EKG Primer2woEKGs
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Diana HyltonEKG Primer2woEKGs
Uploaded by
Diana HyltonEKG
Primer
Seminar Brumfield
Roadmap
Paper and measurements Rate Rhythm Axis Intervals Bundle Branch Blocks Ischemia and infarctions Sample EKGs
Paper
At standard speed of 25 mm/s
1 little box is 0.04 seconds 5 little boxes is 0.20 seconds 5 big boxes is 1 second
(5 x 0.04s = 0.20s)
Rate
Nml 60 to 100 Estimate by (or Cycles in 6sec of strip x 10)
Rhythm
Start with 3 questions
Nml, Too Fast or Too Slow Ventricular or Supraventicular Regular or Irregular
MORE LATER
Axis
Nml 0 +90 Right axis deviation +900 +1800 Left axis deviation -300 -900 0 0 Indeterminate/Extreme axis deviation -90 -180
Intervals
PR interval: Nml 0.12 0.2 seconds QRS interval: Nml <0.12 seconds QTcorrected: Nml 0.36 0.41 seconds
Bundle Branch Blocks (BBB)
Left BBB (QRS complex 0.12 sec)
Broad tall R wave (can be mildly notched) in lead I and V6 QS or rS wave in lead V1
Bundle Branch Blocks (BBB)
Right BBB (QRS complex 0.12 sec)
rSR Complex (M) in lead V1, V2 or V3 Wide S wave in lead I and V6
Waveforms and Ischemia
Pathologic Q waves
Need to be 0.04 sec wide and 1mm deep (1 small box wide and 1 small box deep) Indicate prior infarction Elevation (infarction) or depression (ischemia)
ST segment abnormalities
T wave abnormalities
Inversion (suggests ischemia)
Ischemia/Infarction Localization
Anterior: ST changes in Leads I and V2-4 (Proximal LAD) Anterior-lateral: ST changes in Leads I, aVL and V1-6 (Proximal LAD) Lateral: ST changes in Leads I, aVL and V5-6 (Distal LAD) Inferior-lateral: ST changes in Leads II, III, aVF and V5-6 (Proximal RCA) Inferior: ST changes in Leads II, III and aVF (Distal RCA)
Rhythm
Rhythm
Start with 3 questions
Nml, Too Fast (>100) or Too Slow (<60) Ventricular (Wide Complex) or Supraventicular (Narrow Complex) Regular or Irregular
Rhythm
Then ask four more:
Is:
there a P before every QRS? there a QRS after every P? the PR interval prolonged? the QRS prolonged?
Bradycardia
Rate below 60 Causes:
Sinus node dysfunction (sick sinus syndrome is symptomatic chronic inappropriate bradycardia) AV blocks:
First Degree Second Degree
Mobitz type I Mobitz type II First Degree
Third Degree (complete heart block)
AV blocks
First Degree
Prolonged PR interval (>0.2 sec) Usually asymptomatic and no intervention needed
AV blocks (cont)
Second Degree
Mobitz type I (Wenckebach)
Progressive prolongation of the PR interval before a blocked beat Usually high AV node block with Narrow QRS Usually asymptomatic and no intervention needed
AV blocks (cont)
Second Degree
Mobitz type II First Degree
Has a fixed PR interval with dropped QRS Low AV nodal or HIS-purkinje system block QRS is usually wide (LBBB or bifascicular block) Need pacemaker
AV blocks (cont)
Third Degree (complete heart block)
Complete lack of AV conduction with escape rhythm produced AV nodal or HIS-purkinje system block No Ps produce QRS complexes (escape rate)
Tachycardia
Narrow Complex Wide Complex
Narrow Complex Tachycardia (NCT)
Regular Rhythm
Sinus Tachycardia (ST) Atrial Flutter (AFl) (discuss) Paroxysmal Supraventricular Tachycardia (PSVT)
AV nodal reentrant Tachycardia (AVNRT) is most common
Irregular Rhythm
Sinus Arrhythmia Atrial Fibrillation (AF) (discuss) Multifocal Atrial Tachycardia (MAT)
Atrial Fibrillation
Most common cardiac arrhythmia
Irregular rhythm
(no P waves)
Irregular fibrillatory waves to flat QRS narrow
(unless conduction defect)
Atrial Flutter
Rapid, regular rhythm with atrial rates of 250350 bpm (Narrow complex unless conduction defect) Ventricular response rate can be 2:1, 4:1, 8:1 (it is
usually a 2:1 block creating the classic 150 bpm regular ventricular rhythm)
classic indenticle flutter waves (sawtooth pattern)
Wide Complex Tachycardia (WCT)
Wide QRS are >0.12 seconds
Causes of Wide Complex
Bundle branch block (BBB) Ventricular Rhythm Hyperkalemia Wolff-Parkinson-White
WCT are:
Ventricular Tachycardia (VT) (discuss) SVT with BBB SVT with aberrant conduction
Ventricular Tachycardia
Ventricular rate is 120-220 bpm PVC-like Wide QRS Concordance
or negative) (all QRS complexes in V1-6 are either positive
Ventricular Fibrillation
Ventricular rate 300-600 bpm Fibrillatory base line (cannot make out QRS
complexes)