EKG rhythm lecture 1 PP...• PR Interval: >200msec • QRS Complex • -Axis: • -Width: •...

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EKG Rhythm Lecture

Transcript of EKG rhythm lecture 1 PP...• PR Interval: >200msec • QRS Complex • -Axis: • -Width: •...

Page 1: EKG rhythm lecture 1 PP...• PR Interval: >200msec • QRS Complex • -Axis: • -Width: • -Height: No Signs Consistent with LVH or RVH • -QT interval (you may wish to add this)

EKG Rhythm Lecture

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1. Rate2. Wide or Narrow Rhythm? Reg Irreg-Irreg P-QRS relationship? P- waves seen? PR interval constant? Are P waves same or different? P waves upright II/III/F? Patterned What is the pattern? Eval P waves & QRS What is the origin or the pattern? What is the underlying rhythm and what interupts? 3. Morphology Axis Pwave / PR QRS (tall? / wide?) ST- T – Q waves (Inf, Ant, Lat)

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AVAILABLE RESOURCES

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AVAILABLE RESOURCES• ECG Interpretation Template • ECG#_______________________________________________________________________ • Rate: • Rhythm: ???? • • -REG vs PATTERN vs IRR-IRR • -P-QRS -what is pattern P-QRS • -⇑ P? -origin of pattern origin of beat

-Origin of the interuption • Pwave: Atrial Enlargement? • PR Interval: >200msec • QRS Complex • -Axis: • -Width: • -Height: No Signs Consistent with LVH or RVH • -QT interval (you may wish to add this) • Q, ST/T Changes: • -Inferior • -Precordial • -High Lateral • SUMMARY STATEMENT-

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Interpret EKG then check next slide

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1 2 3 4 5 6 7

RATE – 7 1/2 beats in 6 secs x 10 = 75

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RHYTHM: Reg vs Irreg vs Patterned?

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RHYTHM: IRREG

P with every QRS? // Any hidden P’s?

P waves upright in II/III/F?

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RHYTHM: IRREG P with every QRS? // Any hidden P’s? Yes P waves upright in II/III/F? Yes Sinus Arrythmia (these QRS can only be coming for SA origin

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Interpret EKG…

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Rate = 50 / Reg… did you see P’s?

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Inverted P’s in lead II = Ectopic Atial Pacemaker

P P P P P P

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Leads II / III / F

Remember that a depolarization traveling away from the inferior leads will have an inverted P wave… thus it cannot be coming from the Sinus node

Depolarization path----

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Interpret EKG:

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Interpret EKG: easy one…. Sinus Brady

Upright P’s before each QRS and no hidden P’s

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Interpret EKG:

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Rate = 65 Is it REG?

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Actually it is Patterned Grouped beats – normal beat then early beat

1 2 1 2 1 2 1 2

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Atrial Bigeminy…the sinus node won’t usually beat early on itself. The early beat is likely a PAC

1 2 1 2 1 2 1 2

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Interpret EKG:

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Rate = 60 This is actually reg (mostly)…There is a P with every QRS, the P are upright. NSR with two early beats

What are the early beats?

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What are the early beats? NSR with PAC’s

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Interpret EKG #6:

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Interpret EKG #6: Rate = 80

Reg vs IRREG vs Pattern?

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Pattern: What is the pattern?

3 normal beats with a wide complex beat 4th. What is the origin of each beat?

1 2 3 Wide

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Final Answer:

NSR with freq PVC’s (Remember Trigeminy is every 3rd beat is a PVC)

1 2 3 Wide

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Couplet 4 Beat Run NonSust Vtach

7 Beat Run Non-Sustained Vtach

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Interpret EKG #7:

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Interpret EKG:

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Interpret EKG: Slow Rate….No P waves…QRS is wide…Origin of beat is from the Ventricle

Idioventricular Escape Rhythm with Sinus Arrest

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Interpret EKG #8:

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Interpret the EKG: -Rate = 80 -Reg -Is there a P – QRS relationship? -Are the Pwaves upright in the Inferior leads?

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Interpret the EKG: -Is there a P – QRS relationship? March out the P’s with the QRS to the end of the strip

-No association b/w P & QRS 3rd Degree Heart Block…. Now what is driving the ventricle to beat?

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Interpret the EKG: -3rd Degree Heart Block…. Now what is driving the ventricle to beat? What is the “escape rhythm?

Narrow complex… the p waves are not associated… this is junctional rhythm

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Interpret EKG #9:

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Interpret EKG #10: Now the rate is remarkable…. 300bpm at some points… Hmm Reg vs IRREG vs Patterned à IRREG

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It is wide! Is it Vtach? No…it is IRREG

What else can make the QRS wide? What origin of these contractions can go at 300bpm and be irreg?

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Answer……..AFIB with Right BBB

Now how can the AV node be conducting at 300 BPM?

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AFIB with Right BBB with conduction down an accessory pathway

AFIB in pt with Wolff-Parkinson-White!

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Interpret EKG #10:

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Interpret EKG #10:

Ectopic Atrial rhythm that converts to sinus rhythm at end of strip

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Interpret EKG #11:

Rate-

Reg vs Irreg vs Pattern

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Interpret EKG #11:

What is the pattern? What is the origin of the rhythm & interuption?

