EKGREVIEW

terry I miller rn msn cern

• ECG paper is graph paper made up of small and larger, heavy-lined squares - Smallest squares are 1 mm wide and 1 mm high 5 small squares between the heavier black lines - 25 small squares within each large square

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- 0.2 sec-

- .04 sec-

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• Width of each small box = 0.04 second Width of each large box (5 small boxes) = 0.20 second 5 large boxes (each consisting of 5 small boxes) = 1 second 15 large boxes = 3 seconds • 30 large boxes = 6 seconds

Normal P WAVE:

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NORMALPRI : " \ / S I. Resting r .-~' -.~~>-=-L V I Resting Depolarization R epolarizalion ..\ S t' I R --:.•• ••••• ...Resting NORMAL STSEGMENT: s /\ R -. I L Resting Depolarization Ae polanzalion._--. Resting I NORMALQRS: .- 'v: . r" i V L Resting Depolarization Repoianzanon . R.

depo Iarizati on (and atrial repo ariza ion) Time Ventricular repo larization Method: ONE Method: TWO The SIX SECOND RULE Count the beats and multiply by 10 LARGE BOX Count the number of large boxes between two consecutive Waveform (R-R intor P-P interval) and divide into 300..R EGG deflections p T a s Atrial depolarjzation VentrrcuIar. . Method: THREE SMALL BOX Count the number of small boxes between two consecutive waveforms (R-R interval or P-P interval) and divide into 1500.

Synchronized Allows time for all chambers to fill with blood and pumps it efficiently to the body. May be left alone.SINUS RHYTHM Normal. RATE: RHYTHM: PWave: PRl: QRS: . treated with medication or a pacemaker. depends on the individual'. RATE: RHYTHM: PWave: PRI: QRS: SINUS BRADYCARDIA Slow but not always harmful. Healthy.

Usually short term and returns to normal rate when cause is gone. Causes heart chambers not to work in synchronization and therefore not efficient pumping of blood to body. inefficient but tolerable. tires the heart and deprives the body of efficient rhythmic pumping. Ifprolonged. stress. regularly irregular. temperature. can be caused by exercise.SINUS TACHYCARDIA Fast but in synch. RATE: RHYTHM: P Wave: PRI: QRS: . RATE: RHYTHM: P Wave: PRI: QRS: ATRIAL FIBRILLATION Most common abnormal rhythm. disease or fear.

t. therefore. Treatment consists of medications. does not allow for efficient blood movement through the heart and to the body. thus.ATRlAL FLUTTER Irregular and the atrium is pumping more often than the ventricle. RATE: RHYTHM: PWave: PRl: QRS: SVT& PSVT : '~' J[[ : U-J!U p~.~ . the heart will tire out" Depending on the underlying rhythm. if not. I " r'- II 1. it may resolve on its own. ' . works the heart too much. :1Ii IlilllIlIl-~ Ii ~ 11-0 ill "VERY fast rhythm._ . converts the irregular rhythm back to normal sinus. RATE: RHYTIIM: PWave: PRI: QRS: .'1 V' <-1.. medical interventions such as medications or cardioversion may have to take place to correct the rate. ablation or cardioversion.

