Reading EKG

1. Rate
1. If intervals are regularly spaced: 300, 150, 100, 75, 50
2. Rhythm
1. Tip 1: Start with Lead II, check for sinus rhythm, best place to check for p waves
2. Tip 2: If cannot see p wave in Lead II, go to strip on the bottom
3. Tip 3: Panoramic view, notice any obvious rhythm
3. Axis Can be affected my abnormal heart mass
4. Interval
1. PR interval: 5 small boxes
1. 3-5 little boxes (3-5 x 40msec = 120sec-200msec)
2. QT interval Prolongation
1. First confirm if QRS complexes are uniform
2. Estimate R-R interval
1. If QT > 1/2 RR interval = clue QT interval prolonged
3. Can degenerate into Torsades de Pointes = Polymorphic Ventricular Tachycardia
5. Morphology
1. ST segment abnormality
1. Can indicate ischemia
2. ST Elevation
3. RV Infarct
1. Avoid Nitrate (can precipitate Hypotension and potential shock)
2. Give Fluids instead
2. Tachycardia
1. Narrow QRS: <3 big boxes
1. Regular
1. Sinus Tach
1. “Camel humps” if P and T waves overlap
2. SVT (no p waves): Atria or AV node
3. Aflutter (2:1, 3:1, 4:1)
1. Re-entrance circuit
2. Anticoagulation needed if high CHAD score
3. 4:1: = 3 atrial flutter between QRS, 4th “hidden under QRS”
4. Can present with Bradycardia if patient was given BB, depends on how many impulses are traveling through AV node
2. Irregular
1. AFib (no p waves)
1. Anticoagulation (if high CHAD score)
2. Procainamide > BB
3. Can have normal or slow HR, depends on how many impulses are traveling through AV node
2. MAT (Diff p waves): COPD
3. Aflutter w/ var conduction
2. Wide QRS: >3 big boxes
1. Regular
1. VTach (Rate 120) “shark teeth”
1. Monomorphic
2. Sinus Tach with aberrant
3. SVT w/BBB/WPW
2. Irregular
1. Afib w/ BBB
2. Afib w/ Pre-excitation
3. VFib
3. WPW
1. Give Procainamide (not BB)
3. Bradyarrhythmia
1. Sinus Bradycardia
1. P followed by QRS?
1. Yes = Sinus Bradycardia
2. No = Heart block
2. 1st Degree Block: PR >0.2sec (5 small boxes)
1. Isolated PR prolongation
3. 2nd Degree Block/Mobitz 1
1. “AV slowly tires until QRS dropped"
4. 2nd Degree Block/Mobitz 2
1. Randomly dropped beats
2. Every QRS coupled to P wave even if P waves are dropped
5. 3rd Degree Block
1. Atria and Ventricle independent
2. If P buried under QRS or T wave, the QRS is funny looking
3. Hint: Symmetric P-P and QRS-QRS interval
WPW

Sinus Tachycardia
“Camel humps”