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Interpret EKG #11: Atrial Trigeminy

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Interpret EKG #12

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Rhythm strip from the same patient earlier in same apptV5

V1

Rhythm strip – same patient

Page 47: EKG rhythm lecture 1 PP...• PR Interval: >200msec • QRS Complex • -Axis: • -Width: • -Height: No Signs Consistent with LVH or RVH • -QT interval (you may wish to add this)

Interpret EKG #12: NSR w/ 2° AVB Mobitz type 2, (pwaves conducted every other and every 4th beat each p wave gets conducted) Pt got immediate transfer and pacer

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Interpret EKG #13

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ORIGIN BEAT-Type

Sinus contraction Atrium flutter Jxn (AV) fib Vent

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Afib // LBBB

You should still be using all the steps!

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Interpret EKG #14 Rate

Reg vs Irreg vs Patterned

Page 52: EKG rhythm lecture 1 PP...• PR Interval: >200msec • QRS Complex • -Axis: • -Width: • -Height: No Signs Consistent with LVH or RVH • -QT interval (you may wish to add this)

Interpret EKG #14 Reg…narrow complex…what is the origin of these beats?

Page 53: EKG rhythm lecture 1 PP...• PR Interval: >200msec • QRS Complex • -Axis: • -Width: • -Height: No Signs Consistent with LVH or RVH • -QT interval (you may wish to add this)

Interpret EKG #14 Junctional Tachycardia? Vs Sinus with 10 AVB (p wave in T?)

We could argue both choices. Which do you favor?

Page 54: EKG rhythm lecture 1 PP...• PR Interval: >200msec • QRS Complex • -Axis: • -Width: • -Height: No Signs Consistent with LVH or RVH • -QT interval (you may wish to add this)

Interpret EKG #14 My opinion- Sinus with 10 AVB (p wave in T?)

Page 55: EKG rhythm lecture 1 PP...• PR Interval: >200msec • QRS Complex • -Axis: • -Width: • -Height: No Signs Consistent with LVH or RVH • -QT interval (you may wish to add this)

Interpret EKG #15: Rate Reg vs Irreg vs Patterned

Page 56: EKG rhythm lecture 1 PP...• PR Interval: >200msec • QRS Complex • -Axis: • -Width: • -Height: No Signs Consistent with LVH or RVH • -QT interval (you may wish to add this)

Interpret EKG #15: It looks like a pattern…but is it really?

Page 57: EKG rhythm lecture 1 PP...• PR Interval: >200msec • QRS Complex • -Axis: • -Width: • -Height: No Signs Consistent with LVH or RVH • -QT interval (you may wish to add this)

Interpret EKG #15: Irreg… now are there P waves?

Page 58: EKG rhythm lecture 1 PP...• PR Interval: >200msec • QRS Complex • -Axis: • -Width: • -Height: No Signs Consistent with LVH or RVH • -QT interval (you may wish to add this)

Interpret EKG #15: No p waves… that is course atrial fibrillation AFIB with ventricular rate of 55-60

Page 59: EKG rhythm lecture 1 PP...• PR Interval: >200msec • QRS Complex • -Axis: • -Width: • -Height: No Signs Consistent with LVH or RVH • -QT interval (you may wish to add this)

Interpret EKG #16:

Really this is an easy one…

Page 60: EKG rhythm lecture 1 PP...• PR Interval: >200msec • QRS Complex • -Axis: • -Width: • -Height: No Signs Consistent with LVH or RVH • -QT interval (you may wish to add this)

Interpret EKG #16:

Atrial Flutter with 3:1 conduction through AV node varying with 4:1 conduction

Page 61: EKG rhythm lecture 1 PP...• PR Interval: >200msec • QRS Complex • -Axis: • -Width: • -Height: No Signs Consistent with LVH or RVH • -QT interval (you may wish to add this)

Interpret #17: Rate… yes it is fast

Reg vs Irreg vs Patterned

Page 62: EKG rhythm lecture 1 PP...• PR Interval: >200msec • QRS Complex • -Axis: • -Width: • -Height: No Signs Consistent with LVH or RVH • -QT interval (you may wish to add this)

Interpret #17: V- tach… someone get the crash cart!

Page 63: EKG rhythm lecture 1 PP...• PR Interval: >200msec • QRS Complex • -Axis: • -Width: • -Height: No Signs Consistent with LVH or RVH • -QT interval (you may wish to add this)

Interpret this Rhythm Strip #18

You must presume the patterned is repeated on either edge of the strip Three beats…then space

Why is this happening?

Page 64: EKG rhythm lecture 1 PP...• PR Interval: >200msec • QRS Complex • -Axis: • -Width: • -Height: No Signs Consistent with LVH or RVH • -QT interval (you may wish to add this)

Interpret this Rhythm Strip #18

This is NSR with every fourth beat being a PAC with the Pwave being buried in the T wave and not being conducted through the refractory AV node

Page 65: EKG rhythm lecture 1 PP...• PR Interval: >200msec • QRS Complex • -Axis: • -Width: • -Height: No Signs Consistent with LVH or RVH • -QT interval (you may wish to add this)

Interpret EKG #19:

Page 66: EKG rhythm lecture 1 PP...• PR Interval: >200msec • QRS Complex • -Axis: • -Width: • -Height: No Signs Consistent with LVH or RVH • -QT interval (you may wish to add this)

Interpret EKG #19:

3rd Degree AV block with junctional escape

Page 67: EKG rhythm lecture 1 PP...• PR Interval: >200msec • QRS Complex • -Axis: • -Width: • -Height: No Signs Consistent with LVH or RVH • -QT interval (you may wish to add this)

Great job…keep practicing.


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