Ecg rhythms charex

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Ecg rhythms charex

  1. 1. ECG review – ACLS Program Ohio State University Medical CenterRhythm ECG Characteristics ExampleNormal Sinus Rhythm Rate: 60-100 per minute Rhythm: R- R =(NSR) P waves: Upright, similar P-R: 0.12 -0 .20 second & consistent qRs: 0.04 – 0.10 second P:qRs: 1P:1qRsSinus Tachycardia Rate: > 100Causes: Rhythm: R- R = Exercise P waves: Upright, similar Hypovolemia P-R: 0.12 -0 .20 second Medications & consistent Fever qRs: 0.04 – 0.10 second Hypoxia P:qRs: 1P:1qRs Substances Anxiety, Fear Acute MI Fight or Flight Congestive Heart FailureSinus Bradycardia Rate: < 60Causes: Rhythm: R- R = intrinsic sinus node P waves: Upright; similar disease P-R: 0.12 -0 .20 second increased & consistent parasympathetic tone qRs: 0.04 – 0.10 second drug effect. P:qRs: 1P:1qRsPublished by: Department of Educational Development and Resources, OSU Medical Center 1© December 2001 by The Ohio State Univeristy Medical Center All Rights Reserved
  2. 2. ECG review – ACLS Program Ohio State University Medical CenterRhythm ECG Characteristics ExamplePremature Atrial Rate: usually < 100,Contractions (PAC) dependant On underlying rhythm ♦ ♦ ♦Causes: Rhythm: irregular normal P waves: Early & upright, excessive use of caffeine, different from Sinus tobacco, or alcohol CHF PR: 0.12 – 0.20 second; different from Sinus PAC = ♦ Myocardial ischemia or qRs: 0.04 – 0.10 second injury P:qRs = 1:1 Hypokalemia, Dig toxicity COPDAtrial Flutter Rate: Atrial rate 250-350Causes: Vent 150 common ischemic heart disease Rhythm: Atrial = Regular Hypoxia Vent = Reg. or irreg Acute MI P waves: Not identifiable Dig Toxicity F waves: Uniform (sawtooth Mitral or Tricuspid valve or picket fence ) disease PRI: not measurable Pulmonary embolism qRs: 0.04 – 0.10 secondAtrial Fibrillation Rate: Atrial: 400-700 Ischemic heart disease Vent. 160-180/minute Hypoxia Rhythm: Atrial: irregular; Acute MI Vent.: irregular Digitalis toxicity P waves: No identifiable Ps Mitral or tricuspid f waves: may be seen. disease PRI: unable to measure (No identifiable P)Published by: Department of Educational Development and Resources, OSU Medical Center 2© December 2001 by The Ohio State Univeristy Medical Center All Rights Reserved
  3. 3. ECG review – ACLS Program Ohio State University Medical CenterRhythm ECG Characteristics Example qRs: usually normalParoxysmal Atrial Rate: usually 160-220 Rhythm: RegularTachycardia P waves: differ in shape fromCauses: Sinus Ps; usually difficult Same as PACs to identify (rate related) PR Interval: Normal when the Ps can be identified; short if WPW present qRs: usually normal Other: Onset sudden, often initiated by a PACPremature Junctional Rate: usually < 100, dependant on theContraction (PJC) underlying rhythmCauses: Rhythm: irregular Same as PACs P waves: Inverted before or after qRs or not visible PR interval: < 0.12 second when inverted P is before qRs qRs: 0.04 – 0.10 second P:qRs = 1:1 if Ps are visibleJunctional escape Rate: 40-60 61 – 100 (accelerated)Rhythm Rhythm: RegularCauses: P waves: Inverted before or after healthy athlete at rest qRs or not visible related to medications- PR interval: < 0.12 second whenPublished by: Department of Educational Development and Resources, OSU Medical Center 3© December 2001 by The Ohio State Univeristy Medical Center All Rights Reserved
  4. 4. ECG review – ACLS Program Ohio State University Medical CenterRhythm ECG Characteristics Example Beta Blockers, Calcium inverted P is before Channel Blockers, Dig qRs Toxicity qRs: 0.04 – 0.10 second or increased P:qRs 1:1 if Ps are visible parasympathetic tone Acute Inferior Wall MI Rheumatic Heart Disease Post-Cardiac Surgery Valvular Disease SA Node Disease HypoxiaJunctional Tachycardia Rate: 101-200Causes: Same as Paroxysmal Same as Junctional Escape Atrial Tachycardia (PAT) Rhythms.Supraventricular Rhythm: Absolutely regular Rate: > 150 per minuteTachycardia (SVT) P Waves: Not visibleAn umrella term used (PRI not measurable)when unable to qRs: normal 0.04 – 0.10 secdistinguish whichrhythm is present.Causes:Same as Sinus, Atrial, andJunctional Tachycardia, andAtrial FlutterPublished by: Department of Educational Development and Resources, OSU Medical Center 4© December 2001 by The Ohio State Univeristy Medical Center All Rights Reserved PVC PVC
