Basic Dysrhythmia Interpretation

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

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

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

Normal Conduction pathways 9 SA Node (60-100) AV Node (40 60) Ventricles (20-40) Tachycardia >100 Bradycardia < 60

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 Sinus Rhythm

1- Sinus Rhythm ( the only normal one ) 12 Rate 60-100 bpm Regular P-R interval Normal Normal identical P waves Each P followed by a QRS Normal QRS Normal QRS PR interval

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

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 Abnormal P WAVE. Or Multiple foci. Or.. Atrial Arrhythmias Regular or irregular Fast most of the time Normal QRS ALWAYS

1- Atrial Fibrillation 16 Always irregular No P wave ( can not be determined ) Normal QRS Unequal R-R = irregular

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

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 Ventricular Rhythms Wide QRS. NO P wave Mostly very fast Could be Lethal

1- Premature Ventricular Contraction (PVC) 20 Premature = comes early with bizarre shape. Most of the time accompany sinus rhythm. PVCs ( early, wide and bizarre)

PVCs continued 21 2- unifocal vs. multifocal multifocal Unifocal

PVCs continued 22 3- Couplets Couplets

PVCs continued 4- Bigeminy every other beat is PVC

PVCs continued 5- Trigeminy every second beat is PVC

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

7- ventricular Fibrillation No P waves, No QRS, only electrical activity present. Lethal, always check Pulse and BP

1- Idioventricular Rhythm 27 Regular No P wave Wide QRS Rate 20-40 No P wave Wide QRS

AV Blocks Prolonged P-R interval or more P waves than QRS Block means DELAY.

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

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

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

4-3rd Degree AV Block (Complete Heart Block) No relationship between P waves and QRS complexes Check the BP immediately

Pulseless Electrical Activity

No electrical Activity (Asystole ) or Ventricular Standstill No QRS, no electrical activity, P waves may present.

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

Any Questions??

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