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    High Yield EKGs Atf

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    Rohit Garg

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    © All Rights Reserved
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    High Yield EKGs Atf

    Uploaded by

    Rohit Garg
    2 views20 pages

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    High Yield EKGs atf

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    © All Rights Reserved
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    2 views20 pages

    High Yield EKGs Atf

    Uploaded by

    Rohit Garg

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
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    AfraTafreeh.

    com

    High Yield EKGs


    Jason Ryan, MD, MPH
    EKGs You Should Know
    1. Sinus rhythm
    2. Atrial Fibrillation/Flutter
    3. Ischemia: ST elevations, ST depressions
    4. Left bundle branch block
    AfraTafreeh.com
    5. Right bundle branch block
    6. PAC/PVC
    7. 1st, 2nd, 3rd degree AV block
    8. Ventricular tachycardia
    9. Ventricular fibrillation/Torsades
    AfraTafreeh.com

    Step 1: Find the p waves


    • Are p waves present?
    Sinus p waves
    • Originate in sinus node
    • Upright in leads II, III, F

    AfraTafreeh.com
    AfraTafreeh.com

    Step 2: Regular or Irregular


    • Distance between QRS complexes (R-R intervals)

    Regular

    Irregular
    Steps 1 & 2
    • P waves present, regular rhythm
    • Sinus rhythm
    • Rare: atrial tachycardia, atrial rhythm
    • No p waves, irregular rhythm
    • Atrial fibrillation – irregularly irregular
    AfraTafreeh.com
    • Atrial flutter with variable block
    AfraTafreeh.com

    Steps 1 & 2
    • P waves present, irregular rhythm
    • Sinus rhythm with PACs
    • Multifocal atrial tachycardia
    • Sinus with AV block
    • No p waves, regular rhythm
    • Hidden p waves: retrograde
    • Supraventricular tachycardias (SVTs)
    • Ventricular tachycardia
    Step 3: Wide or narrow
    • Narrow QRS (<120ms; 3 small boxes)
    • His-Purkinje system works
    • No bundle branch blocks present
    • Wide QRS
    • Most likely a bundle branch block
    AfraTafreeh.com
    • Ventricular rhythm (i.e. tachycardia)
    AfraTafreeh.com

    QRS Interval
    Normal QRS

    Right Bundle
    Branch Block

    Left Bundle
    Branch Block
    Step 4: Check the intervals
    • PR (normal <210ms; ~5 small boxes; ~1 big box)
    • Prolonged in AV block
    • Lengthens with vagal tone, drugs
    • Shortens with sympathetic tone
    • QT (normal <1/2 R-RAfraTafreeh.com
    interval)
    • Prolonged with ↓ Ca (tetany; numbness; spasms)
    • Prolonged by antiarrhythmic drugs
    • Shortened with ↑ Ca (confusion, constipation)
    AfraTafreeh.com

    Step 5: ST segments
    • T wave abnormalities
    • Inverted: ischemia
    • Peaked: Early ischemia, hyperkalemia (↑K)
    • Flat/U waves: Hypokalemia (↓K)
    • ST Depression
    • Subendocardial ischemia
    • ST Elevation
    • Transmural ischemia
    Normal Sinus Rhythm

    AfraTafreeh.com
    AfraTafreeh.com

    Right Bundle Branch Block


    Left Bundle Branch Block

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    AfraTafreeh.com

    Atrial Fibrillation
    Atrial Flutter

    AfraTafreeh.com
    AfraTafreeh.com

    Ventricular Tachycardia
    Ventricular Tachycardia

    AfraTafreeh.com
    AfraTafreeh.com

    Torsades de pointes
    • ↑ risk with prolonged Qt interval
    • Antiarrhythmic drugs
    • Congenital long Qt syndrome
    • Antibiotics (erythromycin, quiniolones)
    • Hypokalemia
    • Hypomagnesemia
    • Rarely hypocalcemia
    PAC and PVC

    AfraTafreeh.com

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