15 vs 223 ekg
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Electrocardiogram Electrocardiogram Rhythm InterpretationRhythm Interpretation
by
Evan M. Hodell 12/00
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What is an EKG?
• An EKG is a method of measuring, displaying and recording the electrical activity of a heart
• Electrical stimuli is amplified to create a “rhythm strip” by a machine that consistently produces representations of the heart’s electrical activity
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BASIC TERMINOLOGY
• Arrhythm ia: Abnormal rhythm• Base line : Flat, straight, isoelectric line• Wave form : Movement away from the
baseline, up or down• S e gm e nt: A line between waveforms• Inte rval: A waveform plus a segment• C om ple x: Combination of several
waveforms
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Electrical System of Heart
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Components of a NSR
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Components of a NSR
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Point of OriginPoint of Origin NameName
• SA Node- Sinus rhythm– Causes regular, rounded P waves, and normal,
narrow QRS complexes
• Atria- Atrial rhythm– Causes irregularly shaped P waves, but still normal,
narrow QRS complexes
• AV Node- Junctional rhythm– Normal, narrow QRS complexes with no P waves
• Perkinjie Fibers- Ventricular rhythm – No P waves, and irregular, wide QRS complexes
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Beginning to Beginning to Recognize RhythmsRecognize Rhythms
• Step 1: Are there P waves?
• Step 2: Are there QRS complexes?
• Step 3: Are the P waves and QRS complexes related?
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Example 1
• STEP 1.–Are there P waves?
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Example 1 Continued
• Are there P waves?– Yes, P waves are easily identifiable
and regular in rate.
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Example 1 Continued
• STEP 2.– Are there QRS complexes?
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Example 1 Continued
• STEP 2.– Yes there are normal, narrow, QRS
complexes.
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Example 1 Continued
• STEP 3– Are they related, 1:1?
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Example 1 Continued
• STEP 3– Are they related, 1:1?
• Yes, there is one P wave for every QRS.
• This is called a sinus rhythm
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Example 2
• Follow steps 1-3 as demonstrated in Ex. 1.• This is also a sinus rhythm.
• Note: The P waves are smaller, yet their regularity in relation to the QRS complexes gives them away.
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Example Three
• Following the same steps, this one doesn’t match up!?!?
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Example 3 continuedExample 3 continued• Step 1
– Are there P waves?• Yes,
– Note: notice the dotted arrows indicate the location of P waves buried in the stronger electrical activity of the QRS complexes.
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Example 3 ContinuedExample 3 Continued
• STEP 2–Are there QRS complexes?
•Yes, there are normal, narrow QRS complexes.
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Example 3 Continued• STEP 3.
– Are they related?• NO, they are both regular in shape and rate, but
there is no relation between them.
– This shows a Complete Heart Block, also called a 3rd degree block.
– Can the Heart effectively pump blood if the Atria and Ventricles are not working together?
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Case Study of Beau
• Beau is an 11 y/o 45 lb. Male Australian Shepard.
• Physical exam: see overhead • Beau presents with a moderate, chronic, nocturnal
cough with mild dyspnea. Secondary exam also reveals a pounding irregular heartbeat and Grade 4 murmur.
• Electrocardiogram was ordered in addition to other tests. Result:
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Case Study of Beau• EKG reveals a Sinus Arrhythmia,
– Beaus heart is “firing off” Premature Atrial Contractions, “PAC’s.
• Potentially indicative of atrial enlargement, or other heart irritability, which may or may not be related to Beau’s cough and current presentation.
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4. Normal Intervals for the Human, Dog and Cat
• Human- HR- 60-100 bpm» PR interval- 0.12-0.20 sec» QRS width max= 0.11 sec » QT interval= 0.36-0.44 sec
• Dog- HR- 60-220 bpm» PR interval= 0.06-0.13 sec» QRS width max= 0.06 sec for large
0.05 sec for small» QT interval= 0.15-0.25 sec
• Cat- HR = 120-240 bpm» PR interval= 0.05-0.09 sec» QRS width max= 0.04 sec» QT interval= 0.12-0.18 sec
» -Tilley L.P. et al 1995
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References
• Aehlert RN Ph. ECG’s Made Easy, Mosby Year Book 1995
• Bledsoe, B. Brady Paramedic Emergency Care, Prentice Hall New Jersey, 1988
• Foster, Bruce D.O. Twelve-Lead Electrocardiography for the ACLS Provide, Waynesboro PA, W.B. Saunders Co., 1996
• Fox. P.R. and Kaplan P. Contemporary Cardiology Issues in Small Animal Practice, Churchill Livingston, New York 1987
• Smith F.W.K, D.J. Hallock, Manual of Canine and Feline Cardiology W.B. Saunders, Philadelphia 1995
• Tilley, L.P. Essentials of Canine and Feline Electrocardiography, 3rd edition Williams and Wilkins, Baltimore 1995