Basic Dysrhythmia Interpretation
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1 Basic Dysrhythmia Interpretation
2 Objectives 2 To understand the Basic ECG To understand the meaning of Dysrhythmia To describe the normal heart conduction system. To describe the normal impulse pathways. To interpret Sinus Rhythm strips accurately. To interpret the Atrial Rhythms strips accurately. To interpret AV Blocks strips accurately. To interpret the Ventricular Rhythm strips Accurately
3 3
4 4
5 5
6 Basic ECG 6 P wave represents atrial activation PR interval is the time from onset of atrial activation to onset of ventricular activation. QRS complex represents ventricular activation QT interval is the duration of ventricular activation and recovery
7 7
8 ECG - Analysis 8 Use a consistent method to analyze an ECG Rate Rhythm Assess P wave Assess P wave to QRS ratio 1=1 Interval duration Identify abnormalities
9 Normal Conduction pathways 9 SA Node (60-100) AV Node (40 60) Ventricles (20-40) Tachycardia >100 Bradycardia < 60
10 Lets Have A Deal!!!! 10 Normal P, normal P-R, normal QRS, normal P:QRS ratio = Sinus Problem in the P wave = Atrial Problem in the QRS = Ventricular More P waves than QRS = 2nd or 3rd Degree AV Block. Fibrillation = always irregular
11 11 Sinus Rhythm
12 1- Sinus Rhythm ( the only normal one ) 12 Rate bpm Regular P-R interval Normal Normal identical P waves Each P followed by a QRS Normal QRS Normal QRS PR interval
13 2- Sinus Tachycardia 13 Same as SR but the rate is > 100 Regular P-R interval Normal Normal identical P waves Each P followed by a QRS
14 3- Sinus Bradycardia 14 Same as SR but the rate is < 60 Regular P-R interval Normal Normal identical P waves Each P followed by a QRS
15 15 Abnormal P WAVE. Or Multiple foci. Or.. Atrial Arrhythmias Regular or irregular Fast most of the time Normal QRS ALWAYS
16 1- Atrial Fibrillation 16 Always irregular No P wave ( can not be determined ) Normal QRS Unequal R-R = irregular
17 2- Atrial Flutter 17 Mostly regular, but it can be irregular No P wave but saw-toothed wave ( F wave ) Normal QRS S wave Normal QRS
18 3- Atrial Tachycardia 18 Some times it is called Supraventricular Tachycardia (SVT). Very fast rate > 150 bpm. Normal QRS. No P wave.(shaped like an umbrella ) No P wave Normal QRS Very fast
19 19 Ventricular Rhythms Wide QRS. NO P wave Mostly very fast Could be Lethal
20 1- Premature Ventricular Contraction (PVC) 20 Premature = comes early with bizarre shape. Most of the time accompany sinus rhythm. PVCs ( early, wide and bizarre)
21 PVCs continued unifocal vs. multifocal multifocal Unifocal
22 PVCs continued Couplets Couplets
23 PVCs continued 4- Bigeminy every other beat is PVC
24 PVCs continued 5- Trigeminy every second beat is PVC
25 6- Ventricular Tachycardia ( V-tach.) A whole strip with PVCs. (Wide QRS) No P waves. If there is no pulse, it is lethal Always check the Pulse and BP
26 7- ventricular Fibrillation No P waves, No QRS, only electrical activity present. Lethal, always check Pulse and BP
27 1- Idioventricular Rhythm 27 Regular No P wave Wide QRS Rate No P wave Wide QRS
28 AV Blocks Prolonged P-R interval or more P waves than QRS Block means DELAY.
29 1-1st Degree AV Block It looks like the sinus rhythm but with prolonged P-R interval.. Normal and identical P waves. Each P is Followed by a QRS Normal QRS. P-R interval is > 0.20 sec. Prolonged P-R interval
30 2-2nd Degree AV Block a- Mobitz I Normal QRS. Identical P waves. P-R interval progressively prolongs until there is P not followed by a QRS P without QRS
31 2-2nd Degree AV Block a- Mobitz II Identical P waves, Not every P is followed by a QRS. When there is a QRS, it has to be preceded by a P wave Atrial rate is regular. Check BP immediately. Identical P waves Every QRS preceded by a P waves
32 4-3rd Degree AV Block (Complete Heart Block) No relationship between P waves and QRS complexes Check the BP immediately
33 Pulseless Electrical Activity
34 No electrical Activity (Asystole ) or Ventricular Standstill No QRS, no electrical activity, P waves may present.
35 Artifact Artifact occurs when something causes a disruption in monitoring. Some common causes are: AC interference Muscle tremors Respiratory artifact-wandering baseline Loose electrode Broken lead wire
36 Any Questions??
37 Thank you
Rate: The atrial and ventricular rates are equal; heart rate is greater than 100 bpm (usually between bpm).
Sinus Bradycardia Regularity: The R-R intervals are constant; the rhythm is regular. Rate: The atrial and ventricular rates are equal; heart rate is less than 60 bpm. P wave: There is a uniform P wave
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