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Unit 2 ekg module 3-1


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Unit 2 ekg module 3-1

  1. 1. ECG Rhythm Interpretation Module III Normal Sinus Rhythm
  2. 2. Course Objectives• To recognize the normal rhythm of the heart - “Normal Sinus Rhythm.”• To recognize the 13 most common rhythm disturbances.• To recognize an acute myocardial infarction on a 12-lead ECG.
  3. 3. Learning Modules• ECG Basics• How to Analyze a Rhythm• Normal Sinus Rhythm• Heart Arrhythmias• Diagnosing a Myocardial Infarction• Advanced 12-Lead Interpretation
  4. 4. Normal Sinus Rhythm (NSR)• Etiology: the electrical impulse is formed in the SA node and conducted normally.• This is the normal rhythm of the heart; other rhythms that do not conduct via the typical pathway are called arrhythmias.
  5. 5. NSR Parameters•Rate 60 - 100 bpm•Regularity regular•P waves normal•PR interval 0.12 - 0.20 s•QRS duration 0.04 - 0.12 sAny deviation from above is sinus tachycardia, sinus bradycardia or an arrhythmia
  6. 6. Arrhythmia FormationArrhythmias can arise from problems in the: • Sinus node • Atrial cells • AV junction • Ventricular cells
  7. 7. SA Node ProblemsThe SA Node can:• fire too slow Sinus Bradycardia• fire too fast Sinus Tachycardia Sinus Tachycardia may be an appropriate response to stress.
  8. 8. Atrial Cell ProblemsAtrial cells can:• fire occasionally Premature Atrial from a focus Contractions (PACs)• fire continuously Atrial Flutter due to a looping re-entrant circuit
  9. 9. Teaching Moment• A re-entrant pathway occurs when an impulse loops and results in self- perpetuating impulse formation.
  10. 10. Atrial Cell ProblemsAtrial cells can also:• fire continuously Atrial Fibrillationfrom multiple fociorfire continuously Atrial Fibrillationdue to multiplemicro re-entrant“wavelets”
  11. 11. Teaching Moment Atrial tissueMultiple micro re-entrant “wavelets”refers to wanderingsmall areas ofactivation whichgenerate fine chaoticimpulses. Collidingwavelets can, in turn,generate new foci ofactivation.
  12. 12. AV Junctional ProblemsThe AV junction can:• fire continuously Paroxysmal due to a looping Supraventricular re-entrant circuit Tachycardia• block impulses AV Junctional Blocks coming from the SA Node
  13. 13. Ventricular Cell ProblemsVentricular cells can:• fire occasionally Premature Ventricular from 1 or more foci Contractions (PVCs)• fire continuously Ventricular Fibrillation from multiple foci• fire continuously Ventricular Tachycardia due to a looping re-entrant circuit