  5. 5. ECG review – ACLS Program Ohio State University Medical CenterRhythm ECG Characteristics ExamplePremature Ventricular Rate: Dependent uponComplex (PVC) underlying rhythmCauses: Rhythm: R – R ≠ Gastric overload P waves: Usually absent, if Stress present, not associated Caffeine, Alcohol, with PVC Nicotine qRs: 0.12 second or greater; Heart Disease bizarre and notched Acid-Base Imbalance ST & T: Often opposite in Electrolyte Imbalance direction to the qRs. Cyclic Antidepressants Hypoxia Timing Acidosis One on a strip = Rare Acute MI One in a row = Isolated Two in a row = Pair, couplet Three in a row = V Tachycardia Pattern Every other = Bigeminy Every third = Trigeminy Morphology Similar shape = Uniformed Different shape = Multiformed Location R – on – T = PVC falls on the T wave of the complex before the PVCVentricular Rate: > 100 per minute and usually not > 220Tachycardia Rhythm: Usually regularCauses: P Waves: ∅ P waves or if Same as PVCs present, not R on T PhenomenonPublished by: Department of Educational Development and Resources, OSU Medical Center 5© December 2001 by The Ohio State Univeristy Medical Center All Rights Reserved
  6. 6. ECG review – ACLS Program Ohio State University Medical CenterRhythm ECG Characteristics Example associated with qRs qRs: Wide (≥ 0.12 sec), bizarre ST/T wave: Opposite direction of qRs A group of three PVCs in a row or more at a rate greater than 100/ minute or more constitutes Ventricular Tachycardia.Ventricular Fibrillation Rate: ∅Causes: Rhythm: ∅ regularity, Acute Myocardial chaotic undulating Infarction waves Untreated Ventricular P Waves: ∅ Tachycardia qRs: ∅ Hypothermia ST/T Wave: ∅ R-on-T PVCs Organized activity: ∅ Electrolyte imbalance Electrical shock No Cardiac Output or PulseIdioventricular Rate: 20-40 per minute Rhythm: R – R =Rhythm P waves: No P waves associatedCauses: to qRs Myocardial Infarction qRs: > 0.12 sec, notched, Digitalis toxicity bizarre appearance Metabolic imbalances ST/T : Opposite direction of qRs Post resuscitation rhythm Rate > 40 to 100 = AcceleratedPublished by: Department of Educational Development and Resources, OSU Medical Center 6© December 2001 by The Ohio State Univeristy Medical Center All Rights Reserved
  7. 7. ECG review – ACLS Program Ohio State University Medical CenterRhythm ECG Characteristics ExampleAsystole Rate: Ventricular rate = 0Causes: Rhythm: ∅ unless Ps are present, Extensive myocardial then regular or irregular damage P waves: may be present Acute respiratory failure qRs: ∅ Ischemia or Infarction P:qRs ∅ Traumatic cardiac arrest Ventricular aneurysm Countershock Hypoxia, Hypothermia Hyperkalemia, Hypokalemia Preexisting acidosis Drug overdose1st degree AV Block υ 1P : 1 qRs υ Prolonged PRI (> 0.20 sec not > 0.40 sec)Published by: Department of Educational Development and Resources, OSU Medical Center 7© December 2001 by The Ohio State Univeristy Medical Center All Rights Reserved
  8. 8. ECG review – ACLS Program Ohio State University Medical CenterRhythm ECG Characteristics Example2nd degree AV Block, υ More P waves than qRsType I υ PRI progressively increases in a cycle until P appears w/o qRs. υ Cyclic pattern reoccurs υR–R≠ = non-conducted P wave2nd degree AV Block, More P waves than qRs υ PRI consistentType II υ qRs normal or wide (bundle branch block) υ R - R≠ or R – R = = non-conducted P wave3rd degree AV Block υ More P waves than qRs υ P not r/t qRs (P too close, P too far) υ PRI varies greatly υ qRs normal or wide υR–R= = non-conducted P wavePublished by: Department of Educational Development and Resources, OSU Medical Center 8© December 2001 by The Ohio State Univeristy Medical Center All Rights Reserved
  9. 9. ECG review – ACLS Program Ohio State University Medical CenterPublished by: Department of Educational Development and Resources, OSU Medical Center 9© December 2001 by The Ohio State Univeristy Medical Center All Rights Reserved

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