1 © 2013 The McGraw-Hill Companies, Inc. All rights reserved. Fast & Easy ECGs, 2E Regularity Fast & Easy ECGs, 2nd E – A Self- Paced Learning Program 55

2 © 2013 The McGraw-Hill Companies, Inc. All rights reserved. Fast & Easy ECGs, 2E Rhythm Another initial step of analyzing an ECG rhythm is determining its rhythm or regularity Q Q

3 © 2013 The McGraw-Hill Companies, Inc. All rights reserved. Fast & Easy ECGs, 2E Rhythm Normally the heart beats in a regular, rhythmic fashion I I

4 © 2013 The McGraw-Hill Companies, Inc. All rights reserved. Fast & Easy ECGs, 2E Rhythm Irregularities in the heart rhythm are considered abnormal and can indicate serious conditions or deteriorate into deadly cardiac dysrhythmias

5 © 2013 The McGraw-Hill Companies, Inc. All rights reserved. Fast & Easy ECGs, 2E Determining Regularity The regularity of a rhythm can be determined by looking at the R-R intervals and P-P intervals

6 © 2013 The McGraw-Hill Companies, Inc. All rights reserved. Fast & Easy ECGs, 2E Determining Regularity If the distance of the R-R intervals and P-P intervals is the same the rhythm is regular I I

7 © 2013 The McGraw-Hill Companies, Inc. All rights reserved. Fast & Easy ECGs, 2E Determining Regularity If the distance differs, the rhythm is irregular

8 © 2013 The McGraw-Hill Companies, Inc. All rights reserved. Fast & Easy ECGs, 2E Determining Regularity Several methods can be used to determine rhythm regularity including: – Paper and Pen Method – Caliper Method – Counting the Small Squares Method I I

9 © 2013 The McGraw-Hill Companies, Inc. All rights reserved. Fast & Easy ECGs, 2E Paper and Pen Method Simple and quick and requires no special tools. To perform: – Place the straight edge of a piece of paper above or over the ECG tracing so that the intervals are still visible – Identify a starting point and place a mark on paper in the corresponding position above it – Find peak of the next consecutive R wave or P wave and place a mark on the paper in the corresponding position above it. – Move the paper across the ECG tracing, aligning the two marks with succeeding R-R intervals or P- P intervals I I

10 © 2013 The McGraw-Hill Companies, Inc. All rights reserved. Fast & Easy ECGs, 2E Caliper Method Requires special, easy to use tool. To perform: – Place ECG tracing on a flat surface – Position one point of caliper on a starting point – Open calipers by pulling the other leg until the point is positioned on the next R wave or P wave – With the calipers open in that position and keeping the point positioned over the second P wave or R wave rotate the calipers across to the peak of the next consecutive P waves or R waves I I

11 © 2013 The McGraw-Hill Companies, Inc. All rights reserved. Fast & Easy ECGs, 2E Counting the Small Squares Method Requires no special tools but is time consuming. To perform: – Count the number of small squares between the peaks of two consecutive R waves (or P waves) and then compare to the other R-R (or P-P) intervals – If the number is the same, the rhythm is regular, if it isn’t it is irregular I I

12 © 2013 The McGraw-Hill Companies, Inc. All rights reserved. Fast & Easy ECGs, 2E Practice Makes Perfect For this tracing, determine if the rhythm is regular or irregular I I

13 © 2013 The McGraw-Hill Companies, Inc. All rights reserved. Fast & Easy ECGs, 2E Practice Makes Perfect For this tracing, determine if the rhythm is regular or irregular I I

14 © 2013 The McGraw-Hill Companies, Inc. All rights reserved. Fast & Easy ECGs, 2E Practice Makes Perfect For this tracing, determine if the rhythm is regular or irregular I I

15 © 2013 The McGraw-Hill Companies, Inc. All rights reserved. Fast & Easy ECGs, 2E Types of Irregularity An irregularity in the rhythm can range from being occasionally irregular to being totally irregular I I

16 © 2013 The McGraw-Hill Companies, Inc. All rights reserved. Fast & Easy ECGs, 2E Occasionally Irregular An occasionally irregular rhythm is mostly regular but from time to time there is an area of irregularity I I

17 © 2013 The McGraw-Hill Companies, Inc. All rights reserved. Fast & Easy ECGs, 2E Very Irregular A very irregular rhythm has many areas of irregularity

18 © 2013 The McGraw-Hill Companies, Inc. All rights reserved. Fast & Easy ECGs, 2E Slightly Irregular May appear to change only slightly as the P-P intervals and R-R intervals vary just a bit One cause is a pacemaker that changes location from site to site Q Q

19 © 2013 The McGraw-Hill Companies, Inc. All rights reserved. Fast & Easy ECGs, 2E Sudden Changes in Heart Rate A normal rate that suddenly accelerates to a rapid rate or slows abruptly produce an irregularity in the rhythm

20 © 2013 The McGraw-Hill Companies, Inc. All rights reserved. Fast & Easy ECGs, 2E Totally Irregular There is no consistency to the irregularity I I

21 © 2013 The McGraw-Hill Companies, Inc. All rights reserved. Fast & Easy ECGs, 2E Patterned Irregularity Also referred to as regularly irregular, this type of regularity repeats itself in a cyclic fashion

22 © 2013 The McGraw-Hill Companies, Inc. All rights reserved. Fast & Easy ECGs, 2E Varying Conduction Ratio Irregularity Is seen when the number of atrial impulses preceding the ventricular impulses varies I I

23 © 2013 The McGraw-Hill Companies, Inc. All rights reserved. Fast & Easy ECGs, 2E Practice Makes Perfect For this tracing, determine the regularity I I

24 © 2013 The McGraw-Hill Companies, Inc. All rights reserved. Fast & Easy ECGs, 2E Practice Makes Perfect For this tracing, determine the regularity I I

25 © 2013 The McGraw-Hill Companies, Inc. All rights reserved. Fast & Easy ECGs, 2E Practice Makes Perfect For this tracing, determine the regularity I I

26 © 2013 The McGraw-Hill Companies, Inc. All rights reserved. Fast & Easy ECGs, 2E Practice Makes Perfect For this tracing, determine the regularity I I

27 © 2013 The McGraw-Hill Companies, Inc. All rights reserved. Fast & Easy ECGs, 2E Practice Makes Perfect For this tracing, determine the regularity I I

28 © 2013 The McGraw-Hill Companies, Inc. All rights reserved. Fast & Easy ECGs, 2E Summary Determining regularity is an initial step of analyzing an ECG rhythm Irregular rhythms are considered abnormal and can be caused by a variety of conditions If the distance of the R-R intervals or P-P intervals is the same, the rhythm is regular – if the distance differs, the rhythm is irregular

29 © 2013 The McGraw-Hill Companies, Inc. All rights reserved. Fast & Easy ECGs, 2E Summary Several methods can be used to determine rhythm regularity, including using calipers, marking a paper with a pen, and counting the small squares between each R-R interval Irregularity may be occasionally irregular, very irregular, or slightly irregular A normal rate that suddenly accelerates to a rapid rate or slows suddenly produces an irregular rhythm

30 © 2013 The McGraw-Hill Companies, Inc. All rights reserved. Fast & Easy ECGs, 2E Summary A totally irregular rhythm has no consistency to the irregularity Patterned irregularity is where the irregularity repeats in a cyclic fashion Irregularity can also be seen in dysrhythmias that have a varying atrial-to-ventricular conduction ratio