The document discusses electrocardiography (ECG or EKG) and defines its key components. An ECG records the electrical activity of the heart through electrodes placed on the skin. It analyzes elements like the P wave, QRS complex, ST segment, T wave, and intervals between them like the PR and QT. Abnormalities in these components can indicate various heart conditions. The document provides details on normal values and clinical significance of an ECG reading.
1) An ECG provides a picture of the electrical activity of the heart by recording the electric waves through electrodes. It can help identify cardiac abnormalities.
2) Key aspects of an ECG include waves, intervals, segments and complexes which indicate different electrical events in the heart. A normal ECG is analyzed based on rhythm, rate, axis, P wave, PR interval, QRS complex, and ST segments.
3) Abnormal findings on an ECG can help diagnose conditions like myocardial infarction, arrhythmias, ventricular hypertrophy, and conduction blocks. Proper placement of electrodes and a systematic approach is used to accurately interpret ECGs.
This document provides an overview of electrocardiogram (ECG) interpretation. It discusses the learning objectives, which are to recognize normal sinus rhythm and 15 common rhythm disturbances on a 3-lead ECG. It also covers interpreting myocardial infarctions on 12-lead ECGs. The document reviews ECG basics, how to analyze rhythms, normal sinus rhythm, cardiac dysrhythmias, and diagnosing myocardial infarctions. It provides examples of normal sinus rhythm and various arrhythmias like premature atrial contractions.
The document provides an overview of electrocardiography (ECG) interpretation. It discusses the heart's electrical conduction system and action potential, as well as the basics of reading an ECG including assessing rhythm, rate, axis, P waves, QRS complex, ST segment, and T waves. It outlines common abnormalities and provides examples of ECG interpretations for case scenarios involving myocardial infarction, left ventricular hypertrophy, sinus arrhythmia, and atrial fibrillation. The goal is to teach readers how to systematically evaluate an ECG tracing and identify potential cardiac issues.
This document provides an overview of electrocardiography (ECG) for paramedics and junior medical officers. It discusses the anatomy and physiology underlying the ECG waveform, including the conduction system of the heart and cardiac action potentials. It then describes how to properly perform and interpret a standard 12-lead ECG, defining the various waves, segments, intervals and other components as well as common abnormalities. Factors that can affect the ECG tracing are also reviewed.
This document discusses various abnormalities that can be seen on electrocardiograms (ECGs). It covers rate abnormalities like tachycardia and bradycardia. It also discusses atrial and ventricular enlargements and the patterns they produce. Various rhythm abnormalities are outlined like junctional rhythm, idioventricular rhythm, and atrioventricular blocks. Bundle branch blocks and fascicular blocks are also described. The document then covers electrolyte disturbances and various arrhythmias including supraventricular arrhythmias, ventricular tachycardias, ventricular fibrillation, and patterns seen in myocardial infarction. It concludes by emphasizing the importance of ECG in identifying many heart conditions and changes.
Interpretation of normal 12 leads electrocardiogram & someHarihar Adhikari
This document provides an overview of interpreting normal 12-lead electrocardiograms and some abnormal findings. It discusses the electrical conduction system of the heart and how depolarization spreads. Key aspects of a normal ECG are described, including intervals, waves, and what each lead measures. Common abnormalities are explained like arrhythmias, conduction defects, myocardial infarction, and hypertrophy. The diagnostic value of ECGs for conditions like coronary artery disease and various cardiac arrhythmias is also covered.
This document provides an overview of basics of ECG, including:
- A brief history of ECG development from 1842 to present day.
- An explanation of what an ECG measures and how it can be used to identify arrhythmias, ischemia, infarction and other cardiac conditions.
- A breakdown of the components of a normal ECG waveform including the P wave, PR interval, QRS complex, ST segment, and T wave.
- Descriptions of the 12-lead ECG system and how each lead views electrical activity from different angles in the heart.
- Explanations of how to analyze an ECG, including determining heart rate and cardiac axis. Bradyarrhythm
1) An ECG provides a picture of the electrical activity of the heart by recording the electric waves through electrodes. It can help identify cardiac abnormalities.
2) Key aspects of an ECG include waves, intervals, segments and complexes which indicate different electrical events in the heart. A normal ECG is analyzed based on rhythm, rate, axis, P wave, PR interval, QRS complex, and ST segments.
3) Abnormal findings on an ECG can help diagnose conditions like myocardial infarction, arrhythmias, ventricular hypertrophy, and conduction blocks. Proper placement of electrodes and a systematic approach is used to accurately interpret ECGs.
This document provides an overview of electrocardiogram (ECG) interpretation. It discusses the learning objectives, which are to recognize normal sinus rhythm and 15 common rhythm disturbances on a 3-lead ECG. It also covers interpreting myocardial infarctions on 12-lead ECGs. The document reviews ECG basics, how to analyze rhythms, normal sinus rhythm, cardiac dysrhythmias, and diagnosing myocardial infarctions. It provides examples of normal sinus rhythm and various arrhythmias like premature atrial contractions.
The document provides an overview of electrocardiography (ECG) interpretation. It discusses the heart's electrical conduction system and action potential, as well as the basics of reading an ECG including assessing rhythm, rate, axis, P waves, QRS complex, ST segment, and T waves. It outlines common abnormalities and provides examples of ECG interpretations for case scenarios involving myocardial infarction, left ventricular hypertrophy, sinus arrhythmia, and atrial fibrillation. The goal is to teach readers how to systematically evaluate an ECG tracing and identify potential cardiac issues.
This document provides an overview of electrocardiography (ECG) for paramedics and junior medical officers. It discusses the anatomy and physiology underlying the ECG waveform, including the conduction system of the heart and cardiac action potentials. It then describes how to properly perform and interpret a standard 12-lead ECG, defining the various waves, segments, intervals and other components as well as common abnormalities. Factors that can affect the ECG tracing are also reviewed.
This document discusses various abnormalities that can be seen on electrocardiograms (ECGs). It covers rate abnormalities like tachycardia and bradycardia. It also discusses atrial and ventricular enlargements and the patterns they produce. Various rhythm abnormalities are outlined like junctional rhythm, idioventricular rhythm, and atrioventricular blocks. Bundle branch blocks and fascicular blocks are also described. The document then covers electrolyte disturbances and various arrhythmias including supraventricular arrhythmias, ventricular tachycardias, ventricular fibrillation, and patterns seen in myocardial infarction. It concludes by emphasizing the importance of ECG in identifying many heart conditions and changes.
Interpretation of normal 12 leads electrocardiogram & someHarihar Adhikari
This document provides an overview of interpreting normal 12-lead electrocardiograms and some abnormal findings. It discusses the electrical conduction system of the heart and how depolarization spreads. Key aspects of a normal ECG are described, including intervals, waves, and what each lead measures. Common abnormalities are explained like arrhythmias, conduction defects, myocardial infarction, and hypertrophy. The diagnostic value of ECGs for conditions like coronary artery disease and various cardiac arrhythmias is also covered.
This document provides an overview of basics of ECG, including:
- A brief history of ECG development from 1842 to present day.
- An explanation of what an ECG measures and how it can be used to identify arrhythmias, ischemia, infarction and other cardiac conditions.
- A breakdown of the components of a normal ECG waveform including the P wave, PR interval, QRS complex, ST segment, and T wave.
- Descriptions of the 12-lead ECG system and how each lead views electrical activity from different angles in the heart.
- Explanations of how to analyze an ECG, including determining heart rate and cardiac axis. Bradyarrhythm
The document provides information on understanding rhythm strips and ECG patterns, including:
- It defines the common waveforms that make up the ECG pattern (P, QRS, T, U waves) and segments between waves.
- Normal values are provided for waveform durations and amplitudes, as well as heart rate.
- Abnormal characteristics of the ECG pattern are described, such as abnormal P waves, PR interval, ST segment, T waves, and QT interval.
- A 5-step process is outlined for analyzing rhythm strips, including evaluating P waves and QRS complexes, calculating heart rates, assessing rhythm regularity, and measuring PR intervals.
This document provides an overview of an ECG rhythm interpretation course. The objectives are to recognize normal sinus rhythm, the 13 most common rhythm disturbances, and acute myocardial infarction on ECG. The learning modules cover ECG basics, analyzing rhythms, normal sinus rhythm, arrhythmias, and 12-lead interpretation. Common rhythms like sinus bradycardia, sinus tachycardia, premature atrial contractions, premature ventricular contractions, atrial fibrillation, atrial flutter, paroxysmal supraventricular tachycardia, ventricular tachycardia, and ventricular fibrillation are defined.
