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Rhythms
Rhythms
Rhythms
Rhythms
Rhythms
Rhythms
Rhythms
Rhythms
Rhythms
Rhythms
Rhythms
Rhythms
Rhythms
Rhythms
Rhythms
Rhythms
Rhythms
Rhythms
Rhythms
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Rhythms

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Introduction to rhytms

Introduction to rhytms

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  • 1. <ul><li>Cardiac monitoring and Rhythm recognition </li></ul>Rhythm in lead II ( most prominent P wave with sufficient amplitude to trigger the rate meter.
  • 2. <ul><li>Electrode positions for cardiac monitor </li></ul><ul><li>+ve Left shoulder, -ve right shoulder: lead I : Good QRS </li></ul><ul><li>-ve right clavicle, +ve left lower chest : lead II good P and QRS enough for triggering rate meter </li></ul><ul><li>-ve left clavicle and +ve left lower chest:Lead III Good P waves </li></ul>
  • 3. <ul><li>Monitoring after Cardiac Arrests </li></ul><ul><li>Rhythm monitores </li></ul><ul><li>Watch for arching if jell and not jelpads are used </li></ul><ul><li>Rhythm interpreted by rhythm strip </li></ul><ul><li>Diagnosis by 12 lead ECG </li></ul>
  • 4. <ul><li>How to read a rhythm strip ? </li></ul><ul><li>Ventricular rate </li></ul><ul><li>Rhythm QRS regular or irregular </li></ul><ul><li>Is Atrial activity present </li></ul><ul><li>Relationship Atrium vs Ventricle </li></ul><ul><li>QRS width normal or prolonged </li></ul>
  • 5. <ul><li>Ventricular rate </li></ul><ul><li>< 60/min Bradychardia </li></ul><ul><li>> 100/min Tachycardia </li></ul><ul><li>1second = 5 large squares </li></ul><ul><li>Number of large squares between beats . Divide into 300 </li></ul>
  • 6. <ul><li>Regular or Irregular rhythm </li></ul><ul><li>Atrial Fibrillation irregular </li></ul><ul><li>check R-R intervals on strip ( paper and mark ) </li></ul><ul><li>Ectopics </li></ul><ul><li>Before next beat : premature ectopic </li></ul><ul><li>late : escape beats </li></ul><ul><li>3 Ectopics consecutive is tachycardia </li></ul><ul><li>If in self terminating runs : paroxysmal </li></ul><ul><li>escape beats are narrow then ventricular </li></ul><ul><li>Broad anywhere in the heart </li></ul>
  • 7. <ul><li>Is Atrial Activity present </li></ul><ul><li>lead V1 will record the best recording of Atrial activity </li></ul><ul><li>Slow rate : vagal stimulus or Adenosine </li></ul><ul><li>Atrial flutter rate 300/min </li></ul><ul><li>Irregularity of Atrial Fibrillation </li></ul><ul><li>Shape of the P wave </li></ul><ul><ul><li>P upright II and AVF : sinoatrial node </li></ul></ul><ul><ul><li>P wave inverted in II and AVF then retrograde conduction </li></ul></ul>
  • 8. <ul><li>Relationship Atrial and Ventricular rhythm </li></ul><ul><li>1st degree block : PR > 0.21 seconds </li></ul><ul><li>2nd Degree Block </li></ul><ul><ul><li>AV Wenckebach ( Mobits I ): progressive prolonging PR until P dropped </li></ul></ul><ul><ul><li>Mobitz II : blocked P wave without PR prolonging (*permanent pacing) </li></ul></ul><ul><ul><li>Fixed 2:1 unlickely to progress </li></ul></ul><ul><li>3rd Degree : Atrioventricular dissociation : Atrial Fibrillation </li></ul>
  • 9. <ul><li>Conduction Ventricles </li></ul><ul><li>RBBB: Broad QRS; R wave in V1 and secondary ST/T changes </li></ul><ul><li>LBBB: Broad QRS; R in I and absence septal q inV6 ( R wave ) </li></ul><ul><li>Hemiblock : </li></ul><ul><ul><li>LAHB:Absence of other causes of left axis deviation with LAD </li></ul></ul><ul><ul><li>LPHB: RAD </li></ul></ul>
  • 10. <ul><li>Causes Left Axis Deviation </li></ul><ul><li>inferior MI </li></ul><ul><li>Wolff-Parkinson-White syndrome </li></ul><ul><li>Ostium primum ASD </li></ul><ul><li>Hyperkalaemia </li></ul>
  • 11. <ul><li>Causes Right Axis Deviation </li></ul><ul><li>Right ventricular Hypertrophy </li></ul><ul><li>Pulmonary Embolism </li></ul><ul><li>Cor Pulmonale </li></ul><ul><li>W-P-W syndrome </li></ul><ul><li>Ostium secundum </li></ul><ul><li>Anterolateral MI </li></ul>
  • 12. <ul><li>Rhythms Associated with cardiac arrest </li></ul><ul><li>VF </li></ul><ul><li>Asystole </li></ul><ul><li>EMD / PEA </li></ul><ul><li>Cardiac output loss </li></ul><ul><ul><li>severe bradycardias </li></ul></ul><ul><ul><li>ventricular tachycardia </li></ul></ul>
  • 13. <ul><li>Ventricular Fibrillation </li></ul><ul><li>ventricular myocardium depolarises at random. All coordination lost </li></ul><ul><li>Confused </li></ul><ul><ul><li>polymorphic ventricular tachycardia ( torsades de pointes ) </li></ul></ul><ul><ul><li>AF in the presence of AV nodal bypass </li></ul></ul>
  • 14. <ul><li>Polymorphic Ventricular Tachcardia </li></ul><ul><li>tachycardia rate varies from beat to beat </li></ul><ul><li>complexes have pointed appearances </li></ul><ul><li>arise from background Long QT syndrome or abnormal T repolarisation </li></ul><ul><li>Treatment : B blockers, magnesium and pacing </li></ul><ul><li>can initiate VF </li></ul>
  • 15. <ul><li>Atrial Fibrillation with pre-excitation </li></ul><ul><li>rapid, broad achycardias </li></ul><ul><li>variable QRS complexes </li></ul><ul><li>W-P-W syndrome : QRS show delayed start </li></ul><ul><li>More organised and lacks chaotic activity of variable amplitude </li></ul>
  • 16. <ul><li>Ventricular Tachycardia </li></ul><ul><li>broad complex tachycardia with rate 120 - 270/min </li></ul><ul><li>QRS configuration constant </li></ul>
  • 17. <ul><li>Asystole </li></ul><ul><li>if suspected the gain controll should be turned up </li></ul><ul><li>check not fine VF </li></ul>
  • 18. <ul><li>Bradycardias </li></ul><ul><li>3rd Degree: Complete heart block : P =90/min or AF ; QRS=20 - 50/min </li></ul>
  • 19. <ul><li>Agonal rhythm </li></ul><ul><li>slow, wide irregular ventricle complexes of varying morphology </li></ul><ul><li>becomes broader before all electrical activity is lost </li></ul>

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