Post on 23-Dec-2015
Kamlya balgoon2009
ECG - AnalysisUse a consistent method to analyze an
ECGRateRhythmAssess P waveAssess P wave to QRS ratio 1=1Interval durationIdentify abnormalities
kemo 2009
Lets Have A Deal!!!!… 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
kemo 2009
ArrhythmiasOriginates from the SA node = SinusOriginates from the atria = atrialOriginates from the AV node = nodal or
JunctionalOriginates from the ventricles ( high ) =
IdioventricularOriginates from the ventricles (myocardial
tissue ) = VentricularImpulse delay in the AV node = BlockNo impulse = Asystole
kemo 2009
Sinus Arrhythmias1- Sinus Rhythm ( the only normal one )
RegularP-R interval NormalNormal identical P wavesEach P followed by a QRSNormal QRSRate 60-100 bpm
PR interval
Normal QRS
kemo 2009
2-Sinus TachycardiaVentricle & a trial rate ; greater than 100Ventricle & a trial rhythm : RegularQRS shape & duration : normal P wave shape normal P-R interval normal between 0,12 & o,20
second Normal identical P wavesEach P followed by a QRSP: QRS ratio : 1:1
kemo 2009
kemo 2009
2-Sinus Tachycardia
2-Sinus TachycardiaCauses
Normal physiologic with increase cardiac out putShock exerciseanxiety feverAnemia Medication sympathomimetic & parasympatholytic
(atropine ,epinephrine )
Treatment Treat cause Medication ( antipyretics , beta blockers )
kemo 2009
3- Sinus BradycardiaVentricle & a trial rate : less than 60Ventricle & a trial rhythm : RegularQRS shape & duration : Normal P wave shape Normal P-R interval Normal between 0,12 &
o,20 second Normal identical P wavesEach P followed by a QRSP: QRS ratio : 1:1
kemo 2009
3 -Sinus Bradycardia
kemo 2009
3 -Sinus BradycardiaCauses
Slower metabolic need ( Sleep , Hypothermia , hypothyroidism ) Vagal stimulation ( vomiting , suction , sever pain ) Medication ( beta blockers , calcium channel blockers )Eye surgery Increase intracranial pressure
Treatment Treat causes Medication ( atropine ,epinephrine )
kemo 2009
4 -Sinus arrhythmia or sinus block Same as sinus but with a missed beat.
After missing a beat, the rhythm will continue in regularity.
A total beat missed
kemo 2009
Sinus arrhythmiaIt occurs impulse irregular rhythm Rate increase with inspiration & decrease
with expiration It include heart disease ( valvular disease )P-R interval NormalNormal identical P wavesEach P followed by a QRSNormal QRSRate 60-100 bpm
kemo 2009
Atrial Arrhythmias General Characteristics P wave Abnormal Multiple Foci Regular or Irregular Fast most of the time Normal QRS always
kemo 2009
A trial dysrhythmias Premature a trial complexA trial FibrillationA trial FlutterAtrial Tachycardia
kemo 2009
A trial dysrhythmias 1- Premature a trial complex An electrical impulse starts in atrium
before next normal impulse of SA node
Causes Caffeine , alcohol , nicotine
Treatment Treat causes
kemo 2009
Premature A trial Complex ( PAC)Ventricle & a trial rate depend on
underlying rhythm Ventricle & a trial rhythm : irregular( due to early p wave creating a PP interval
is shorter QRS shape & duration : normal P wave shape an early & different p
wave , hidden in T wave P-R interval Normal between 0,12 & o,20
second Each P followed by a QRSP: QRS ratio : 1:1 kemo 2009
Premature A trial Complex ( PAC)
kemo 2009
2 -A trial Fibrillation Atrial fibrillation causes
rapid ,disorganized & of artial muscle
Unequal R-R = irregular
kemo 2009
1 -Atrial Fibrillation Causes Heart failure , A rtial enlargement, hypertension ,Treatment Digoxin , Beta blockers ( Diogxin )
Anticoagulant if rhythm present for greater 48 hours
Synchronized cardio version if rhythm present less for 48 hours
kemo 2009
Atrial FibrillationVentricle & a trial rate : a trial rate 300 –
600 Ventricle rate 120 to 200 in untreated a
trial fibrillation Ventricle & a trial rhythm : highly irregularQRS shape & duration : normal P wave shape : no discernible p wave ,
irregular undulating wave are seen are termed fibrillatory or f waves
P-R interval not can measure Each P followed by a QRSP: QRS ratio : many :1
kemo 2009
Unequal R-R = irregular
kemo 2009
Atrial Fibrillation
kemo 2009
3 -A trial Flutter�ٍF wave
Normal QRS
2 -Atrial FlutterCauses Heart disease ( valvular disorder ,
Rheumatic & ischemic heart disease )
Treatment Adenocard Diltazem
kemo 2009
Atrial FlutterIt occur in atrium & creates impulses at an artial rate 250 to 400 times per minute
It cause serious signs ( chest pain .shortness breathing ,low blood pressure )
Treatment Electrical Cardiovesion
kemo 2009
Atrial FlutterVentricle & a trial rate : a trial rate 250 –
400 Ventricle rate 75to 150 in untreated a
trial fibrillation Ventricle & a trial rhythm : Mostly
regular, but it can be irregularQRS shape & duration : normal P wave shape : saw –toothed shape this
waves are referred to as F wave P-R interval : multiple F wave Each P followed by a QRSP: QRS ratio : 2 :1 , 3 :1, 4 :1kemo 2009
4- Atrial TachycardiaSome times it is called
Supraventricular Tachycardia ( SVT ).
Very fast rate > 150 bpm.Normal QRS.No P wave .or very difficult discern
No P waveNormal QRS
Very fast
kemo 2009
4 -Atrial TachycardiaSome times it is called
Supraventricular Tachycardia ( SVT ). Very fast rate > 150 bpm.Normal QRS.No P wave.
No P waveNormal QRS
Very fast
kemo 2009
4 -Atrial TachycardiaCasesIschemia Hypoxia Heart failure
Treatment Adenocard Diltazem Synchronized cardioversion
kemo 2009
kemo 2009