This document provides an overview of cardiac physiology concepts including preload, afterload, contractility and the phases of the cardiac cycle. It then links these concepts to ECG patterns and discusses how electrolyte imbalances can affect the ECG. Specific conditions like atrial fibrillation, myocardial infarction and ventricular tachycardia are examined. A case study example is presented of a patient experiencing a potential inferior wall MI. Key aspects of the ECG like the ST segment and T wave are discussed in relation to evaluating for cell injury during a heart attack. Finally, a short quiz is provided to test recognition of ECG components.
This document provides an overview of electrocardiography (ECG) and how to interpret ECG strips in the context of toxicology. It begins by defining the objectives of learning ECG and its importance in toxicology. It then describes the basic components of an ECG including the waves, intervals, complexes, leads, and normal values. The document explains how to assess heart rate and rhythm on an ECG strip. Finally, it demonstrates some common ECG changes that can occur due to toxic exposures, such as sinus tachycardia, sinus bradycardia, and heart block.
This document provides an overview of an ECG workshop that aims to teach the anatomy and physiology of the heart, understanding ECGs, ischaemia and myocardial infarction, caring for cardiac patients, and case studies. It covers topics like the anatomy of the heart chambers and coronary arteries, electrical conduction system, understanding ECG lead placement and components of the PQRST complex, identifying abnormalities like ischemia, infarction locations and evolutions, and care of the cardiac patient.
This document provides an outline for a presentation on electrocardiography (ECG) and includes sections on the history of ECG, terminology, types of waveforms, the cardiac conduction system, cardiac action potential, ECG leads and placement, analyzing ECGs, nursing management of arrhythmias and heart blocks, and emergency drugs. It begins with an introduction to ECG and defines it as the recording of the electrical activity of the heart. Key points covered include the names and functions of different parts of the cardiac conduction system, how to analyze an ECG for rate, rhythm and blood flow information, nursing assessments and interventions for various arrhythmias, and information about common emergency drugs used to treat cardiac issues.
The document provides information on electrocardiography (ECG) including:
1. It describes the normal conduction system of the heart and how it relates to the ECG waves and intervals.
2. It explains the basics of reading an ECG such as determining the heart rate, analyzing waves, segments, and intervals, and identifying abnormalities.
3. It discusses ECG findings associated with various cardiac conditions like myocardial infarction, left ventricular hypertrophy, bundle branch blocks, and cardiac arrhythmias.
This document provides an overview of ECG interpretation including:
- The anatomy of the heart's conduction system and how ECG leads are attached
- How to read an ECG strip and calculate heart rate
- Normal P, QRS, and T waves along with intervals like PR and QT
- Abnormalities that can indicate conditions like blocks, arrhythmias, and hypertrophy
- Electrolyte imbalances that can affect the ECG tracing
It concludes with examples of ECG strips and questions to test the reader's understanding.
This document provides an overview of EKG waveforms and arrhythmias. It discusses the electrical activity and associated muscle movements in the atria and ventricles that produce the different waves of the EKG. Common arrhythmias like AV block, atrial flutter, and atrial fibrillation are described. The characteristics of normal sinus rhythm as well as abnormal rhythms including premature ventricular contractions, ventricular tachycardia, and ventricular fibrillation are summarized. The document provides a guide for interpreting EKG readings to identify arrhythmias and dysrhythmias.
ECG: In 1895 first described by Einthoven, known as 'FATHER OF ECG'. It is a non invasive method. recording of electrical impulses generated in the heart. Important Investigated tool, cardiac activity. #PURVISHAH
The ECG represents the electrical activity of the heart. It can provide insight into cardiac pathophysiology by analyzing the distinctive waveforms of each cardiac event. The ECG can identify arrhythmias, ischemia, infarction, pericarditis, chamber hypertrophy, and electrolyte disturbances. The standard 12-lead ECG consists of 3 limb leads, 3 augmented limb leads, and 6 precordial leads, which provide different views of the heart. Analysis of the P wave, PR interval, QRS complex, ST segment, T wave, and QT interval can reveal normal sinus rhythm or abnormalities that require further investigation.
This document provides an overview of how to interpret common ECG abnormalities through 3 sentences or less summaries:
1) It outlines how to measure rate, rhythm, intervals, complexes, and waves on an ECG and identifies what is considered normal.
2) Key abnormal rhythms, rates, intervals, and waves are defined along with their potential causes, such as sinus bradycardia, atrial fibrillation, various heart blocks, ventricular tachycardia, ST segment changes, T wave inversions, bundle branch blocks, and more.
3) Methods for localizing myocardial infarctions and abnormalities seen in conditions like hyperkalemia and hypothermia are also summarized.
The ECG represents the electrical activity of the heart during the cardiac cycle. Each waveform provides insight into cardiac physiology and pathology. The ECG can be used to identify arrhythmias, ischemia, infarction, conduction abnormalities, chamber enlargement, and electrolyte disturbances. It consists of 12 leads that view the heart from different angles. The waveform intervals like P wave, PR interval, QRS complex, and ST segment must be carefully analyzed to interpret the ECG tracing.
The document discusses electrocardiography (ECG) and summarizes key information about ECG interpretation. It outlines the cardiac conduction system, the 12-lead ECG system, rules for a normal ECG tracing, and methods for determining heart rate. Ten specific rules for a normal ECG are described, including normal widths for the PR interval and QRS complex. The document also summarizes various cardiac rhythms that can be identified on ECG such as sinus bradycardia, sinus tachycardia, atrial fibrillation, ventricular tachycardia, and ventricular fibrillation.
- An ECG records the electrical activity of the heart over time using electrodes placed on the skin. It detects tiny electrical changes arising from the heart muscle contracting during each heartbeat.
- The cardiac impulse originates in the sinoatrial node and travels through the atria and ventricles via specialized conduction pathways before the ventricles contract.
- A standard 12-lead ECG provides multiple views of the heart to analyze the rate and rhythm of the heart as well as measure key intervals like the PR interval, QRS duration, and QT interval to identify any abnormalities.
This document provides an overview of basics of electrocardiography (ECG or EKG). It discusses the history of ECG development from 1842 to modern use. Key aspects of ECG are described, including the cardiac cycle waveform known as PQRST, conduction system, normal values, and interpretation of abnormalities. Common uses of ECG include identifying arrhythmias, ischemia, infarction and other cardiac conditions. Proper placement of ECG leads and use of rules to evaluate a normal tracing are also outlined.
This document contains 17 questions about ECG interpretations with corresponding answers. Each question provides an ECG reading and clinical scenario, and the answers analyze the ECG findings and provide a diagnosis. Some of the conditions addressed include atrial fibrillation, atrial flutter, ventricular tachycardia, STEMI, non-STEMI, Brugada syndrome, WPW syndrome, hyperkalemia, pulmonary embolism, pericarditis, hypothermia, and more. The document serves as a teaching aid with examples of ECG interpretations for various cardiac conditions and presentations.
This document provides an overview of ECG samples and diagnosis for medical students. It discusses the basics of ECG interpretation, normal sinus rhythm, intervals, waveforms, abnormalities, myocardial infarction, bundle branch blocks, ventricular hypertrophy, atrial fibrillation, and more. Examples of various abnormal ECG patterns are presented along with explanations. Sources include textbooks and online resources for ECG learning. The document is intended for educational presentation purposes.
The document provides an introduction to an ECG presentation aimed at teaching ECG interpretation fundamentals to doctors. It outlines the objectives of sensitizing doctors to ECG learning, explaining clinical concepts, illustrating patterns with diagrams and real ECG charts, and highlighting differential diagnoses. Resources consulted for the presentation are listed. Basic ECG terminology and components are defined, including complexes, intervals and graph paper measurements. Examples of normal ECGs and some abnormal rhythms are shown.
The document describes several types of normal and abnormal cardiac rhythms as identified by an electrocardiogram (EKG or ECG). It provides descriptions and EKG criteria for normal sinus rhythm, sinus bradycardia, sinus tachycardia, premature atrial complexes, atrial fibrillation, atrial flutter, supraventricular tachycardia, premature junctional complexes, junctional rhythm, various degrees of atrioventricular block, premature ventricular contractions, ventricular bigeminy, and ventricular tachycardia.
