Dr.Binoy Skaria binoyskaria@hotmail.com binoy.skaria@heartofengland.nhs.uk 13/07/15
Acknowledgement Medtronic, Google images & Elsevier for slides Natalie Ryan, Events Manager, HEFT- for organising the event and inviting me to speak
30 minutes followed by discussion Basics of ECG Common ECGs/ rhythm strips & their basis Some common & less common conditions
Cardiac Conduction: Cycle Initiation
P Wave
AV Node
Bundle Branches
Purkinje Fibers
QRS Complex
Plateau Phase
T-Wave
ECG Complex
Rate P-P Regularity R-R Regularity Less than 60bpm Regular Regular P wave P:QRS Ratio 1:1 Present PR Interval QRS Width Normal Normal
Rate P-P Regularity R-R Regularity P wave P:QRS Ratio PR Interval QRS Width Greater than 100bpm, Gradual onset Regular Regular Present 1:1, associated Normal, gradually shortens with HR increase Normal
Rate P-P Regularity R-R Regularity P wave P:QRS Ratio PR Interval QRS Width 60-100bpm Irregular Irregular Present 1:1, associated Normal Normal
Rate P-P Regularity R-R Regularity P wave P:QRS Ratio PR Interval QRS Width Varies Irregular Irregular Present, except during pause 1:1, associated Normal Normal
Rate P-P Regularity R-R Regularity P wave P:QRS Ratio PR Interval QRS Width 100-180bpm, Sudden onset Regular Regular Morphology will differ from sinus p-wave 1:1, associated Interval of ectopic focus will differ from sinus PR Normal, but can develop aberrant (wide) complexes
Rate P-P Regularity R-R Regularity P wave P:QRS Ratio PR Interval QRS Width Greater than 100bpm Irregularly irregular Irregularly irregular At least 3 different p-wave morphologies 1:1, associated Varies Normal
Rate P-P Regularity R-R Regularity P wave P:QRS Ratio PR Interval QRS Width Varies Chaotic atrial activity Irregularly irregular Usually No discernable p-waves None None Normal, but can develop aberrant (wide) complexes
Rate P-P Regularity R-R Regularity P wave P:QRS Ratio PR Interval QRS Width 40-60bpm None, or Regular if antegrade or retrograde Regular Variable (none, antegrade, or retrograde) None, or 1:1 if antegrade or retrograde None, short, or retrograde Normal
Rate P-P Regularity R-R Regularity P wave P:QRS Ratio PR Interval QRS Width 20-40bpm None Regular None None None Wide complex (>/= 0.12sec).
Rate P-P Regularity R-R Regularity P wave P:QRS Ratio PR Interval QRS Width 100-200bpm Variable Regular Dissociated atrial rate Variable None Wide complex (>/= 0.12sec).
Rate P-P Regularity R-R Regularity P wave P:QRS Ratio PR Interval QRS Width Depends on underlying rhythm Regular Regular Present, Normal 1:1, associated Prolonged, > 0.20sec Normal
Rate P-P Regularity R-R Regularity P wave P:QRS Ratio PR Interval QRS Width Depends on underlying rhythm Regular Regularly irregular Present Variable; 2:1, 3:2, 4:3, etc Variable, gradually lengthens until dropped Normal
Rate P-P Regularity R-R Regularity P wave P:QRS Ratio PR Interval QRS Width Depends on underlying rhythm Regular Regularly irregular Present Variable; 2:1, 3:2, 4:3, etc Normal for conducted beats Normal
Atrial Rate Ventricular Rate P-P Regularity R-R Regularity P wave P:QRS Ratio PR Interval QRS Width Atrial rate is the underlying rhythm (i.e, Sinus, Atrial Fib, etc.) Ventricular rate is from the dissociated escape rhythm Regular Regular Present Variable, dissociated Variable, No pattern Normal (Junctional escape rhythm) Wide (Ventricular escape rhythm)
Rate P-P Regularity R-R Regularity P wave P:QRS Ratio PR Interval QRS Width Depends on the underlying Atrial Fibrillation, Ventricular rate can be fast or slow. Chaotic atrial activity Irregularly irregular Usually absent None None Wide (>0.12ms)
Identify the Rhythm: A. Ventricular Tachycardia B. Sinus Bradycardia C. Complete Heart Block D. Atrial Fibrillation E. Ventricular Fibrillation
Identify the rhythm A. Ventricular Tachycardia B. Sinus Bradycardia C. Complete Heart Block D. Atrial Fibrillation E. Ventricular Fibrillation
Identify the Rhythm: A. Ventricular Tachycardia B. Sinus Bradycardia C. Complete Heart Block D. Atrial Fibrillation E. Ventricular Fibrillation
Identify the Rhythm: A. Ventricular Tachycardia B. Sinus Bradycardia C. Complete Heart Block D. Atrial Fibrillation E. Ventricular Fibrillation
Micro re-entry : AVNRT
Macro re-entry : Type 1 flutter
WPW- macro re- entrant
Concealed WPW
Polymorphic VT
Arrhythmia in LQTS