Ecg interpretation l.jpg
This presentation is the property of its rightful owner.
Sponsored Links
1 / 30

ECG Interpretation PowerPoint PPT Presentation


  • 345 Views
  • Updated On :
  • Presentation posted in: General

ECG Interpretation. Arrhythmias of Formation Chapters 4-5. Types of Arryhthmias:. Sinus Problems: Formed in the sinus node, but irregular Ectopic Problems: Formed outside of the sinus node Conduction Problems: Formed in the sinus node, but conduction in error

Download Presentation

ECG Interpretation

An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -

Presentation Transcript


ECG Interpretation

Arrhythmias of Formation

Chapters 4-5


Types of Arryhthmias:

  • Sinus Problems: Formed in the sinus node, but irregular

  • Ectopic Problems: Formedoutside of the sinus node

  • Conduction Problems: Formed in the sinus node, but conduction in error

  • Pre-Excitation Problems: “Short circuits” in normal conduction


Causes of Arrhytmias:

  • Hypoxia: Lung disease

  • Ischemia: CAD, angina (local hypoxia)

  • Sympathetic Stimulation: Nervous, exercise, CHF, hyperthyroidism

  • Drugs: Caffeine, cocaine, stimulants…many antiarryhtmic drugs…

  • Electrolyte Disturbances: K+, Ca++, Mg++

  • Bradycardia: “Escape” rhythms…

  • Stretch: CHF, hypertrophy, valve disease


Rhythm ID: Algorithm

  • P-Wave: rate and rhythm

  • QRS: rate and rhythm - shape

  • P-R Interval: Is AV conduction normal? P:QRS regular?

  • T Wave and QT Interval

  • Any unusual complexes?

  • IS IT DANGEROUS?


Clinical Manifestations:

  • Asymptomatic – generally benign

  • Palpitations – Awareness may cause anxiety

  • Compromised CO – Syncope

  • Myocardial Ischemia – tachy

  • CHF – Chronic insufficiency

  • Sudden Death – Cardiac arrest


Define “Normal”

  • Regular Atrial and Ventricular Rhythms: 1P : 1 QRS

  • Rates: 60-100

  • P Morphology: small, round, regular and positive in Lead II

  • QRS Morph: Similar size and shape

  • Positive T waves in Lead II


P-Wave:

  • 1.SA Node “fires”

  • 2. Right and Left Atria Depolarize

  • 3. AV Node “pauses”

  • Questions:

    • P waves present?

    • Regular rhythm?

    • 1/QRS?

AV

Node

SA Node

LA/RA

Depol


Sinus Rhythms

  • Normal Sinus Rhythm: 1P/QRS: 60-100 bpm

  • Sinus brady: 1P/QRS: <60 bpm

  • Sinus tachy: 1P/QRS: >100 bpm

  • Sinus Arrhythmia: 1P/QRSNormalIrregularities caused by inspiration/expiration – more noticeable in children / elderly


ABSENT PQRS Complex: Sinus Arrest:

  • Causes:

    • Heart disease, acute infection, VAGAL stimulation (Bush’s Pretzel Problem?)

    • Sick Sinus Syndrome: Usually in elderly – more irregular

  • DANGER?

    • Rare and asymptomatic

    • Frequent and symptomatic


Atrial Arrhythmias:

  • PAC: Premature Atrial Contraction

  • Atrial Tachycardias: SVT – with or without blocks, PAT

  • Atrial Flutter:

  • Atrial Fibrillation


Premature Atrial Contractions:

  • Ectopic

  • Triggered by: Alcohol, nicotine, anxiety, fatigue, fever, and infections

  • Usually benign

  • Clinical Manifestations: Palpitations or “skipped beats”


PAC - ID:

  • Irregular P-R rhythms

  • Premature, irregular P waves (sometimes “lost” in the T wave)


Atrial Tachycardias:

  • Also: Supra Ventricular Tachycardia (PSVT)

  • Rates: 100-250 bpm

  • Regular Rhythms

  • “Hidden” P waves (could be inverted – indicating a Junctional focus PSVT)

  • PAT = Common in warm-up/cool down and doesn’t respond to Carotid Massage (don’t try this!)


Afib – Aflut…


Atrial Fibrillation: Atrial Fib and/or

PSVT?


Atrial Flutter: 2:1 Ventricular “capture”

Ventricles can only respond to every other

Atrial conduction


Multi-focal origins -chaotic

Rate: >400 bpm

IRREGULAR-R

Atrial Cardiac Output is lost :

One focus - organized

Rate: 200-400 bpm

Atrial Cardiac Output is compromised

Fibrillation vs. Flutter?

Atria contribute ~20% of the total

Cardiac output: A-Fib is non-lethal


Summarize: Sinus and Atrial Rhythms

  • Sinus: Normal, Tachy, Brady

  • Absent P: Sinus Arrest, A-fib, Junctional (PSVT), PAT

  • Weird P: A-Flut, PAC


Formation Arrhythmias

Junctional and Ventricular

Chapters 6-7


Junctional:

  • Form in the AV (Junction) Node

  • May be an “Escape” rescue if SA node fails to fire or conduct

    • Escape Rate ~40-60 bpm

  • May be an “Ectopic” Irritable Focus

    • Ectopic Rate ~ 60-100 bpm

  • Responds to vagal stimulus

  • P Waves inverted, missing or after the QRS


Ventricles: QRS Rhythms

  • Regular rhythms?

    • R-R intervals equivalent

  • Regular “irregular” rhythms?

    • R-R intervals equivalent with occasional irregularities

  • Irregular rhythms?

    • R-R intervals irregular


Regular “Irregular”

  • Premature Beats: PVC

    • Widened QRS, not associated with preceding P wave

    • Usually does not disrupt P-wave regularity

    • T wave is “inverted” after PVC

    • Often Followed by compensatory ventricular pause


Notice a Pattern in the PVC’s?


PVC Patterns:

  • PVC: 1 Isolated beat

  • Couplet: 2 consecutive PVC’s

  • Bigeminy: PVC every other beat

  • Non-Sustained VT: >3 beats for less than 1 minute

  • Sustained VT: > 1 minute of ventricular tachycardia


Irregular Ventricular Rhythms: CHAOTIC

  • Ventricular Fibrillation:

    • Multi-focal origins

    • Irregular wave morphologies

    • Cardiac Output = 0

    • Coarse vs. Fine V-Fib


Clinical Manifestations – PVC’s

  • Often benign BUT

  • Compromised CO

  • Possibly precipitate a lethal arrhythmia: Vtach, VFib


More on PVC’s

  • Cardiac Output: Pulse deficit = reduced CO (~20%)

  • One PVC usually asymptomatic

  • Symptoms: LOC or dizziness demand treatment

  • Risk of Lethal Arrhythmias: V-Tach more dangerous in CAD


Rules of Malignancy:

  • Frequency: > 6 / minute

  • Runs: 3+ consecutive

  • Multiform

  • “R on T”

  • PVC’s during MI


What is the threat of sustained Ventricular Tachycardia?1. What happens to diastole? 2. What happens to Cardiac Output? 3. What happens to myocardial perfusion?4. What happens to myocardial VO2?


Winslow Homer: “The Stile”


  • Login