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EKGPrimer
Seminar
Brumfield
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Roadmap Paper and measurements
Rate
Rhythm
Axis
Intervals
Bundle Branch Blocks Ischemia and infarctions
Sample EKGs
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PaperAt standard speed of 25 mm/s
1 little box is 0.04 seconds
5 little boxes is 0.20 seconds (5 x 0.04s = 0.20s)
5 big boxes is 1 second
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Rate Nml 60 to 100
Estimate by (or Cycles in 6sec of strip x 10)
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Rhythm Start with 3 questions
Nml, Too Fast or Too Slow
Ventricular or Supraventicular
Regular or Irregular
MORE LATER
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Axis Nml 0
0+90
0
Right axis deviation +900+180
0
Left axis deviation-
30
0
-
90
0
Indeterminate/Extreme axis deviation -900-180
0
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Intervals
PR interval: Nml 0.12 0.2 seconds
QRS interval: Nml
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Bundle Branch Blocks (BBB) Left BBB (QRS complex 0.12 sec)
Broad tall R wave (can be mildly notched) in lead Iand V6
QS or rS wave in lead V1
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Bundle Branch Blocks (BBB) Right BBB (QRS complex 0.12 sec)
rSR Complex (M) in lead V1, V2 or V3
Wide S wave in lead I and V6
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Waveforms and Ischemia Pathologic Q waves
Need to be 0.04 sec wide and 1mm deep (1 small
box wide and 1 small box deep) Indicate prior infarction
ST segment abnormalities
Elevation (infarction) or depression (ischemia)
T wave abnormalities
Inversion (suggests ischemia)
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Ischemia/Infarction Localization Anterior: ST changes in Leads I and V2-4
(Proximal LAD)
Anterior-lateral: ST changes in Leads I, aVLand V1-6 (Proximal LAD)
Lateral: ST changes in Leads I, aVL and V5-6(Distal LAD)
Inferior-lateral: ST changes in Leads II, III,aVF and V5-6 (Proximal RCA)
Inferior: ST changes in Leads II, III and aVF(Distal RCA)
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Rhythm
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Rhythm Start with 3 questions
Nml, Too Fast (>100) or Too Slow (
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Rhythm Then ask four more:
Is:
there a P before every QRS?
there a QRS after every P?
the PR interval prolonged?
the QRS prolonged?
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Bradycardia Rate below 60
Causes:
Sinus node dysfunction (sick sinus syndrome issymptomatic chronic inappropriate bradycardia)
AV blocks:
First Degree
Second Degree Mobitz type I
Mobitz type II First Degree
Third Degree (complete heart block)
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AV blocks
First Degree
Prolonged PR interval (>0.2 sec)
Usually asymptomatic and no interventionneeded
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AV blocks (cont)
Second Degree
Mobitz type I (Wenckebach)
Progressive prolongation of the PR interval before ablocked beat
Usually high AV node block with Narrow QRS
Usually asymptomatic and no intervention needed
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AV blocks (cont)
Second Degree
Mobitz type II First Degree
Has a fixed PR interval with dropped QRS
Low AV nodal or HIS-purkinje system block
QRS is usually wide (LBBB or bifascicular block)
Need pacemaker
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AV blocks (cont)
Third Degree (complete heart block)
Complete lack of AV conduction with
escape rhythm producedAV nodal or HIS-purkinje system block
No Ps produce QRS complexes (escaperate)
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Tachycardia
Narrow Complex
Wide Complex
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Narrow Complex Tachycardia (NCT)
Regular Rhythm Sinus Tachycardia (ST)
Atrial Flutter (AFl) (discuss) Paroxysmal Supraventricular Tachycardia (PSVT)
AV nodal reentrant Tachycardia (AVNRT) is mostcommon
Irregular Rhythm Sinus Arrhythmia
Atrial Fibrillation (AF) (discuss)
Multifocal Atrial Tachycardia (MAT)
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Atrial Fibrillation
Most common cardiac arrhythmia
Irregular rhythm
Irregular fibrillatory waves to flat (no P waves)
QRS narrow(unless conduction defect)
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Atrial Flutter
Rapid, regular rhythm with atrial rates of 250350bpm (Narrow complex unless conduction defect)
Ventricular response rate can be 2:1, 4:1, 8:1(it isusually a 2:1 block creating the classic 150 bpm regular
ventricular rhythm) classic indenticle flutter waves (sawtooth pattern)
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Wide Complex Tachycardia (WCT)
Wide QRS are >0.12 seconds Causes of Wide Complex
Bundle branch block (BBB)
Ventricular Rhythm
Hyperkalemia
Wolff-Parkinson-White
WCT are: Ventricular Tachycardia (VT) (discuss) SVT with BBB
SVT with aberrant conduction
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Ventricular Tachycardia
Ventricular rate is 120-220 bpm
PVC-like Wide QRS
Concordance(all QRS complexes in V1-6 are either positiveor negative)
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Ventricular Fibrillation
Ventricular rate 300-600 bpm
Fibrillatory base line(cannot make out QRS
complexes)
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