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Basic Arrhythmias Interpretation Cardiac Electrophysiology Natalie Bermudez, RN, BSN, MS Clinical Educator for Telemetry
Myocardial Cardiac Cell Types ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Cardiac Cell Activity ,[object Object],[object Object],[object Object]
Primary Characteristics of Cardiac Cells ,[object Object],[object Object],[object Object],[object Object],[object Object]
Is it  GOOD  or  BAD ??? ,[object Object],[object Object],Automaticity It is definitely REALLY GOOD THING!! But it can also be a  REALLY BAD THING!!
Electrolytes and Cardiac Cells ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Polarization Depolarization   Repolarization Electrical Activity at the Cellular Level
Cardiac Action Potential ,[object Object],[object Object]
Slow-Response Cells ,[object Object],[object Object],[object Object]
Fast-Response Cells ,[object Object],[object Object],[object Object]
Phases of Action Potential ,[object Object],[object Object],[object Object],[object Object]
Phases of Action Potential ,[object Object],[object Object],[object Object],[object Object]
Phases of Action Potential ,[object Object],[object Object],[object Object],[object Object]
 
POLARIZATION ,[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],DEPOLARIZATION
[object Object],REPOLARIZATION
Refractory Period ,[object Object],[object Object],[object Object]
What is an EKG? ,[object Object],[object Object]
Isoelectric Line & Waveforms ,[object Object],[object Object]
Deflections ,[object Object],[object Object],[object Object]
Positive & Negative Poles ,[object Object],[object Object]
Positive & Negative Poles See Overhead Slide 1-1
Cardiac Monitors Electrodes, Poles, Wires, Leads, and Electrode Placement
Five-Leadwire System
Electrode Pad Placement ,[object Object],An electrode pad is the medium through electrical activity is registered/recorded Proper placement of the electrode pad is the most important step in obtaining a good quality and accurate EKG tracing  An EKG lead provides a view of the heart’s electrical activity between two points or poles (one positive & one negative) The EKG waveforms are recorded via an electrode/wire system – i.e.  five-leadwire system
Poles & Lead II ,[object Object],[object Object],[object Object],[object Object]
LEAD II ,[object Object]
Irritability versus Escape ,[object Object],[object Object],[object Object]
More EKG Terminology Focus, Ectopy, Aberrancy, Artifact
Important Terminology ,[object Object],[object Object]
Aberrancy ,[object Object],[object Object]
Artifact ,[object Object],[object Object],[object Object]
Cardiac Electrophysiology The Electrical Conduction Pathway
Nervous System Stimulation ,[object Object],[object Object]
Nervous System Stimulation ,[object Object],[object Object]
Pacemaker ,[object Object],[object Object],[object Object],[object Object]
The Electrical Conduction Pathway
SA Node ,[object Object],[object Object],[object Object],[object Object]
AV Node   (The Gatekeeper) ,[object Object],[object Object],[object Object],[object Object]
AV Node   (The Gatekeeper) ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Ventricular Conduction ,[object Object],[object Object],[object Object],[object Object],[object Object]
EKG COMPLEX
PQRST = One EKG complex = One Cardiac Cycle Total Duration of a Cardiac Cycle = ___________ seconds
P Wave ,[object Object],[object Object],[object Object],[object Object]
P Wave Abnormalities ,[object Object],[object Object],[object Object]
PR Segment ,[object Object],[object Object]
QRS Complex Depicts the electrical impulse traveling through the ventricles and ventricular depolarization (contraction). Not all QRS complexes have a Q, R, and S.
QRS Complex Q wave  is the FIRST negative deflection  R wave  is the FIRST positive deflection S wave  is the negative deflection that follows the R wave J Point  is the point where the QRS complex ends See Overhead Slide 1-3
QRS Complex Variations Overhead Slide 1-2
ST-Segment ,[object Object]
ST-Segment Elevation & Depression ,[object Object]
ST-Segment Depression ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
ST-Segment Elevation ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
T Wave Depicts ventricular repolarization Refractory Period
T Waves Positive Deflection  (above baseline < 5 mm) Should appear rounded and symmetrical Peak is closer to the end of the wave
Elevated T Waves Positive Deflection  (above baseline  >  5 mm) Tall, peaked (tented) HYPERKALEMIA  or MYOCARDIAL INJURY
Inverted T Waves Negative Deflection  (below baseline) Causes: Myocardial Ischemia Myocardial Infarction Pericarditis Ventricular Enlargement Bundle Branch Block Subarachnoid Hemorrhage Certain Drugs (quinidine or procainamide)
U Wave Depicts last phase of ventricular repolarization or endocardial repolarization???
U Wave U Wave < 2 mm Seen most commonly with BRADYCARDIC rate Can cause inaccuracies when measuring QT intervals
U Wave U Wave < 2 mm Large = hypokalemia, cardiomyopathy, LV enlargement Some drugs may cause a large U wave May cause Torsades de Pointes
Atrial Repolarization ??? Hidden beneath the QRS complex.
 
EKG Graph Paper
Waveform Measurements
PR Interval Measurement: 0.12 – 0.20 seconds Represents the time from SA node firing to the end of AV node delay
PRI Abnormalities Prolonged or Inconsistent PRI’s may indicate a type of heart block: 1 st  degree AVB Mobitz 1 or Mobitz 2 Complete AVB
PRI Abnormalities Shortened or Nonexistent PRI’s may indicate: Tachycardic Rhythms  WPW Syndrome Junctional Rhythms Ectopic Atrial Rhythms Ventricular Rhythms
PRI Abnormalities See Overhead Slide 1-4
PR Interval PRI= PRI=
QRS Duration Measurement: 0.04 – 0.10 seconds Represents the travel time of electrical activity through the ventricles
QRS Complex Variations Wide and/or notched QRS complexes:  - BBB’s  - Aberrant ventricular  conductivity - Rhythms with Ventricular Focus
Aberrant QRS Complex See Overhead Slide 1-5
QRS Duration QRS= QRS=
QT Interval Measurement: < ½ the distance of the preceding R-R interval Represents travel time through ventricles to the end of ventricular repolarization Normally varies according to age, sex, and particularly heart rate
QT Rate Corrected HR  ↑  = QT interval  ↓   HR  ↓  = QT interval  ↑   QTc =  QT + 1.75 (ventricular rate – 60)
QT Interval QT= QTc= QT= QTc=
Prolonged QT Intervals Represents a prolonged time to repolarization May lead to  R-on-T Phenomenon and ventricular dysrhythmias!!!
Basics to Interpreting Strips ,[object Object],[object Object],[object Object],[object Object],[object Object]
RHYTHM ,[object Object],[object Object],[object Object],[object Object],[object Object]
HEART RATE ,[object Object],[object Object]
Calculating Heart Rates The 6-Second Rule The Rule of 300’s The 1500 Rule
6-Second Strip ,[object Object],[object Object],[object Object],[object Object],[object Object]
Rule of 300’s ,[object Object],[object Object],[object Object],[object Object],[object Object]
Rule of 300’s Scale of 300 1 large square = 300 bpm 2 large squares = 150 bpm 3 large squares = 100 bpm 4 large squares = 75 bpm 5 large squares = 60 bpm 6 large squares = 50 bpm
1500 Rule ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
P Waves ,[object Object],[object Object],[object Object],[object Object]
PRI ,[object Object],[object Object],[object Object]
QRS Complex ,[object Object],[object Object],[object Object]
QT Interval or QTc ,[object Object],[object Object]
Extras??? ,[object Object],[object Object]
 
References ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

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