle
V = Ventricle
O = NoneO = NoneO = None (fixed-rate pacemaker)
O = None (fixed-rate pacemaker)
O =
None
Anti-tachycardia Functions
Function that can be programmed
Response to Sensing
Chamber Sensed
Chamber Paced
QUESTIONS
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