ECG Rhythm Interpretation

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Slide 1 :

ECG Rhythm Interpretation Module IV a Sinus Rhythms and Premature Beats

Slide 2 :

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.

Slide 3 :

Learning Modules ECG Basics How to Analyze a Rhythm Normal Sinus Rhythm Heart Arrhythmias Diagnosing a Myocardial Infarction

Slide 4 :

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

Slide 5 :

Sinus Rhythms Sinus Bradycardia Sinus Tachycardia

Slide 6 :

Rhythm #1 30 bpm Rate? Regularity? regular normal 0.10 s P waves? PR interval? 0.12 s QRS duration? Interpretation? Sinus Bradycardia

Slide 7 :

Sinus Bradycardia Deviation from NSR - Rate < 60 bpm

Slide 8 :

Sinus Bradycardia Etiology: SA node is depolarizing slower than normal, impulse is conducted normally (i.e. normal PR and QRS interval).

Slide 9 :

Rhythm #2 130 bpm Rate? Regularity? regular normal 0.08 s P waves? PR interval? 0.16 s QRS duration? Interpretation? Sinus Tachycardia

Slide 10 :

Sinus Tachycardia Deviation from NSR - Rate > 100 bpm

Slide 11 :

Sinus Tachycardia Etiology: SA node is depolarizing faster than normal, impulse is conducted normally. Remember: sinus tachycardia is a response to physical or psychological stress, not a primary arrhythmia.

Slide 12 :

Premature Beats Premature Atrial Contractions (PACs) Premature Ventricular Contractions (PVCs)

Slide 13 :

Rhythm #3 70 bpm Rate? Regularity? occasionally irreg. 2/7 different contour 0.08 s P waves? PR interval? 0.14 s (except 2/7) QRS duration? Interpretation? NSR with Premature Atrial Contractions

Slide 14 :

Premature Atrial Contractions Deviation from NSR These ectopic beats originate in the atria (but not in the SA node), therefore the contour of the P wave, the PR interval, and the timing are different than a normally generated pulse from the SA node.

Slide 15 :

Premature Atrial Contractions Etiology: Excitation of an atrial cell forms an impulse that is then conducted normally through the AV node and ventricles.

Slide 16 :

Teaching Moment When an impulse originates anywhere in the atria (SA node, atrial cells, AV node, Bundle of His) and then is conducted normally through the ventricles, the QRS will be narrow (0.04 - 0.12 s).

Slide 17 :

Rhythm #4 60 bpm Rate? Regularity? occasionally irreg. none for 7th QRS 0.08 s (7th wide) P waves? PR interval? 0.14 s QRS duration? Interpretation? Sinus Rhythm with 1 PVC

Slide 18 :

PVCs Deviation from NSR Ectopic beats originate in the ventricles resulting in wide and bizarre QRS complexes. When there are more than 1 premature beats and look alike, they are called “uniform”. When they look different, they are called “multiform”.

Slide 19 :

PVCs Etiology: One or more ventricular cells are depolarizing and the impulses are abnormally conducting through the ventricles.

Slide 20 :

Teaching Moment When an impulse originates in a ventricle, conduction through the ventricles will be inefficient and the QRS will be wide and bizarre.

Slide 21 :

Ventricular Conduction Normal Signal moves rapidly through the ventricles Abnormal Signal moves slowly through the ventricles

Slide 22 :

End of Module IV a Sinus Rhythms and Premature Beats Proceed to Module IV a Practice Quiz on WebCT

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ECG Basics; How to Analyze a Rhythm; Normal Sinus Rhythm; Heart Arrhythmias; Diagnosing a Myocardia more ECG Basics; How to Analyze a Rhythm; Normal Sinus Rhythm; Heart Arrhythmias; Diagnosing a Myocardial Infarction. Arrhythmias. Sinus Rhythms; Premature Beats ... less
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