Cardiac arrhythmias are abnormalities in the heart's rhythm. There are two main types: bradycardia, a slow heart rate, and tachycardia, a fast heart rate. Various arrhythmias are described including sinus bradycardia, heart block, atrial fibrillation, atrial flutter, AV nodal reentry tachycardia, ventricular fibrillation, and ventricular tachycardia. Treatment depends on the type of arrhythmia and may include medication, cardioversion, ablation, or pacemaker implantation. Diagnosis involves ECG, echocardiogram, blood tests, and other cardiac tests. Lifestyle changes and avoiding arrhythmia triggers can help management.
The document provides information on understanding rhythm strips and ECG patterns, including:
- It defines the common waveforms that make up the ECG pattern (P, QRS, T, U waves) and segments between waves.
- Normal values are provided for waveform durations and amplitudes, as well as heart rate.
- Abnormal characteristics of the ECG pattern are described, such as abnormal P waves, PR interval, ST segment, T waves, and QT interval.
- A 5-step process is outlined for analyzing rhythm strips, including evaluating P waves and QRS complexes, calculating heart rates, assessing rhythm regularity, and measuring PR intervals.
This document provides an overview of an ECG rhythm interpretation course. The objectives are to recognize normal sinus rhythm, the 13 most common rhythm disturbances, and acute myocardial infarction on ECG. The learning modules cover ECG basics, analyzing rhythms, normal sinus rhythm, arrhythmias, and 12-lead interpretation. Common rhythms like sinus bradycardia, sinus tachycardia, premature atrial contractions, premature ventricular contractions, atrial fibrillation, atrial flutter, paroxysmal supraventricular tachycardia, ventricular tachycardia, and ventricular fibrillation are defined.
This document provides an overview of cardiac physiology concepts including preload, afterload, contractility and the phases of the cardiac cycle. It then links these concepts to ECG patterns and discusses how electrolyte imbalances can affect the ECG. Specific conditions like atrial fibrillation, myocardial infarction and ventricular tachycardia are examined. A case study example is presented of a patient experiencing a potential inferior wall MI. Key aspects of the ECG like the ST segment and T wave are discussed in relation to evaluating for cell injury during a heart attack. Finally, a short quiz is provided to test recognition of ECG components.
This document provides an overview of electrocardiography (ECG) and how to interpret ECG strips in the context of toxicology. It begins by defining the objectives of learning ECG and its importance in toxicology. It then describes the basic components of an ECG including the waves, intervals, complexes, leads, and normal values. The document explains how to assess heart rate and rhythm on an ECG strip. Finally, it demonstrates some common ECG changes that can occur due to toxic exposures, such as sinus tachycardia, sinus bradycardia, and heart block.
This document provides an overview of an ECG workshop that aims to teach the anatomy and physiology of the heart, understanding ECGs, ischaemia and myocardial infarction, caring for cardiac patients, and case studies. It covers topics like the anatomy of the heart chambers and coronary arteries, electrical conduction system, understanding ECG lead placement and components of the PQRST complex, identifying abnormalities like ischemia, infarction locations and evolutions, and care of the cardiac patient.
This document provides an outline for a presentation on electrocardiography (ECG) and includes sections on the history of ECG, terminology, types of waveforms, the cardiac conduction system, cardiac action potential, ECG leads and placement, analyzing ECGs, nursing management of arrhythmias and heart blocks, and emergency drugs. It begins with an introduction to ECG and defines it as the recording of the electrical activity of the heart. Key points covered include the names and functions of different parts of the cardiac conduction system, how to analyze an ECG for rate, rhythm and blood flow information, nursing assessments and interventions for various arrhythmias, and information about common emergency drugs used to treat cardiac issues.
The document provides information on electrocardiography (ECG) including:
1. It describes the normal conduction system of the heart and how it relates to the ECG waves and intervals.
2. It explains the basics of reading an ECG such as determining the heart rate, analyzing waves, segments, and intervals, and identifying abnormalities.
3. It discusses ECG findings associated with various cardiac conditions like myocardial infarction, left ventricular hypertrophy, bundle branch blocks, and cardiac arrhythmias.
This document provides an overview of ECG interpretation including:
- The anatomy of the heart's conduction system and how ECG leads are attached
- How to read an ECG strip and calculate heart rate
- Normal P, QRS, and T waves along with intervals like PR and QT
- Abnormalities that can indicate conditions like blocks, arrhythmias, and hypertrophy
- Electrolyte imbalances that can affect the ECG tracing
It concludes with examples of ECG strips and questions to test the reader's understanding.
This document provides an overview of EKG waveforms and arrhythmias. It discusses the electrical activity and associated muscle movements in the atria and ventricles that produce the different waves of the EKG. Common arrhythmias like AV block, atrial flutter, and atrial fibrillation are described. The characteristics of normal sinus rhythm as well as abnormal rhythms including premature ventricular contractions, ventricular tachycardia, and ventricular fibrillation are summarized. The document provides a guide for interpreting EKG readings to identify arrhythmias and dysrhythmias.
ECG: In 1895 first described by Einthoven, known as 'FATHER OF ECG'. It is a non invasive method. recording of electrical impulses generated in the heart. Important Investigated tool, cardiac activity. #PURVISHAH
The ECG represents the electrical activity of the heart. It can provide insight into cardiac pathophysiology by analyzing the distinctive waveforms of each cardiac event. The ECG can identify arrhythmias, ischemia, infarction, pericarditis, chamber hypertrophy, and electrolyte disturbances. The standard 12-lead ECG consists of 3 limb leads, 3 augmented limb leads, and 6 precordial leads, which provide different views of the heart. Analysis of the P wave, PR interval, QRS complex, ST segment, T wave, and QT interval can reveal normal sinus rhythm or abnormalities that require further investigation.
This document provides an overview of how to interpret common ECG abnormalities through 3 sentences or less summaries:
1) It outlines how to measure rate, rhythm, intervals, complexes, and waves on an ECG and identifies what is considered normal.
2) Key abnormal rhythms, rates, intervals, and waves are defined along with their potential causes, such as sinus bradycardia, atrial fibrillation, various heart blocks, ventricular tachycardia, ST segment changes, T wave inversions, bundle branch blocks, and more.
3) Methods for localizing myocardial infarctions and abnormalities seen in conditions like hyperkalemia and hypothermia are also summarized.
The ECG represents the electrical activity of the heart during the cardiac cycle. Each waveform provides insight into cardiac physiology and pathology. The ECG can be used to identify arrhythmias, ischemia, infarction, conduction abnormalities, chamber enlargement, and electrolyte disturbances. It consists of 12 leads that view the heart from different angles. The waveform intervals like P wave, PR interval, QRS complex, and ST segment must be carefully analyzed to interpret the ECG tracing.
The document discusses electrocardiography (ECG) and summarizes key information about ECG interpretation. It outlines the cardiac conduction system, the 12-lead ECG system, rules for a normal ECG tracing, and methods for determining heart rate. Ten specific rules for a normal ECG are described, including normal widths for the PR interval and QRS complex. The document also summarizes various cardiac rhythms that can be identified on ECG such as sinus bradycardia, sinus tachycardia, atrial fibrillation, ventricular tachycardia, and ventricular fibrillation.
- An ECG records the electrical activity of the heart over time using electrodes placed on the skin. It detects tiny electrical changes arising from the heart muscle contracting during each heartbeat.
- The cardiac impulse originates in the sinoatrial node and travels through the atria and ventricles via specialized conduction pathways before the ventricles contract.
- A standard 12-lead ECG provides multiple views of the heart to analyze the rate and rhythm of the heart as well as measure key intervals like the PR interval, QRS duration, and QT interval to identify any abnormalities.
This document provides an overview of basics of electrocardiography (ECG or EKG). It discusses the history of ECG development from 1842 to modern use. Key aspects of ECG are described, including the cardiac cycle waveform known as PQRST, conduction system, normal values, and interpretation of abnormalities. Common uses of ECG include identifying arrhythmias, ischemia, infarction and other cardiac conditions. Proper placement of ECG leads and use of rules to evaluate a normal tracing are also outlined.
This document contains 17 questions about ECG interpretations with corresponding answers. Each question provides an ECG reading and clinical scenario, and the answers analyze the ECG findings and provide a diagnosis. Some of the conditions addressed include atrial fibrillation, atrial flutter, ventricular tachycardia, STEMI, non-STEMI, Brugada syndrome, WPW syndrome, hyperkalemia, pulmonary embolism, pericarditis, hypothermia, and more. The document serves as a teaching aid with examples of ECG interpretations for various cardiac conditions and presentations.
