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    Module 4b Ecg

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    Module 4b Ecg

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    Download as ppt, pdf, or txt
    5 views23 pages

    Module 4b Ecg

    Uploaded by

    m4mv5zrfcc

    Copyright:

    © All Rights Reserved
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
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    ECG Rhythm Interpretation

    Module IV b

    Supraventricular and
    Ventricular Arrhythmias
    Course Objectives

    • To recognize the normal rhythm of the


    heart - “Normal Sinus Rhythm.”
    • To recognize the 13 most common
    rhythm disturbances.
    • To recognize an acute myocardial
    infarction on a 12-lead ECG.
    Learning Modules

    • ECG Basics
    • How to Analyze a Rhythm
    • Normal Sinus Rhythm
    • Heart Arrhythmias
    • Diagnosing a Myocardial Infarction
    • Advanced 12-Lead Interpretation
    Arrhythmias

    • Sinus Rhythms
    • Premature Beats
    • Supraventricular Arrhythmias
    • Ventricular Arrhythmias
    • AV Junctional Blocks
    Supraventricular Arrhythmias

    • Atrial Fibrillation
    • Atrial Flutter
    • Paroxysmal Supraventricular
    Tachycardia
    Rhythm #5

    • Rate? 100 bpm


    • Regularity? irregularly irregular
    • P waves? none
    • PR interval? none
    • QRS duration? 0.06 s
    Interpretation? Atrial Fibrillation
    Atrial Fibrillation

    • Deviation from NSR


    – No organized atrial depolarization, so no
    normal P waves (impulses are not
    originating from the sinus node).
    – Atrial activity is chaotic (resulting in an
    irregularly irregular rate).
    – Common, affects 2-4%, up to 5-10% if >
    80 years old
    Atrial Fibrillation

    • Etiology: Recent theories suggest that it


    is due to multiple re-entrant wavelets
    conducted between the R & L atria.
    Either way, impulses are formed in a
    totally unpredictable fashion. The AV
    node allows some of the impulses to
    pass through at variable intervals (so
    rhythm is irregularly irregular).
    Rhythm #6

    • Rate? 70 bpm
    • Regularity? regular
    • P waves? flutter waves
    • PR interval? none
    • QRS duration? 0.06 s
    Interpretation? Atrial Flutter
    Atrial Flutter

    • Deviation from NSR


    – No P waves. Instead flutter waves
    (note “sawtooth” pattern) are formed at
    a rate of 250 - 350 bpm.
    – Only some impulses conduct through
    the AV node (usually every other
    impulse).
    Atrial Flutter

    • Etiology: Reentrant pathway in the right


    atrium with every 2nd, 3rd or 4th
    impulse generating a QRS (others are
    blocked in the AV node as the node
    repolarizes).
    Rhythm #7

    • Rate? 74 148 bpm


    • Regularity? Regular  regular
    • P waves? Normal  none
    • PR interval? 0.16 s  none
    • QRS duration? 0.08 s
    Interpretation? Paroxysmal Supraventricular
    Tachycardia (P
    For more presentations www.medicalppt.blogspot.com
    PSVT

    • Deviation from NSR


    – The heart rate suddenly speeds up,
    often triggered by a PAC (not seen
    here) and the P waves are lost.
    PSVT

    • Etiology: There are several types of


    PSVT but all originate above the
    ventricles (therefore the QRS is narrow).
    • Most common: abnormal conduction in
    the AV node (reentrant circuit looping in
    the AV node).
    Ventricular Arrhythmias

    • Ventricular Tachycardia
    • Ventricular Fibrillation
    Rhythm #8

    • Rate? 160 bpm


    • Regularity? regular
    • P waves? none
    • PR interval? none
    • QRS duration? wide (> 0.12 sec)
    Interpretation? Ventricular Tachycardia
    Ventricular Tachycardia

    • Deviation from NSR


    – Impulse is originating in the ventricles
    (no P waves, wide QRS).
    Ventricular Tachycardia

    • Etiology: There is a re-entrant pathway


    looping in a ventricle (most common
    cause).

    • Ventricular tachycardia can sometimes


    generate enough cardiac output to
    produce a pulse; at other times no pulse
    can be felt.
    : Torsades de pointes
    is a form of V-tach -1
    .usually due to prolonged QT interval -2
    .there is usually an underlying rhythm -3
    it may look like a “paroxysm” or cluster of V-tach -4
    waveforms & then it picks up again the underlying
    .rhythm, whatever rhythm it may be
    Rhythm #9

    • Rate? none
    • Regularity? irregularly irreg.
    • P waves? none
    • PR interval? none
    • QRS duration? wide, if recognizable
    Interpretation? Ventricular Fibrillation
    Ventricular Fibrillation

    • Deviation from NSR


    – Completely abnormal.
    Ventricular Fibrillation

    • Etiology: The ventricular cells are


    excitable and depolarizing randomly.

    • Rapid drop in cardiac output and death


    occurs if not quickly reversed
    coarse V-fib

    fine V-fib

    asystole

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