basic ekg reviewr2

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).




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


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


35 R none .16-.18

SR with PVC’S


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


PVC PVC PVC PVC

40 R .16 .08

Every other beat

SR with PVC’s to VT


42 .18I .06

PVC PVC PVC PVC’smultiformed

R R R

PVC QRS -.14

VTACH


188 R none .22

Is there a pulse?

NO PULSE = DEAD RHYTHM

VTACH to VFIB


none188 .22R to I

VENTRICULAR FIBRILLATION


none none none none

DEAD RHYTHM

ASYSTOLE


none none none none

Check pulse Check leads

DEAD RHYTHM

May have just P waves

TORSADES de POINTES


300+ I none UTD

Twisting of points

VENTRICULAR PACEMAKER


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

basic ekg reviewr2

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