This document provides an overview of ECG samples and diagnosis for medical students. It discusses the basics of ECG interpretation, normal sinus rhythm, intervals, waveforms, abnormalities, myocardial infarction, bundle branch blocks, ventricular hypertrophy, atrial fibrillation, and more. Examples of various abnormal ECG patterns are presented along with explanations. Sources include textbooks and online resources for ECG learning. The document is intended for educational presentation purposes.
The document provides an introduction to an ECG presentation aimed at teaching ECG interpretation fundamentals to doctors. It outlines the objectives of sensitizing doctors to ECG learning, explaining clinical concepts, illustrating patterns with diagrams and real ECG charts, and highlighting differential diagnoses. Resources consulted for the presentation are listed. Basic ECG terminology and components are defined, including complexes, intervals and graph paper measurements. Examples of normal ECGs and some abnormal rhythms are shown.
The document describes several types of normal and abnormal cardiac rhythms as identified by an electrocardiogram (EKG or ECG). It provides descriptions and EKG criteria for normal sinus rhythm, sinus bradycardia, sinus tachycardia, premature atrial complexes, atrial fibrillation, atrial flutter, supraventricular tachycardia, premature junctional complexes, junctional rhythm, various degrees of atrioventricular block, premature ventricular contractions, ventricular bigeminy, and ventricular tachycardia.
Cardiac arrhythmias are abnormalities in the heart's rhythm. There are two main types: bradycardia, a slow heart rate, and tachycardia, a fast heart rate. Various arrhythmias are described including sinus bradycardia, heart block, atrial fibrillation, atrial flutter, AV nodal reentry tachycardia, ventricular fibrillation, and ventricular tachycardia. Treatment depends on the type of arrhythmia and may include medication, cardioversion, ablation, or pacemaker implantation. Diagnosis involves ECG, echocardiogram, blood tests, and other cardiac tests. Lifestyle changes and avoiding arrhythmia triggers can help management.
This document discusses bradyarrhythmias, which are heart rhythms that are slower than normal. It defines key measurements in electrocardiograms including the P wave, PR interval, QRS complex, and QT interval. Common types of bradyarrhythmias include sinus bradycardia, junctional rhythm, and atrioventricular blocks. Treatment depends on whether the patient is stable or unstable and may involve medications to increase heart rate like atropine or transcutaneous pacing. The document provides details on evaluating and treating different types of bradycardic rhythms and their underlying causes.
This document discusses dysrhythmias, which are disorders of the heart's electrical conduction or rhythm. Dysrhythmias can be diagnosed by electrocardiogram and may cause changes in blood pressure or pumping of the heart. Common types of dysrhythmias discussed include normal sinus rhythm, sinus bradycardia, sinus tachycardia, premature atrial complexes, atrial flutter, and atrial fibrillation. Nursing management focuses on treating the underlying cause, controlling heart rate, and preventing complications like stroke.
This document provides an overview of tachyarrhythmias. It begins by defining arrhythmia and tachycardia. It then discusses the etiology, pathogenesis and mechanisms of tachycardia. It describes the different types of tachyarrhythmias including supraventricular tachycardia involving the atria, AV node, and ventricular tachycardia. For each type, it provides details on definition, signs and symptoms, ECG findings, etiology, and treatment approaches. It specifically addresses atrial flutter, atrial fibrillation, AV nodal reentrant tachycardia, Wolff-Parkinson-White syndrome, premature ventricular contractions, ventricular tachycardia, and ventricular fib
This document provides an overview of supraventricular tachycardia (SVT), including its definition, classification, and management. It discusses 10 specific types of SVT in detail: sinus tachycardia, inappropriate sinus tachycardia, sinus node re-entrant tachycardia, postural orthostatic tachycardia syndrome, focal atrial tachycardia, multifocal atrial tachycardia, macro-re-entrant atrial tachycardias, atrioventricular nodal re-entrant tachycardia, atrioventricular re-entrant tachycardia, and non-re-entrant junctional tachycardias. For
This document provides definitions and descriptions of various cardiac arrhythmias in 3-5 bullet points each, covering topics such as rate, P wave characteristics, QRS width, conduction patterns, rhythm, common causes, and potential treatment approaches. A total of 16 different arrhythmias are defined, including sinus tachycardia, sinus bradycardia, premature atrial contractions, atrial fibrillation, various types of heart block, bundle branch block, ventricular premature complexes, ventricular tachycardia, ventricular fibrillation, idioventricular rhythm, and asystole. The document serves as an educational guide for technicians on how to recognize and classify different arrhythmia patterns.
The electrocardiogram (ECG) records the electrical activity of the heart during each cardiac cycle. It detects the P wave, QRS complex, and T wave which represent atrial depolarization, ventricular depolarization, and ventricular repolarization, respectively. The ECG is used to analyze the heart rate, rhythm, and intervals between waves to diagnose cardiac conditions. Common arrhythmias include premature beats, supraventricular tachycardias like atrial flutter, and atrial fibrillation which is characterized by disorganized atrial activity and an irregular ventricular response.
This document discusses syncope, which is a transient loss of consciousness due to temporary reduced blood flow to the brain. It notes that syncope accounts for around 1% of emergency department visits and is a common cause of hospitalization for those over 65. Establishing the exact cause is difficult as the patient has usually recovered by the time they are examined. The document then discusses various causes of syncope and nonsyncopal attacks that can be mistaken for syncope. It provides breakdowns of common causes by age group and discusses the natural history and risk stratification of syncope of unknown cause in the emergency department.
Brady and tachyarrythmias diagnosis and managementAlphonse Aswin
This document provides information on interpreting electrocardiograms (ECGs) and diagnosing and treating bradyarrhythmias and tachyarrhythmias. It discusses the conduction pathway, interpreting ECG waveforms, common arrhythmias originating from the sinoatrial node, atria, atrioventricular node and ventricles. Diagnostic criteria and treatment options are provided for sinus bradycardia, sick sinus syndrome, junctional rhythms, ventricular escape rhythms, first-, second- and third-degree heart block, sinus tachycardia, atrial flutter, atrial fibrillation, multifocal atrial tachycardia, ventricular tachycardia, and ventricular fibrillation. The
The document provides an overview of how to read electrocardiograms (ECGs). It begins by explaining the normal cardiac conduction system and the electrical signals seen on an ECG, including the P wave, QRS complex, and T wave. It then discusses various cardiac rhythms and conduction abnormalities such as sinus rhythm, different types of atrioventricular block, and bundle branch block. The document also covers ECG interpretation criteria like rate, rhythm, intervals, and changes indicating ischemia. Overall, the document serves as a basic guide for understanding the fundamentals of electrocardiography.
The document discusses electrocardiography (ECG), providing details on the standard 12-lead ECG procedure, what each lead measures, and ECG paper formatting. Common cardiac arrhythmias and conduction abnormalities that can be detected from the ECG are summarized, including sinus bradycardia, atrial flutter, atrial fibrillation, ventricular tachycardia, and Wolff-Parkinson-White syndrome. Characteristics of right and left bundle branch block are also outlined.
Arrhythmias refer to abnormalities in the cardiac rhythm. There are two main types: bradycardia where the heart rate is slow, and tachycardia where the heart rate is fast. Specific arrhythmias include sinus bradycardia, various types of heart block, atrial fibrillation, atrial flutter, AV nodal re-entry tachycardia, ventricular tachycardia, and ventricular fibrillation. Diagnosis involves electrocardiography and other tests. Treatment depends on the type of arrhythmia but may include medications, catheter ablation, pacemaker implantation, or cardioversion. Lifestyle modifications and avoiding arrhythmia triggers can also help management.
Perioperative arrhythmias are common and can be caused by patient factors, anesthesia, or surgery. The document defines and classifies different types of arrhythmias including sinus, atrial, junctional, and ventricular rhythms. It describes the characteristic electrocardiogram patterns of normal sinus rhythm as well as abnormal rhythms like sinus bradycardia, premature atrial contractions, atrial fibrillation, and premature ventricular contractions. Perioperative management strategies are discussed for select arrhythmias depending on their stability and symptoms. Continuous ECG monitoring is important for arrhythmia detection during the perioperative period.
