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Introduction to Electrocardiography & Dysrhythmias

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Presentation on theme: "Introduction to Electrocardiography & Dysrhythmias"— Presentation transcript:

1 Introduction to Electrocardiography & Dysrhythmias
Janet Smith, RN, MPH

2 Objectives To gain a basic knowledge of cardiac electrophysiology
To understand the representations of the cardiac cycle on the ECG To master techniques used for learning the characteristics of the different dysrhythmias To learn measurement and count techniques essential for dysrhythmia interpretation

3 Definitions Tachycardia Bradycardia Intrinsic Firing Rate
Isoelectric Line Rate of > 100 Rate if < 100 The normal firing rate for the rhythm of a certain pacemaker The baseline of a rhythm where no electrical activity is present

4 Definitions Depolarization Repolarization Refractory period
The complete electrical firing of the cells of the heart The time during which the cells recharge after depolarization The time during the repolarization when cells rearm

5 Definitions PR Interval
The distance between the beginning of innervation of the sinus node to the beginning of ventricular depolarization

6

7 Cardiac Conduction

8 Cardiac Conduction R P T Q S

9 Cardiac Conduction ST Seg. Q R S PR s <.12 s

10 EKG Paper Measures time – horizontal in seconds
Measures amplitude – vertical in milliamps Uses the Metric system Is very good for accuracy

11 EKG Paper 1 mm .04 sec. .2 sec.

12 Rate Measurement 300 divided by number of big blocks between R – R interval (must be a regular rhythm) i.e. 300/4 = 75

13 Rate Measurement Memorization and counting backward between R – R interval (must be regular)

14 Dysrhythmia Characteristics

15 Normal Sinus Rhythm Rhythm: Rate: P Waves: P-R Interval:
(Q)RS Complex: Regular BPM Upright/Normal s ( ms) s ( ms)

16 Sinus Bradycardia Rhythm: Rate: P Waves: P-R Interval: (Q)RS Complex:
Regular < 60 BPM Upright/Normal s ( ms) s ( ms)

17 Sinus Tachycardia Rhythm: Rate: P Waves: P-R Interval: (Q)RS Complex:
Regular > 100 and < 160 BPM Upright/Normal s ( ms) s ( ms)

18 Sinus Dysrhythmia Rhythm: Rate: P Waves: P-R Interval: (Q)RS Complex:
Irregular BPM Upright/Normal s ( ms) s ( ms)

19 Sinus Arrest Rhythm: Rate: P Waves: P-R Interval: (Q)RS Complex:
Irregular Normal - slow Upright/Normal s ( ms) s ( ms)

20 Premature Atrial Contractions
Rhythm: Rate: P Waves: P-R Interval: (Q)RS Complex: Irregular (PACs);Non-compensatory Depends on underlying rhythm Upright/Normal s ( ms) s ( ms)

21 (Paroxysmal) Atrial Tachycardia
Rhythm: Rate: P Waves: P-R Interval: (Q)RS Complex: Regular > BPM Upright/Normal s ( ms) s ( ms)

22 Supraventricular Tachycardia
Rhythm: Rate: P Waves: P-R Interval: (Q)RS Complex: Regular > BPM Indiscernible None seen s ( ms)

23 Atrial Flutter Rhythm: Rate: P Waves: P-R Interval: (Q)RS Complex:
Atrial: Regular; Ventr.: Varies Atrial: ; Ventr.: Varies Big F-Waves – Saw tooth pattern Normally constant – may vary s ( ms)

24 Atrial Fibrillation Rhythm: Rate: P Waves: P-R Interval:
(Q)RS Complex: Irregularly irregular ventricular Atrial: ; Ventr.: Varies Little F-Waves – no pattern No discernable P waves s ( ms)

25 Junctional Rhythm Rhythm: Rate: P Waves: P-R Interval: (Q)RS Complex:
Regular 40-60 BPM Inverted – prior to or after; absent < .12s if present s ( ms)

26 First Degree AV Block Rhythm: Rate: P Waves: P-R Interval:
(Q)RS Complex: Regular; can be irregular Usually BPM; Rhythm dep. Upright/Normal > .20 s (200 ms); Constant s ( ms)

