ECG

Rhythm
Analysis
M. Chadi Alraies, MD
Chief Medical Resident
Case western Reserve University / St. Vincent Hospital
Wednesday, April 07, 2010
P
QRS
Q
R
S
T
P
T
J
ECG
Components
Bachmanns bundle
Left bundle branch
Posterior division
Anterior division
Purkinje fibers
Right bundle branch
Bundle of His
AV node
Internodal pathways
Sinus node
ECG Speed = 5 medium squares / sec
1 small square = 0.04 sec
1 medium square = 5 small squares = 0.2 sec
1 large square = 5 medium squares = 1 sec
P. wave P. wave
P. wave P. wave
<2.5 s.s.
<0.1 sec
<2.5 s.s.
<0.1 sec
PR interval
3-5 s.s.
0.12-0.2 sec
QRS complex
<3 s.s.
<0.12 sec
Reading ECG Rhythm
Rate
P waves
PR interval
QRS complexes
Others
Rate
Irregular
Regular 300 / # m. sq
1500 / # s. sq
# of QRS within 30 m. sq (6 big sq = 6 sec) x 10
60-100 / min
11
300 / 4 = 75
1500 / 20 = 75
8 x 10 = ~ 80
1 2 3 4 5 6
=30 m sq
1
3 2
5
4
6 7
QRS complexes
Duration
< 3 ss
> 3 ss
Shape : fixed / variable
22
Regular / Irregular
P waves
Shape : fixed / variable
Present / Absent
3 3
PR interval
Fixed / Variable
Duration
< 3 ss
3-5 ss
> 5 ss
44
Tachycardias
Pacing Rhythm
Normal Sinus Rhythm
Bradycardias
Extrasystole
Dying Rhythm
Normal Sinus Rhythm
1
3 2
5
4
6 7
Normal Sinus Rhythm
Rate
P waves
PR interval
QRS
75/min
Sinus
NL / F
Narrow / R / F
Others ----
Tachycardias
Rate
Supraventrecular
QRS
>100/min
Ventricular
Narrow Wide
Narrow Complex Tachycardia
Sinus Tachycardia
Atrial Tachycardia
Multifocal
Flutter
Fibrillation
Junctional Tachycardia
Sinus Tachycardia
100-200 Rate
P waves
PR interval
QRS
>100/min
Sinus
NL / F
Narrow / R / F
Others ----
P-SVT
150-250 Rate
P waves
PR interval
QRS
>100/min
----
----
Narrow / R / F
Others ----
Atrial Flutter
Rate
P waves
PR interval
QRS
>100/min
2 / QRS
----
Narrow / R
Others Saw-tooth
~ 300
Atrial Flutter
Rate
P waves
PR interval
QRS
>100/min
2-4 / QRS
----
Narrow / IR
Others Saw-tooth
~ 300
Atrial Fibrillation
Rate
P waves
PR interval
QRS
>100/min
----
----
Narrow / IR
Others Irregular baseline
> 350
Wide Complex Tachycardia
Ventricular Tachycardia
WPW - SVT
Ventricular Tachycardia
Rate
P waves
PR interval
QRS
>100/min
----
----
wide / R
Others ----
150
Ventricular Fibrillation
Rate
P waves
PR interval
QRS
>100/min
----
----
wide / IR
Others Bizarre
WPW
Rate
P waves
PR interval
QRS
>100/min
present
Short
wide / R
Others Delta w
Bradycardias
Rate
Sinus
QRS
<60/min
Ventricular Escape R
3
rd
deg AV Block
Narrow Wide
1
st
& 2
nd
deg AV Block
Escape R (At, Junctional)
Sinus Bradycardias
Rate
P waves
PR interval
QRS
<60/min
Sinus
NL
Narrow / R
Others ----
45/min
1
st
deg AV Block
Rate
P waves
PR interval
QRS
<60/min
Present
Prolonged
Narrow / R
Others ----
35/min
2
nd
deg AV Block
Rate
P waves
PR interval
QRS
<60/min
Present-not always followed by QRS
Progressive Prolongation
Narrow / IR
Others ----
Mobitz Type I (Wenckebach): Mobitz Type I (Wenckebach):
2
nd
deg AV Block
Rate
P waves
PR interval
QRS
<60/min
Present-not always followed by QRS
N / Fixed
Narrow / IR
Others ----
Mobitz Type II Mobitz Type II
3
rd
deg AV Block
Rate
P waves
PR interval
QRS
30/min
Present-AV dissociation
----
wide / R
Others ----
30-40/min
Accelerated idioventricular Rhythm
Rate
P waves
PR interval
QRS
75/min
Absent / Present-AV dissociation
----
wide / R
Others ----
Escape Rhythm
Atrial Escape
Junctional Escape
Ventricular Escape
Extrasystole
Rate
P waves
PR interval
QRS
75/min
Present
Nl
Narrow / IR
Others PAC
Extrasystole
Rate
P waves
PR interval
QRS
75/min
Present
Nl
Narrow / IR
Others PVC
Pacing Rhythm
Agonal rhythm & Asystole
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