This document provides an overview of ECG rhythm interpretation. It discusses normal sinus rhythm and various arrhythmias including bradycardias related to problems with the sinus node or heart blocks. Tachycardias covered include sinus tachycardia, atrial fibrillation, atrial flutter, and supraventricular tachycardia. Premature ventricular contractions and ventricular tachycardia/fibrillation are also reviewed. For each rhythm abnormality, the document describes etiology, characteristics, signs/symptoms and treatment approaches.
The document discusses various types of arrhythmias that may occur during anesthesia including narrow and broad complex arrhythmias. It defines arrhythmia and outlines the conduction pathways in the heart. For narrow complex arrhythmias it describes sinus arrhythmias, premature atrial contractions, sinus bradycardia, sinus tachycardia, junctional tachycardia, atrial flutter and fibrillation. For broad complex arrhythmias it covers ventricular ectopy, ventricular tachycardia and fibrillation. Management strategies are provided for selected arrhythmias.
The document provides an overview of cardiac conduction systems and ECG interpretation. It describes the normal intrinsic conduction rates of the sinoatrial node, atrioventricular node, and bundle of His. It then details the components of the ECG like the P wave, PR interval, QRS complex, ST segment, and T wave. Various arrhythmias are explained like sinus bradycardia, premature atrial contractions, atrial flutter, atrial fibrillation, and different types of heart block. Methods for calculating heart rate from the ECG are also summarized.
Lec 9 narrow complex wide complex tachycardia for mohsEhealthMoHS
This document provides an overview of narrow complex tachycardias and wide complex tachycardias. It describes different types of supraventricular tachycardias including AV nodal reentry tachycardia, AV reentry tachycardia, and Wolff-Parkinson-White syndrome. It also discusses the presentation of supraventricular tachycardias and their acute management with vagal maneuvers, adenosine, or verapamil. The document then covers broad complex tachycardias, differentiating ventricular tachycardia from supraventricular tachycardia. It also reviews ventricular fibrillation, flutter, torsades de pointes, long QT syndrome, and their treatment.
This document provides information on cardiac conduction systems, normal ECG rhythms, cardiac arrhythmias, and arrhythmia management. It defines normal sinus rhythm on ECG and describes the two main types of arrhythmias as bradycardia and tachycardia. Nine common arrhythmias are defined including atrial flutter, atrial fibrillation, junctional rhythm, and various ventricular arrhythmias. Treatment options for arrhythmias include electrical cardioversion, antiarrhythmic medications, and pacemakers.
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2. An ECG is a simple, noninvasive procedure; used to record the electrical
activity of the heart. Abbreviated as ECG and EKG. Electrodes are placed
on the skin of the chest and that, measures electrical activity all over the
heart.
3. Electrocardiogram records the electrical signals in your heart. It's a
common test used to detect heart problems and monitor the heart's
status in many situations.
also called ECG or EKGs
ECG is a noninvasive, painless test with quick results. During an
ECG, sensors (electrodes) that can detect the electrical activity of
heart are attached to chest and sometimes on limbs.
4. P wave
P wave should be always before QRS complex, separated by PQ
interval. P wave is a sign of normal atrial depolarization.
Parameters:
duration: 110 ms; >/ 0.11 sec
amplitude: 0.25 mV;
positivity:
positive − always in leads I and II;
negative − always in aVR lead.
5. •The QRS complex indicates ventricular depolarization. The
QRS interval is measured from the end of the PR interval to the
end of the S.
• Duration less than or equal to 0.12 seconds, amplitude greater
than 0.5 mV in at least one standard lead, and greater than 1.0
mV in at least one precordial lead.
•Upper limit of normal amplitude is 2.5 - 3.0 mV.
small septal Q waves in I, aVL, V5 and V6 (duration less than or
equal to 0.04 seconds; amplitude less than 1/3 of the amplitude
of the R wave in the same lead).
6. ST Segment
ST segment is iso electric line, period of no electrical activity of the heart.
Should be in the same level as PQ interval. Every elevation or depression of
this line is pathological.
Physiological duration is 320 ms.
T Wave
T wave represents repolarization of ventricles.]
Normally rounded and asymmetrical,
should be upright in leads V2 - V6, inverted in aVR
amplitude of at least 0.2 mV in leads V3 and V4 and at least 0.1 mV in leads V5
and V6
Physiological duration 160 ms.
U Wave
The U wave is ordinarily small and follows T wave and usually has the same
polarity as T wave.[1]
8. PQ Interval
PQ interval is a period of atrial contraction. The depolarization is
delayed in AV node.
Parameters: duration: 120−200 ms
PR interval:The PR Interval indicates atrioventricular conduction time.
The interval is measured from where the P wave begins until the
beginning of the QRS complex.
0.12 and 0.20 seconds. The P-R interval should be between 120-200
ms (3-5 small squares)
9. Durations normally less than or equal to 0.40 seconds for males and 0.44
seconds for females.
The QT interval indicates ventricular activity, both depolarization and
repolarization. Measure the QT interval from the beginning of the QRS
complex to the end of the T wave.
10.
11.
12.
13.
14.
15.
16. Einthoven’s Law explains that Lead II’s complex
is equal to the sum of the corresponding
complexes in Leads I and III and is given as II =
I + III
17.
18. Heart rate
Count the number of large squares present within one R-R interval
Divide 300 by this number to calculate the heart rate
21. Second degree AV block, type1
Second degree AV block , type 2
Third degree AV block
Premature ventricular contraction
Ventricular tachycardia
Ventricular fibrillation
Asystole
Pulseless electrical activity
22.
23. In sinus bradycardia the condition pathway is the same as that in sinus
rhythm but the SA node fires at a rate less than 60b/min .
Symptomatic bradycardia refers to an HR that is less than 60 b/min and is
inadequate for the patient’s condition , causing the patient to experience
symptoms (eg chest pain, syncope)
24. Sinus bradycardia may be a normal sinus rhythm in aerobically trained
athletes and in some people during sleep.
It also occurs in response to carotid massage, Valsalva maneuver,
hypothermia , increased intraocular pressure, vagal stimulation , and
administration of certain drugs .
Hypothyroidism , increased intracranial pressure, hypoglycemia and
inferior myocardial infarction.
25. In sinus bradycardia, HR is less than 60 beats/min and the rhythm is
regular.
The p wave precedes each QRS complex and has a normal shape and
duration.
The PR interval is normal, and the QRS complex has a normal shape and
duration .
CLINICAL SIGNIFICANCE:
Signs of symptomatic bradycardia include
pale,
cool skin,
26. hypotension ,
weakness,
angina,
dizziness or syncope,
confusion,
disorientation and
shortness of breath
27. Atropine (An anticholinergic drug)
Transcutaneous pacing
Dopamine or epinephrine infusion
Permanent pacemaker therapy may be needed.
28.
29. The condition pathway is the same in sinus tachycardia as that in normal
sinus rhythm .
The discharge rate from the sinus node increases because of vagal
inhibition or sympathetic stimulation.
The sinus rate is 101 to 200 b/min .
CLINICAL ASSOCIATION :
Physiologic and psychologic stressors such as
Exercise
fever
31. Anxiety
Fear
It also be effect of drugs such as
Epinephrine
Norepinephrine
Atropine
Caffeine
Theophylline or
Hydralazine
In addition , many over-the – counter cold remedies have active
ingredients ( pseudoephedrine) that cause tachycardia.
32. In sinus tachycardia HR is 101 to 200 b/min and the rhythm is regular.
The p wave is normal , precedes each QRS complex , and has a normal
shape and duration .
The PR interval is normal, and the QRS complex has a normal shape and
duration.
CLINICAL SIGNIFICANCE:
Dizziness
DYSPNEA
Hypotension because of decreased CO.
33. Increased myocardial oxygen consumption is associated with an
increased HR.
Angina or an increase in infarction size may accompany sinus
tachycardia in patient with CAD or acute MI.
TREATMENT:
Vagal maneuver
IV beta adrenergic blockers(metoprolol)
Adenosine
Calcium channel blockers( diltiazem)
Synchronized cardioversion
34.
35. PAC is a contraction starting from an ectopic focus in the atrium (eg
location other than SA node ) and coming sooner than the next expected
sinus beat.
The ectopic signal starts in the left or right atrium and travels across the
atria by an abnormal pathway.
This creates a distorted P wave .
At the AV node it , it may be stopped ( nonconducted PAC) , delayed
(lengthened PR interval ) or conducted normally.
