15  vs 223 ekg
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15 vs 223 ekg

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    15  vs 223 ekg 15 vs 223 ekg Presentation Transcript

    • Electrocardiogram Rhythm Interpretation by Evan M. Hodell 12/00
    • What is an EKG?
      • An EKG is a method of measuring, displaying and recording the electrical activity of a heart
      • Electrical stimuli is amplified to create a “rhythm strip” by a machine that consistently produces representations of the heart’s electrical activity
    • BASIC TERMINOLOGY
      • Arrhythmia: Abnormal rhythm
      • Baseline: Flat, straight, isoelectric line
      • Waveform : Movement away from the baseline, up or down
      • Segment: A line between waveforms
      • Interval: A waveform plus a segment
      • Complex: Combination of several waveforms
    • Electrical System of Heart
    • Components of a NSR
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    • Components of a NSR
    • Point of Origin Name
      • SA Node- Sinus rhythm
        • Causes regular, rounded P waves, and normal, narrow QRS complexes
      • Atria- Atrial rhythm
        • Causes irregularly shaped P waves, but still normal, narrow QRS complexes
      • AV Node- Junctional rhythm
        • Normal, narrow QRS complexes with no P waves
      • Perkinjie Fibers- Ventricular rhythm
        • No P waves, and irregular, wide QRS complexes
    • Beginning to Recognize Rhythms
      • Step 1: Are there P waves?
      • Step 2: Are there QRS complexes?
      • Step 3: Are the P waves and QRS complexes related?
    • Example 1
      • STEP 1.
            • Are there P waves?
    • Example 1 Continued
      • Are there P waves?
        • Yes, P waves are easily identifiable and regular in rate.
    • Example 1 Continued
      • STEP 2.
        • Are there QRS complexes?
    • Example 1 Continued
      • STEP 2.
        • Yes there are normal, narrow, QRS complexes.
    • Example 1 Continued
      • STEP 3
        • Are they related, 1:1?
    • Example 1 Continued
      • STEP 3
        • Are they related, 1:1?
          • Yes, there is one P wave for every QRS.
          • This is called a sinus rhythm
    • Example 2
      • Follow steps 1-3 as demonstrated in Ex. 1.
      • This is also a sinus rhythm.
      • Note: The P waves are smaller, yet their regularity in relation to the QRS complexes gives them away.
    • Example Three
      • Following the same steps, this one doesn’t match up!?!?
    • Example 3 continued
      • Step 1
        • Are there P waves?
          • Yes,
        • Note: notice the dotted arrows indicate the location of P waves buried in the stronger electrical activity of the QRS complexes.
    • Example 3 Continued
      • STEP 2
        • Are there QRS complexes?
          • Yes, there are normal, narrow QRS complexes.
    • Example 3 Continued
      • STEP 3.
        • Are they related?
          • NO, they are both regular in shape and rate, but there is no relation between them.
        • This shows a Complete Heart Block, also called a 3rd degree block.
        • Can the Heart effectively pump blood if the Atria and Ventricles are not working together?
    • Case Study of Beau
      • Beau is an 11 y/o 45 lb. Male Australian Shepard.
      • Physical exam: see overhead
          • Beau presents with a moderate, chronic, nocturnal cough with mild dyspnea. Secondary exam also reveals a pounding irregular heartbeat and Grade 4 murmur.
          • Electrocardiogram was ordered in addition to other tests. Result:
    • Case Study of Beau
      • EKG reveals a Sinus Arrhythmia,
        • Beaus heart is “firing off” Premature Atrial Contractions, “PAC’s.
          • Potentially indicative of atrial enlargement, or other heart irritability, which may or may not be related to Beau’s cough and current presentation.
    • 4. Normal Intervals for the Human, Dog and Cat
      • Human- HR- 60-100 bpm
              • PR interval- 0.12-0.20 sec
              • QRS width max= 0.11 sec
              • QT interval= 0.36-0.44 sec
      • Dog- HR- 60-220 bpm
              • PR interval= 0.06-0.13 sec
              • QRS width max= 0.06 sec for large 0.05 sec for small
              • QT interval= 0.15-0.25 sec
      • Cat- HR = 120-240 bpm
              • PR interval= 0.05-0.09 sec
              • QRS width max= 0.04 sec
              • QT interval= 0.12-0.18 sec
              • -Tilley L.P. et al 1995
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    • References
      • Aehlert RN Ph. ECG’s Made Easy , Mosby Year Book 1995
      • Bledsoe, B. Brady Paramedic Emergency Care, Prentice Hall New Jersey, 1988
      • Foster, Bruce D.O. Twelve-Lead Electrocardiography for the ACLS Provide, Waynesboro PA, W.B. Saunders Co., 1996
      • Fox. P.R. and Kaplan P. Contemporary Cardiology Issues in Small Animal Practice, Churchill Livingston, New York 1987
      • Smith F.W.K, D.J. Hallock, Manual of Canine and Feline Cardiology W.B. Saunders, Philadelphia 1995
      • Tilley, L.P. Essentials of Canine and Feline Electrocardiography, 3 rd edition Williams and Wilkins, Baltimore 1995