PVCs on their own my not be a concern.'_'..."1-0.-. t ffi ...'T-++ + 1tt ~' rrt•. fer.•. i~-" .. ]ili:fir ...:11]#' i.• _ ~ .'.tu u t ~ 1fdrt~jE4 -..1 ~. .~ 't'f. Not uniformed with early contractions and may lead to further cardiac complications". treatment is strongly indicated... ~ " j IH 1 ill t.~fi 1--': ~ " -... • ~b'1+" r:n 1 r.. . I f+r..PREMATURE ATRIAL COMPLEXES -e-e- ~H. :-++t. .. +--+ ~--+ .~ . . ~ . RATE: RHYTHM: PWave: PRI: QRS: •• PREMATURE VENTRICULAR COMPLEXES " Irregular Rhythm.+t:...-1-_ . . " • 1 I ___ !.. I-.i...I~~t :t- -+ .:lli'L:tt t ' 1...!+ --.f~ .:: :~t::mF ~.: ff nIT ilp!1l I 1t . I i ~ -. J :.. .H ?. '.~. . m ... : IT t~ .d:rtt.. Not uniformed with early contractions and decreases function of the heart".•...4 '. I..+1.~1:~~)-. " ttn --+-~:' 1 :W +.-..~ ~. Tr...~~! . l::±±!: it' • EEi.. -~.....:. ...-. .++.:..1:: i:f'. I IU:t r f"-• .ici=f. : 1" 1 .. .:t!: '''-+- .ill ... . but when they occur frequently or have runs of 4 or more.::.. ~. RATE: RHYTHM: P Wave: PRI: QRS: .p....' ~ _i. r j t M::.~1 L t11~.! " Irregular Rhythm..'. .: ' t:il'" .' .:. Z' ~. "ThT+t H·1" • - ~ ' •• FHH+ III .- ±:J TjJ '-. -. 1T 1~ .J..:.•~ ...lB..-'.-- mt H~ .jt '.a.t.+!+ ...tlj li~n:..-:-< + ~ b • -.--. . .•.j.• '. ~:~.u. >.. 't" .. '1~' . J!:~ r. ..'+.. "~l iiL 1'..'''''t ... .i-II~ . . l. tit .rn m. Fm." .-:+ ..L. 'Wt-'. ~~ -+-f- fFj~-l ..ll f 1 rtt nP~~ '.2 ~ :1+<11 r- ~'" .a. pi:o...+ -e-r+r- tin "l1'~ .fIg • r -+ . lr..+'H1H 7""""""'" -.w . "':-~" . ffit fml+f ~ .

RATE: RHYTHM: PWave: PRI: QRS: ?)(J >.. RATE: RHYTHM: P Wave: PRI: QRS: F~STDEGREEHEARTBLOCK --!-.2 a .: " The communication between the Atrium and the Ventricles is slightly delayed" This is not a dangerous rhythm. but may be a precursor to more serious rhythms.-- - --~ --t=..@NCTIONAL RHYTHM " Electrical impulses down the heart from top to bottom and may be delayed".

but exhibits random drops of Ventricular beats"....=FT ... T ~ "t i' . i'~-. -- ::::t ~ t.I--± -...SECOND DEGREE HEART BLOCK TYPE I r.1-::::::t:.."-=1 1".-. -~ j -.-.-'--1--4 "~-= I .:-+:: I' - t!_ +-- 3'..i~.. Serious rhythm. .: :---=t-:-.-=-.. t ..--r--11""""-.:. . RATE: RHYTHM: PWave: PRI: QRS: . --.-1:.:::-. -It - ~---i= =-r=. -.:--- -~-"~- t ~ '.-:.' ::s- j - 1---- -::i!- -+- " The communication between the Atrium and the Ventricle progressively becomes more and more delayed until a beat is missed altogether" The more frequent there is a missed beat...- . --~ --.. .. -:-:.c=:±=~.. '----'--I f t 1--1'. required immediate treatment.i--. '- -'-1-- . --1- - .:{..1:-=.-~ ~-' .~ --. usually artificial electrical stimulation "pacemaker" RATE: RHYTHM: PWave: PRI: QRS: ...'. - -" - -. the more serious the problem. -: -.:-.": . ~~+-~I---lrI I' .• -+r -. SECOND DEGREE HEART BLOCK TYPE II "The communication between the Atrium and the Ventricle is normal.i -i ._.~'1t..

will require external source for impulse production and control. "There is no communication between the Atrium and the Ventricle.TIllRD DEGREE HEARTBLOCK 1. Pacemaker" RATE: RHYTHM: PWave: PR1: QRS: VENTRICULAR FIDRILLATION " A lethal rhythm. the entire heart is quivering. therefore beats are missed frequently. - 1:-= I --+- -- • . thus no circulation is present. requires immediate interventions" RATE: RHYTHM: PWave: PR1: QRS: . i. e.

requires immediate interventions" RATE: RHYTHM: PWave: PRI: QRS: VENTRICULAR TACHYCARDIA " A lethal rhythm. the heart beat fa idly but with less than adequate circulation.IDIOVENTRICULAR RHYTHM " A lethal rhythm. rate is very slow with minimal to no circulation. requires immediate / interventions" I RATE: r I / / / .

ASYSTOLE " The Worst and Most lethal rhythm. there is no electrical nor mechanical activity in the heart" RATE: RHYTHM: PWave: PRI: QRS: .

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