If the signal moves through the AV node , In most cases it is conducted
normally through the ventricles.
36. EMOTIONAL STRESS or physical fatigue or from the use of caffeine,
tobacco , or alcohol
Hypoxia
Electrolyte imbalance
Hyperthyroidism
COPD
CAD and
Valvular disease
37. RHYTHM is irregular
The P wave has a different shape from that of a P wave originating in the
SA node, or it may be hidden in the preceding T wave.
The PR interval may be shorter or longer than the PR interval coming
from the SA node , but it is within normal limits.
The QRS complex is usually normal
If the QRS interval is 0.12 second or more , abnormal conduction through
the ventricles occurs.
38. Patient may report palpitations or a sense that their hearts “skipped a beat
.”
In person with heart disease , frequent PACs may indicate enhanced
automaticity of the atria or a re-entry mechanism.
Such PACs may warn of or start more serious dysrhythmias ( eg,
supraventricular tachycardia)
TREATMENT :
Withdrawal of sources of stimulation such as caffeine or
sympathomimetic drugs may be needed.
Beta adrenergic blockers may be used to decrease PACs.
39.
40. PSVT is a dysrhythmia starting in an ectopic focus anywhere above the
bifurcation of the bundle of His .
Identification of the ectopic focus is often difficult even with a 12-lead ECG
,
PSVT occurs because of a re-entrant phenomenon (reexcitation of the
atria when there is a one-way block).
Usually a PAC triggers a run of repeated premature beats.
Paroxysmal refers to an abrupt onset and ending .
Termination is sometimes followed by a brief period of asystole(absence
of all cardiac electrical activity).
41. some degree of AV block may be present.
PSVT can occur in the presence of Wolff-Parkinson –white syndrome,
or “preexcitation”.
In this syndrome , there is extra conduction or accessory pathways.
CLINICAL ASSOCIATION:
Overexertion
Emotional stress
Deep inspiration
Stimulants such as caffeine and tobacco
PSVT is also associated with rheumatic heart disease
Digitalis toxicity
CAD and corpulmonale
42. In PSVT the HR is 150 to 220 b/min , and the rhythm is regular or
slightly irregular.
The P wave is often hidden in the preceding T wave
If seen, it may have an abnormal shape.
The PR interval may be shortened or normal, and the QRS complex is
usually normal.
CLINICAL SIGNIFICANCE:
A prolonged episode and HR greater than 180 b/min will cause
decreased CO because of Reduced stroke volume
Symptoms often include hypotension
Palpitations
Dyspnea
Angina
43. PSVT includes vagal stimulation and drug therapy.
Common vagal maneuvers include Valsalva , carotid massage and
coughing.
IV adenosine is the drug of choice to convert PSVT to a normal sinus
rhythm .
This drug has a short half-life (10 second) and is well tolerated .
IV beta adrenergic blockers , calcium channel blockers ,and amiodarone
can also be used.
If vagal stimulation and drug therapy are ineffective and the patient
becomes hemodynamically unstable , synchronized cardioversion is used.
44. Injection site should be as close to the heart as possible (eg antecubital
area)
Give IV dose rapidly (over 1-2 sec) and follow with a rapid 20ml normal
saline flush .
Monitor patient ECG continuously .
Brief period of asystole is common.
Observe patient for flushing ,dizziness , chest pain, or palpitations.
45.
46. AF is an atrial tachydysrhythmia identified by recurring, regular,
sawtooth –shaped flutter waves that originate from a single ectopic
focus in the right atrium or less commonly , the left atrium.
CLINICAL ASSOCIATIONS :
Associated with CAD
Hypertension
Mitral valve disorders
Pulmonary embolus
Chronic lung disease
Cor pulmonale
cardiomyopathy
47. Hyperthyroidism
The use of drug such as digoxin
Quinidine
Epinephrine
ECG CHARACTERISTICS :
Atrial rate is 200 to 350 b/min .
The ventricular rate varies based on the conduction ratio .
In 2:1 conduction , the ventricular rate is typically found to be
approximately 150 b/min.
48. Atrial rhythm is regular , and ventricular rhythm is usually regular.
The atrial flutter waves represent atrial depolarization followed by
repolarization.
The PR interval is variable and not measurable .
The QRS complex is usually normal.
Because the AV NODE can delay signals from the atria , there is usually
some AV block in a fixed ratio of flutter waves to QRS complex
49. The high ventricular rates (greater than 100 b/min) and loss of the atrial
“kick”(atrial contraction reflected by a sinus P wave) that are associated
with atrial flutter decrease CO.
This can cause serious consequences such as HF, especially in the patient
with underlying heart disease .
Patients with atrial flutter have an increased risk of stroke because of the
risk of thrombus formation in the atria from the stasis of blood.
Warfarin is given to prevent stroke in patients who have atrial flutter.
50. The primary goal in treatment of AF is to slow the ventricular response by
increasing AV block.
Drugs used to control ventricular rate include calcium channel blockers
and beta adrenergic blockers .
Electrical cardio version can be performed when the patient is clinically
unstable.
Antidysrhythmia drugs are used to convert AF to sinus rhythm( eg
amiodarone, flecainide , dronedarone) .
Radiofrequency catheter ablation is the treatment of choice for AF.
51.
52. AF is characterized by a total disorganization of atrial electrical activity
because of multiple ectopic foci, resulting in loss of effective atrial
contraction.
The dysrhythmia may be paroxysmal ( eg beginning and ending
spontaneously ) or persistent ( lasting more than 7 days ).
CLINICAL ASSOCIATION :
AF usually occurs in underlying heart disease such as CAD , valvular
heart disease , HF , cardiomyopathy , hypertensive heart disease , and
pericarditis.
It often develop acutely with thyrotoxicosis , alcohol intoxication ,
caffeine , electrolyte imbalance , stress and cardiac surgery
53. During AF , the atrial rate may be as high as 350 to 600 b/min .
P wave are replaced by chaotic , fibrillatory waves.
Ventricular rate varies , and the rhythm is usually irregular .
When the ventricular rate is between 60 and 100 b/min , it is AF with a
controlled ventricular response.
The PR interval is not measurable and the QRS complex usually has a
normal shape and duration .
54. A result in a decrease in CO because of ineffective atrial contraction or
rapid ventricular response.
Thrombi (clots ) form in the atria because of blood stasis.
An embolized clot may develop and move to the brain , causing a stroke.
TREATMENT :
The goal of treatment include a decrease in ventricular response ( to less
than 100 b/min) , prevention of stroke , conversion of sinus rhythm.
Drugs are used to control include calcium channel blockers , beta
adrenergic blockers ( eg metoprolol, digoxin)
55. For some patients, pharmacologic or electrical conversion of AF to a
normal sinus rhythm may be considered (eg reduced exercise tolerance
with rate control drugs, contraindication to warfarin).
The most common antidysrhythmia drugs used for conversion to and
maintenance of sinus rhythm include amiodarone and ibutilide.
If a patient is in atrial fibrillation for longer than 48 hours,
anticoagulation therapy with warfarin is needed for 3 to 4 weeks before
the cardioversion and for several weeks after successful cardioversion.
Anticoagulation therapy is necessary because the procedure can cause
the clots to dislodge, placing the patient at risk for stroke.
A transesophageal ECG may be performed to rule out clots in the atria.
If no clots are present , anticoagulation therapy may not be required
before the cardioversion procedure.
56. If drug or cardioversion does not convert AF to normal sinus rhythm ,
long term anticoagulation therapy is required.
Warfarin is the drug of choice , and patients are monitored for
therapeutic levels (eg INR).
Recently , alternatives to warfarin have been approved for
anticoagulation therapy in patients with nonvalvular atrial fibrillation.
These drugs do not require routine laboratory testing and include
dabigatran , apixaban, rivaroxaban.
The maze procedure is a surgical intervention that stops atrial
fibrillation by interrupting the ectopic electrical signals that are
responsible for the dysrhythmia.
Incisions are made in both atria, and cryoablation (cold therapy) is
used to stop the formation and conduction of these signals and restore
normal sinus rhythm.
57.
58. Junctional dysrhythmias refer to dysrhythmias that start in the area of the
AV node.
They result because the SA node fails to fire or the signal is blocked.
When this occurs , the AV node becomes the pacemaker of the heart .
The impulse from the AV node usually move in a retrograde (backward )
fashion.
This procedure an abnormal P wave that occurs just before or after the
QRS complex or that is hidden in the QRS complex.
