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EKG 2 - PowerPoint PPT Presentation


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EKG 2. Normal Sinus Rhythm. Sinus Node is the Pacemaker Rate 60-100 bpm R-R intervals constant; rhythm regular Rate: atrial and ventricular rates = P Waves: Uniform; One P Wave for every QRS complex PRI: .12-.20 seconds; constant across strip QRS measures less than .12 seconds.

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normal sinus rhythm
Normal Sinus Rhythm
  • Sinus Node is the Pacemaker
  • Rate 60-100 bpm
  • R-R intervals constant; rhythm regular
  • Rate: atrial and ventricular rates =
  • P Waves: Uniform; One P Wave for every QRS complex
  • PRI: .12-.20 seconds; constant across strip
  • QRS measures less than .12 seconds
sinus bradycardia
Sinus Bradycardia
  • Sinus Node is the PM; < 60 bpm
  • R-R intervals are constant; rhythm is regular
  • Atrial & Ventricular rates =; HR < 60
  • Uniform P Waves
  • PRI interval measures b/t .12-.20 seconds
  • QRS complex measures < .12 seconds
sinus tachycardia
Sinus Tachycardia
  • Sinus Node is PM. Rate > 100 bpm
  • R-R regular
  • Atrial & Ventricular Rates =
  • HR usually b/t 100-160 bpm
  • Uniform P Wave in front of QRS
  • PRI interval b/t .12 - .20 seconds
  • QRS measures less than .12 seconds
sinus arrhythmia
Sinus Arrhythmia
  • Sinus Node is PM
  • Rate increases as pt breathes in and decreases when breathing out
  • R-R intervals vary
  • HR usually 60-100 bpm but may be slower
  • Uniform P Wave in front of QRS
  • PRI interval b/t .12-.20 seconds
  • QRS measures less than .12 seconds
premature atrial contraction
Premature Atrial Contraction
  • Pacemaker is irritable focus in atrium
  • Single beat will interrupt regularity
  • Rate: Underlying rhythm
  • P Wave: Different Morphology - It will be flattened, notched, or otherwise unusual
  • PRI: .12-.20 seconds; may be prolonged
  • QRS: Less than .12 seconds
wandering pacemaker
Wandering Pacemaker
  • Pacemaker sites wanders b/t Sinus, Atria, and AV Junction
  • Slightly irregular
  • Atrial & Ventricular Rates = . Heart Rate usually b/t 60-100 bpm. Sometimes slower
  • Morphology of P Wave changes as PM site changes
  • PRI should be less than .20 seconds
  • QRS: Less than .12 seconds
atrial tachycardia
Atrial Tachycardia
  • PM is irritable site within atria
  • R-R constant ; Rhythm is regular
  • Atrial & Vent. Rates =. HR usually b/t 150-250 bpm
  • P Wave: One P to every QRS; May be flattened or notched; P Waves can be lost in preceding T Wave
  • PRI: .12-20 seconds
  • QRS measures less than .12 seconds
atrial flutter
Atrial Flutter
  • Single irritable focus in atria
  • Atrial rhythm is regular; Ventricualr rhythm may or may not be regualr
  • Rate: Atrial rate b/t 250-350 bpm
  • P Wave: “Saw tooth” or flutter waves.
  • PRI: Not measured
  • QRS: Less than .12 seconds
atrial fibrillation
Atrial Fibrillation
  • Several foci iniate impulses
  • Atrial & Ventricular rhythm is unmeasurable; chaotic
  • Rate: Atria - Too fast to count. Vent. = if less than 100 “controlled”, if > 100 then “rapid ventricular response”.
  • P Wave: No true P Waves
  • PRI: Not measured
  • QRS less than .12 seconds
first degree heart block
First Degree Heart Block
  • AV Node holds each Sinus impulse longer
  • Regularity will depend on underlying rhythm
  • P Waves: Upright and uniform.
  • PRI: Constant across the strip but will always be greater than .20 seconds
  • QRS less than .12 seconds
2nd degree heart block classical
2nd Degree Heart Block (Classical)
  • AV Node conducts/blocks some beats
  • If conduction ratio is consistant= regular; if not consistant the rhythm will be irregular
  • Atrial rate normal; ventricular rate usually bradycardia.
  • P Waves upright & uniform. More P Waves than QRS complexes
  • PRI may be longer than .20. QRS < .12
2nd degree heart block wenckebach
2nd Degree Heart BlockWenckebach
  • Sinus Node initiates impulses; delayed in AV Node; One is finally blocked
  • R-R irregular. R-R interval gets progressively shorter as PRI gets longer
  • Rate: Usually a little slower than normal
  • PRI: PR gets longer, until one P Wave is not followed by QRS. Repeats cycle.
  • QRS: Less than .12 seconds
third degree heart block complete hb
Third Degree Heart BlockComplete HB
  • Complete block at AV Node. Atria and Ventricles function separately
  • P-P & R-R intervals are regular.
  • Atrial rate - normal. Ventricular rate slower
  • P Waves: Upright & Uniform - More P Waves than QRS complexes
  • PRI: There is no PRI
  • QRS: Depends on foci
premature ventricular contraction
Premature Ventricular Contraction
  • Irritable focus within the ventricles
  • The underlying rhythm can be reular or irregular
  • Rate: Underlying rhythm
  • P Waves: The ectopic is not preceeded by a P Wave
  • PRI: No PRI
  • QRS: Wide and bizarre
pvc s
PVC’s
  • QRS: at least .12 seconds. T Wave frequently in the opposite direction from QRS
  • > 6 per minute
  • Two PVC’s - Couplet
  • Bigeminy, Trigeminy
  • Multifocal PVC’s
idioventricular rhythm
Idioventricular Rhythm
  • Ventricles initiate a regular impulse at 20-40 bpm
  • The rhythm is usually regular, it can slow as the heart dies
  • Rate: 20-40 bpm
  • No P Waves
  • No PRI
  • QRS - Wide and bizarre at least .12
ventricular tachycardia
Ventricular Tachycardia
  • Irritable focus in Ventricles
  • Usually regular
  • Rate: Atrial rate cannot be determined; Ventricular rate 150-250 bpm
  • P Waves: No P Waves with QRS’
  • PRI: No PRI
  • QRS: Wide & bizarre, measuring at least .12 seconds.
ventricular fibrillation
Ventricular Fibrillation
  • Multiple foci in ventricles become irritable; heart starts to fibrillate rather than contract
  • Regularity: Totally chaotic
  • Rate: Cannot be determined
  • P Waves: No discernible P Waves
  • PRI There is no PRI
  • QRS: No QRS complexes
asystole
Asystole
  • The heart has no electrical activity
  • Check the leads!!!!
  • Only a straight line