27 Second Degree AV Block (Type I)
Rhythm: Rate: P Waves: P-R Interval: (Q)RS Complex: Atrial: Reg.; Ventr.: Regularly irreg. Atrial: Normal; Vent.: Norm./Slow Normal: extra P waves Not constant; Lengthens - drops beat Usually s ( ms)

28 Second Degree AV Block (Type II) Classical
Rhythm: Rate: P Waves: P-R Interval: (Q)RS Complex: Atrial: Reg.; Ventr.: Regular or irreg. Atrial: Normal; Ventricular: Slow Normal; extra P waves Constant on conducted beats Usually s ( ms)

29 Second Degree AV Block (Type II) Variable
Rhythm: Rate: P Waves: P-R Interval: (Q)RS Complex: Atrial: Reg.; Ventr.: Regular or irreg. Atrial: Normal; Ventricular: Slow Normal; extra P waves Constant on conducted beats Usually s ( ms)

30 Third-Degree AV Block Rhythm: Rate: P Waves: P-R Interval:
(Q)RS Complex: Atrial & Ventricular: Regular Atrial: Normal; Vent.: 40-60; < 40 Normal: extra P waves No Atrial/Ventricular Relationship <.12 s (120 ms) Junct.;> .12 Ventr.

31 Pacemaker Rhythm Rhythm: Rate: P Waves: P-R Interval: (Q)RS Complex:
Paced: Reg.; Demand: Irregular Varies with pacemaker rate May be present No relationship > .12 s (120 ms);Ventricular

32 Premature Ventricular Contractions
Rhythm: Rate: P Waves: P-R Interval: (Q)RS Complex: Irregular (PVCs); Compensatory Depends on underlying rhythm None on premature beat None on PVCs > .12s (120 ms) on PVC

33 Ventricular Tachycardia
Rhythm: Rate: P Waves: P-R Interval: (Q)RS Complex: Usually Regular BPM If present, not associated None > .12s (120 ms)

34 Ventricular Fibrillation
Rhythm: Rate: P Waves: P-R Interval: (Q)RS Complex: Chaotic;no set rhythm;fine/coarse None Absent No discernable; medium F-waves

35 Asystole Rhythm: Rate: P Waves: P-R Interval: (Q)RS Complex:
No electrical activity No electrical rhythm Absent

36 Idioventricular Rhythm
Rate: P Waves: P-R Interval: (Q)RS Complex: Usually Regular 15-40 BPM None > .12 s (120 ms);exaggerated

37

38 TIME FOR SOME PRACTICE

39 REMEMBER!!! Use a systematic approach Go through all the steps
Take your time! Compare with your characteristics list Interpret the dysrhythmia

40 Atrial Flutter Rhythm: Rate: P Waves: P-R Interval: (Q)RS Complex:
Irregular 70 Big F (Flutter) Waves .20 s Normal; s

41 Sinus Dysrhythmia Rhythm: Rate: P Waves: P-R Interval: (Q)RS Complex:
Irregular 60 BPM Normal; upright .16 s Normal

42 Third Degree Heart Block
Rhythm: Rate: P Waves: P-R Interval: (Q)RS Complex: Regular 37 BPM Normal; upright; extra Non-constant; No relationship Normal

43 Sinus Tachy with PVCs (UF)
Rhythm: Rate: P Waves: P-R Interval: (Q)RS Complex: Irregular (due to ectopics) 110 BPM Present underlying; none ectopics .16 s Normal; .16 for ectopics

44 Sinus Arrest Rhythm: Rate: P Waves: P-R Interval: (Q)RS Complex:
Regularly Irregular; loses complexes 40 BPM Normal; upright .16 s Normal

45 Sinus Rhythm with PAC Rhythm: Rate: P Waves: P-R Interval:
(Q)RS Complex: Irregular (due to ectopics) 60 Normal; upright; present for ectopic .18 s; .14 s for ectopic Normal for all complexes

46 Sinus Rhythm with V-Tach
Rate: P Waves: P-R Interval: (Q)RS Complex: Irregular (due to ectopics) 80 BPM Normal; upright – none for ectopics .14 s; none on ectopics Normal; .14 s on ectopics

47 Acute Anterior MI

48 Summary You need to learn the definitive characteristics
Use a complete, systematic approach to dissect the rhythm Take your time Mistakes are made when steps are skipped Practice! Practice! Practice!


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