The impulse usually moves normally through the ventricles.
59. Junctional premature beats may occur , and they are treated in a manner
similar to that for PACs .
Other junctional dysrhythmias include junctional escape rhythm
accelerated junctional rhythm , and junctional tachycardia.
CLINICAL ASSOCIATIONS :
Junctional dysrhythmias are often associated with CAD , HF ,
cardiomyopathy, electrolyte imbalance ,inferior MI , and rheumatic heart
disease.
Certain drugs ( eg digoxin, nicotine, amphetamines, caffeine) can also
cause junctional drsrhythmias.
60. In junctional escape rhythm the HR is 40 to 60 beats/min
It is 61 to 100 b/min in accelerated junctional rhythm and 101 to 180 b/min
in junctional tachycardia.
Rhythm is regular.
The p wave is abnormal in shape and inverted, or it may be hidden in the
QRS complex .
The PR interval is less than 0.12 sec when the p wave precedes the QRS
complex .
The QRS complex is usually normal.
61. Junctional escape rhythm serve as a safety mechanism when the SA node
has not been effective.
Escape rhythm such as this should not be suppressed.
Accelerated junctional rhythm is due to sympathetic stimulation to
improve CO.
Junctional tachycardia indicates a more serious problem.
This rhythm may reduce CO , causing the patient to become
hemodynamically unstable (eg hypotensive).
62. If a patient has symptoms with a junctional escape rhythm , atropine can
be used.
In accelerated junctional rhythm and junctional tachycardia caused by
drug toxicity, the drug is stopped .
In the absence of digitalis toxicity, beta adrenergic blockers , calcium
channel blockers ,and amiodarone are used for rate control.
Cardioversion should not be used .
63.
64. First degree AV block is a type of AV block in which every impulse is
conducted to the ventricles but the time of AV conduction is prolonged.
After the impulse moves through the AV node , the ventricles usually
respond normally.
CLINICAL ASSOCIATIONS :
First –degree AV block is associated with MI, CAD, rheumatic fever,
hyperthyroidism , electrolyte imbalance(eg hypokalemia), vagal
stimulation and drug such as digoxin, ,beta adrenergic blockers, calcium
channel blockers and flecainide.
65. HR is normal and rhythm is regular .
The P wave is normal, the PR interval is prolonged (greater than 0.20
second) and the QRS complex usually has a normal shape and duration .
CLINICAL SIGNIFICANCE :
Is not usually not serious but can be a sign of higher degrees of AV block .
Patients with first degree AV block are asymptomatic
66. There is no treatment for first degree AV block.
Changes to potentially causative situations may be considered.
Monitor patients for any new changes in heart rhythm (eg more serious
AV block)
67.
68. Mobitz 1 or wenckebach heart block include a gradual lengthening of the
PR interval.
It occurs because of a prolonged AV conduction time until an atrial
impulse is nonconducted and a QRS complex is blocked.
Type 1 AV block most commonly occurs in the AV node, but it can also
occurs in the His-purkinje system.
CLINICAL ASSOCIATION
Type 1 AV block may result from drugs such as digoxin or β-adrenergic
blockers .
It may also associated with CAD and other disease that can slow AV
conduction.
69. Atrial rate is normal , but ventricular rate may be slower because of
nonconducted or blocked QRS complex resulting in bradycardia.
Once a ventricular beat is blocked , the cycle repeats itself with
progressive lengthening of the PR interval until another QRS complex is
blocked.
Ventricular rhythm is irregular .
The P wave has a normal shape .
The QRS complex has a normal shape and duration .
70. Type 1 AV block is usually a result of myocardial ischemia or inferior MI.
In some patients ( eg acute MI) it may be a warning sign of a more serious
AV conduction disturbance (eg complete heart block )
TREATMENT :
If the patient is symptomatic , atropine is used to increase HR or a
temporary pacemaker may be needed , especially if the patient has had an
MI.
If the patient is asymptomatic the rhythm is closely observed with a
transcutaneous pacemaker on standby .
Bradycardia is more likely to become symptomatic when hypotension , HF
or shock is present.
71.
72. Mobitz 2 heart block a P wave is nonconducted without progressive PR
lengthening .
This usually occurs when a block in one of the bundle branches is present.
In which certain number of impulses from the SA node are not conducted
to the ventricles.
This occurs the ratio 2:1,3:1, and so on (eg two P waves to one QRS complex
, three P waves to one QRS complex) .
It may occurs with varying ratio .
73. TYPE 2 AV block is associated with
Rheumatic heart disease
CAD
Anterior MI
Drug toxicity
74. Ventricular rhythm may be irregular .
The P wave has a normal shape .
The PR interval may be normal or prolonged in duration and remains
constant on conducted beats.
The QRS complex is usually greater than 0.12 second because of bundle
branch block.
CLINICAL SIGNIFICANCE :
Often progress to 3rd degree AV block associated with poor prognosis.
Reduced HR frequently results in decreased CO with subsequent
75. Hypotension and myocardial ischemia.
Type 2 AV block is an indication for therapy with a permanent pacemaker.
Treatment :
Temporary pacemaker necessary before the insertion of a permanent
pacemaker.
If the patient become symptomatic ( hypotension , angina)
76.
77. or complete heart block , constitutes one form of AV dissociation in
which no impulses from the atria are conducted to the ventricles.
The atria are stimulated and contract independently of the ventricles.
The ventricular rhythm is an escape rhythm , and the ectopic pacemaker
may be above or below the bifurcation of the bundle of His .
CLINICAL ASSOCIATION :
Severe heart disease including
CAD
MI
78. Myocarditis
Cardiomyopathy
Systemic disease such as
Amyloidosis
Scleroderma
Drugs can cause AV block
Digoxin
β-adrenergic blockers
Calcium channel blockers
79. The atrial rate is usually a sinus rate of 60 to 100 b/min.
If it is in the AV node, the rate is 40 to 60 b/min, and if it is in the His –
purkinje system , it is 20 to 40 b/min.
The P wave has a normal shape .
The PR interval is variable , and other is no relationship between the P
wave and QRS complex.
CLINICAL SIGNIFICANCE :
Reduced CO with subsequent ischemia
HF
80. Shock
Syncope
Bradycardia
Even period of asystole
TREATMENT :
Atropine
Dopamine
Epinephrine (temporary measures to increase HR and BP)
Patient need a permanent pacemaker as soon as possible.
81.
82. PVC is a contraction coming from an ectopic focus in the ventricles.
It is the premature (early) occurrence of a QRS complex .
A PVC is wide and distorted in shape compared with a QRS complex
coming down the normal conduction pathway.
PVCs that arise from different foci appear different in shape from each
other and are called multifocal PVCs .
PVCs that have the same shape are called unifocal PVCs
When every other beat is a PVC , the rhythm is called ventricular
bigeminy.
83. When every third beat is a PVC , it is called ventricular trigeminy.
Two consecutive PVCs are called a couplet.
VT occurs when there are three or more consecutive PVCs .
R-on-T phenomenon occurs when a PVC falls on the T wave of a preceding
beat .
This is especially dangerous because the PVC is firing during the relative
refractory phase of ventricular repolarization .
Excitability cardiac cells increase during this time , and the risk for the
PVC to start VT or ventricular fibrillation is great
85. Electrolyte imbalances
Hypoxia
Fever
Exercise
Emotional stress
Disease states associated with PVCs include
MI
Mitral valve prolapse
HF
CAD
86. HR varies according to intrinsic rate and number of PVCs.
Rhythm is irregular because of premature beats.
The P wave is rarely visible and is usually lost in the QRS complex of the
PVC .
Retrograde conduction may occur, and the P wave may be seen after the
ectopic beat.
The PR interval is not measurable
The QRS complex is wide and distorted in shape, lasting more than 0.12
sec .
The T wave is generally large and opposite in direction to the major
direction of the QRS complex
87. In heart disease , PVCs may reduce the CO and lead to angina and HF
depending on frequency.
Because PVCs in CAD or acute MI indicate ventricular irritability ,
assess the patients physiologic response to PVCs.
TREATMENT :
OXYGEN therapy for hypoxia
Electrolyte replacement
Assessment of the patients hemodynamic status
β adrenergic blockers
Procainamide
amiodarone
88.
89. It occurs when an ectopic focus or foci fire repeatedly and the ventricles
takes control as the pacemaker.
Different forms of VT exist , depending on QRS configuration.
