15 vs 223 ekg


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15 vs 223 ekg

  1. 1. Electrocardiogram Rhythm Interpretation by Evan M. Hodell 12/00
  2. 2. What is an EKG? <ul><li>An EKG is a method of measuring, displaying and recording the electrical activity of a heart </li></ul><ul><li>Electrical stimuli is amplified to create a “rhythm strip” by a machine that consistently produces representations of the heart’s electrical activity </li></ul>
  3. 3. BASIC TERMINOLOGY <ul><li>Arrhythmia: Abnormal rhythm </li></ul><ul><li>Baseline: Flat, straight, isoelectric line </li></ul><ul><li>Waveform : Movement away from the baseline, up or down </li></ul><ul><li>Segment: A line between waveforms </li></ul><ul><li>Interval: A waveform plus a segment </li></ul><ul><li>Complex: Combination of several waveforms </li></ul>
  4. 4. Electrical System of Heart
  5. 5. Components of a NSR
  6. 11. Components of a NSR
  7. 12. Point of Origin Name <ul><li>SA Node- Sinus rhythm </li></ul><ul><ul><li>Causes regular, rounded P waves, and normal, narrow QRS complexes </li></ul></ul><ul><li>Atria- Atrial rhythm </li></ul><ul><ul><li>Causes irregularly shaped P waves, but still normal, narrow QRS complexes </li></ul></ul><ul><li>AV Node- Junctional rhythm </li></ul><ul><ul><li>Normal, narrow QRS complexes with no P waves </li></ul></ul><ul><li>Perkinjie Fibers- Ventricular rhythm </li></ul><ul><ul><li>No P waves, and irregular, wide QRS complexes </li></ul></ul>
  8. 13. Beginning to Recognize Rhythms <ul><li>Step 1: Are there P waves? </li></ul><ul><li>Step 2: Are there QRS complexes? </li></ul><ul><li>Step 3: Are the P waves and QRS complexes related? </li></ul>
  9. 14. Example 1 <ul><li>STEP 1. </li></ul><ul><ul><ul><ul><li>Are there P waves? </li></ul></ul></ul></ul>
  10. 15. Example 1 Continued <ul><li>Are there P waves? </li></ul><ul><ul><li>Yes, P waves are easily identifiable and regular in rate. </li></ul></ul>
  11. 16. Example 1 Continued <ul><li>STEP 2. </li></ul><ul><ul><li>Are there QRS complexes? </li></ul></ul>
  12. 17. Example 1 Continued <ul><li>STEP 2. </li></ul><ul><ul><li>Yes there are normal, narrow, QRS complexes. </li></ul></ul>
  13. 18. Example 1 Continued <ul><li>STEP 3 </li></ul><ul><ul><li>Are they related, 1:1? </li></ul></ul>
  14. 19. Example 1 Continued <ul><li>STEP 3 </li></ul><ul><ul><li>Are they related, 1:1? </li></ul></ul><ul><ul><ul><li>Yes, there is one P wave for every QRS. </li></ul></ul></ul><ul><ul><ul><li>This is called a sinus rhythm </li></ul></ul></ul>
  15. 20. Example 2 <ul><li>Follow steps 1-3 as demonstrated in Ex. 1. </li></ul><ul><li>This is also a sinus rhythm. </li></ul><ul><li>Note: The P waves are smaller, yet their regularity in relation to the QRS complexes gives them away. </li></ul>
  16. 21. Example Three <ul><li>Following the same steps, this one doesn’t match up!?!? </li></ul>
  17. 22. Example 3 continued <ul><li>Step 1 </li></ul><ul><ul><li>Are there P waves? </li></ul></ul><ul><ul><ul><li>Yes, </li></ul></ul></ul><ul><ul><li>Note: notice the dotted arrows indicate the location of P waves buried in the stronger electrical activity of the QRS complexes. </li></ul></ul>
  18. 23. Example 3 Continued <ul><li>STEP 2 </li></ul><ul><ul><li>Are there QRS complexes? </li></ul></ul><ul><ul><ul><li>Yes, there are normal, narrow QRS complexes. </li></ul></ul></ul>
  19. 24. Example 3 Continued <ul><li>STEP 3. </li></ul><ul><ul><li>Are they related? </li></ul></ul><ul><ul><ul><li>NO, they are both regular in shape and rate, but there is no relation between them. </li></ul></ul></ul><ul><ul><li>This shows a Complete Heart Block, also called a 3rd degree block. </li></ul></ul><ul><ul><li>Can the Heart effectively pump blood if the Atria and Ventricles are not working together? </li></ul></ul>
  20. 25. Case Study of Beau <ul><li>Beau is an 11 y/o 45 lb. Male Australian Shepard. </li></ul><ul><li>Physical exam: see overhead </li></ul><ul><ul><ul><li>Beau presents with a moderate, chronic, nocturnal cough with mild dyspnea. Secondary exam also reveals a pounding irregular heartbeat and Grade 4 murmur. </li></ul></ul></ul><ul><ul><ul><li>Electrocardiogram was ordered in addition to other tests. Result: </li></ul></ul></ul>
  21. 26. Case Study of Beau <ul><li>EKG reveals a Sinus Arrhythmia, </li></ul><ul><ul><li>Beaus heart is “firing off” Premature Atrial Contractions, “PAC’s. </li></ul></ul><ul><ul><ul><li>Potentially indicative of atrial enlargement, or other heart irritability, which may or may not be related to Beau’s cough and current presentation. </li></ul></ul></ul>
  22. 27. 4. Normal Intervals for the Human, Dog and Cat <ul><li>Human- HR- 60-100 bpm </li></ul><ul><ul><ul><ul><ul><li>PR interval- 0.12-0.20 sec </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>QRS width max= 0.11 sec </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>QT interval= 0.36-0.44 sec </li></ul></ul></ul></ul></ul><ul><li>Dog- HR- 60-220 bpm </li></ul><ul><ul><ul><ul><ul><li>PR interval= 0.06-0.13 sec </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>QRS width max= 0.06 sec for large 0.05 sec for small </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>QT interval= 0.15-0.25 sec </li></ul></ul></ul></ul></ul><ul><li>Cat- HR = 120-240 bpm </li></ul><ul><ul><ul><ul><ul><li>PR interval= 0.05-0.09 sec </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>QRS width max= 0.04 sec </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>QT interval= 0.12-0.18 sec </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>-Tilley L.P. et al 1995 </li></ul></ul></ul></ul></ul>
  23. 32. References <ul><li>Aehlert RN Ph. ECG’s Made Easy , Mosby Year Book 1995 </li></ul><ul><li>Bledsoe, B. Brady Paramedic Emergency Care, Prentice Hall New Jersey, 1988 </li></ul><ul><li>Foster, Bruce D.O. Twelve-Lead Electrocardiography for the ACLS Provide, Waynesboro PA, W.B. Saunders Co., 1996 </li></ul><ul><li>Fox. P.R. and Kaplan P. Contemporary Cardiology Issues in Small Animal Practice, Churchill Livingston, New York 1987 </li></ul><ul><li>Smith F.W.K, D.J. Hallock, Manual of Canine and Feline Cardiology W.B. Saunders, Philadelphia 1995 </li></ul><ul><li>Tilley, L.P. Essentials of Canine and Feline Electrocardiography, 3 rd edition Williams and Wilkins, Baltimore 1995 </li></ul>