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