Monomorphic VT has QRS complexes that are the same in shape, size,
and direction.
Polymorphic VT occurs when the QRS complexes gradually change back
and forth from one shape , size, and direction to another over a series of
beat.
Polymorphic VT associated with a prolonged QT interval .
90. VT may be sustained (longer than 30 sec) or nonsustained (less than 30
sec ).
The development of VT is an ominous sign
It is a life-threatening dysrhythmia because of decreased CO and the
possibility of development of VF , which is lethal
CLINICAL ASSOCIATION :
VT associated with
MI
CAD
91. Significant electrolyte imbalances,
cardiomyopathy,
mitral valve prolapse
Long QT syndrome
Drug toxicity
Central nervous system disorder
Can be seen in patient who have no evidence of cardiac disease.
92. Ventricular rate is 150 to 250 b/min
Rhythm may be regular or irregular
AV dissociation may be present , with P wave occurring independently of
the QRS complex.
The atria may be depolarized by the ventricles in a retrograde fashion.
The P wave is usually buried in the QRS complex , and the PR interval is
not measurable.
The QRS complex is distorted in appearance and wide ( greater than 0.12
sec in duration )
The T wave is in the opposite direction of the QRS complex
93. VT can be stable( patient has a pulse )
Unstable ( patient is pulseless )
Sustained VT causes a severe decrease in CO because of decreased
ventricular diastolic filling times and loss of atrial contraction.
Hypotension
Pulmonary edema
Decreased cerebral blood flow
Cardiopulmonary arrest
94. If the VT is monomorphic and the patient is clinically stable (eg pulse is
present) and has preserved left ventricular function
IV procainamide, sotalol, amiodarone is used
These drugs can also be used if the VT is polymorphic with a normal
baseline QT interval
Polymorphic VT with a prolonged baseline QT interval is treated with IV
magnesium, isoproterenol , phenytoin .
Drugs that prolong the QT interval ( eg dofetilide ) should be
discontinued.
95. VT without a pulse is a life-threatening situation .
It is treated in the same manner as VF
CPR and rapid defibrillation are the first line of treatment ,followed by
the administration of vasopressors ( epinephrine ) and
antidysrhythmics ( eg amiodarone ) if defibrillation is unsuccessful.
An accelerated idioventricular rhythm (AIVR) can develop when the
intrinsic pacemaker rate ( SA node or AV node ) becomes less than that
of a ventricular ectopic pacemaker.
The rate is between 40 to 100 b/ min .
Commonly associated with acute MI and reperfusion of the
myocardium after thrombolytic therapy or angioplasty of coronary
arteries
96.
97. Is a severe derangement of the heart rhythm characterized on ECG by
irregular waveforms of varying shapes and amplitude.
This represents the firing of multiple ectopic foci in the ventricle.
Mechanically the ventricle is simply “quivering” with no effective
contraction , and consequently no CO occurs.
VF is a lethal dysrhythmia.
CLINICAL ASSOCIATIONS :
Occurs in acute MI and myocardial ischemia and in chronic disease such
as HF and cardiomyopathy
98. It may occur during cardiac pacing or cardiac catheterization procedure
because of catheter stimulation of the ventricles.
Electric shock
Hyperkalemia
Hypoxemia
Acidosis
Drug toxicity
99. HR is not measurable .
Rhythm is irregular and chaotic.
The P wave is not visible , and the PR interval and the QRS interval are
not measurable.
CLINICAL SIGNIFICANCE :
VF result in an unresponsive , pulseless, and apneic state.
if it is not rapidly treated the patient will not recover.
100. CPR and ACLS with the use of defibrillation and definite drug therapy (eg
epinephrine , vasopressin )
There should be no delay in using a defibrillator once available
101.
102. Asystole represents the total absents of ventricular electrical activity
Occasionally P waves are seen
No ventricular contraction occurs because depolarization does not occur
Patient are unresponsive, pulseless, apneic
Asystole is the lethal dysrhythmia that require immediate treatment
VF may masquerade as Asystole
Always assess the rhythm in more than one lead
103. Asystole is usually a result of advance cardiac disease, a severe cardiac
conduction system disturbance or end stage HF
Clinical significance
Generally the patient with Asystole has end stage HD or has a prolonged
arrest and cannot be resuscitated
Treatment
CPR with initiation of ACLS measures
This include definitive drug therapy with Epinephrine and/or Vasopressin
and intubation
104.
105. The PEA is a situation in which organized electrical activity is seen on the
ECG but there is no mechanical activity of the ventricles and the patient
has no pulse
It is most common dysrhythmias seen after defibrillation
Prognosis poor unless the underline causes quickly identified and treated
106. The most common lying cause of
PEA include,
hypovolemia
Hypoxia
Metabolic acidosis
Hyperkalemia
Hypokalemia
Hypoglycemia
Hypothermia
Toxins
Cardiac tamponade
Thrombosis
Tension pneumothorax
Trauma
107. Treatment begins with CPR followed by drug therapy Ex: Epinephrine and
intubation
108. The sudden cardiac death refers to death from a cardiac cause
Most SCD result from ventricular dysrhythmias, specifically VT, VF
109. Defibrilation is the treatment of choice to end VF and pulseless VT
Rapid defibrillation within 2 minutes is critical to a successful patient
outcomes
Defibrilation involves the passage of an electric shock through the heart to
depolarise the cell of the myocardium
Goal
Following repolarization of myocardial cells will allow the SA node to
resume the role of pace maker
110. Monophasic
It deliver energy in one direction
Initial shock with 360 joules
Biphasic
Deliver energy in 2 direction
Deliver successful shocks at lower
energies (120-200 joules)and with
fewer post shock ECG
abnormalities than monophasic
defibrillators
114. Hand-free multifunction defibrillator pads are available and are placed on
the chest
Connect cable form the pads to the defibrillator
Charge and discharge the defibrillator using buttons on the defibrillator
All personals are clear before discharging the defibrillator
115. Synchronized cardioversion is the therapy of choice for the patient
with ventricular tachydysrhythmias ( eg VT with pulse) or
supraventricular tachydysrhythmias ( eg atrial fibrillation with a rapid
ventricular response)
A synchronized circuit in the defibrillator delivers a shock that is
programmed to occur on the R wave of the QRS complex of the ECG.
If synchronized cardioversion is done on a nonemergency basis (the
patient is awake and hemodynamically stable), the patient is sedated (
IV midazolam) before the procedure.
If a patient with supraventricular tachycardia or VT with a pulse
becomes hemodynamically unstable , synchronized cardioversion
should be performed as quickly as possible
116. Start the initial energy for synchronized cardioversion at 50 to 100 joules (
biphasic defibrillator) and 100 joules ( monophasic defibrillator ) and
increase if needed.
If the patient become pulseless or the rhythm changes to VF , turn the
synchronizer switch off and performed defibrillation.
117. The implantable cardioverter defibrillator is an important technology for
patients who
1. Have survived SCD
2. Have spontaneous sustained VT
3. Have syncope with inducible VT or VF during EPS
4. Are at high risk for future life threatening dysrhythmias ( eg have
cardiomyopathy)
The ICD consists of a lead system placed via subclavian vein to the
endocardium
118. A battery powered pulse generator is implanted subcutaneously , usually
over the pectoral muscle on the patient nondominant side.
The pulse generator is similar in size to a pacemaker
The ICD sensing system monitors the HR and rhythm identifies VT or VF
After sensing system detects a lethal dysrhythmias , the device delivers 25
joules or less shock to the patient heart
If the first shock is unsuccessful , the device recycles and can continue to
deliver shocks.
These device use algorithms that detect dysrhythmia and determine the
appropriate response.
119.
120. They also provide backup pacing for bradydysrthmias that may occur after
defribrillation.
Preprocedure and postprocedure nursing care of the patient undergoing
ICD placement is similar to the care of a patient undergoing permanent
pacemaker implantation.
Leaflet
121. Use electrical energy to” burn” or ablate areas of the conduction system as
definite treatment of tachydysrhythmias .
Ablation therapy is done after EPS has identified the sources of the
dysrhythmia .
An electrode tipped ablation catheter ablates accessory pathways or
ectopic sites in the atria, the AV NODE ,and the ventricles.
Catheter ablation is considered the nonpharmacologic treatment of
choice for atrial dysrhythmias resulting in rapid ventricular rates and AV
nodal re-entrant tachycardia refractory to drug therapy