Eh Kasi Ganito (EKG) yan

NOV 6, 2015
AXIS DETERMINATION
 Axis Determination
STEP1: Isolate a
Quadrant/Line.
STEP 2: what is more
biphasic among
those perpendicular
to those from
isolated quadrant?
Axis Determination
Axis Determination
Axis Determination
ASSESSING RHYTHM
 The ECG Paper

One large box = 0.2s

One small box = 0.04s
Cardiac Conduction System
R-R Interval
 PR Interval
The PR Interval is the time of ATRIAL
DEPOLARIZATION and the delay before
VENTRICULAR DEPOLARIZATION
Normal Range of 0.12-0.2s (3-5 small boxes)
QRS Complex Duration
QRS Complex corresponds to the VENTRICULAR
CONTRACTION
Normal <0.12s (<3 small boxes)
 Assessing Rhythm: The 5
Essential Steps
STEP 1: calculate RATE
o bradycardia, normal (60-100) , tachycardia
STEP 2: establish REGULARITY
o regular, occasionally irregular, regularly irregular, irregularly
irregular
STEP 3: assess P WAVES
o Are there P waves? Do they look alike? Is there one P per
QRS? Do the P waves occur at a regular rate?
STEP 4: determine PR INTERVAL
o REMEMBER: Normal is 0.12-0.2s (3-5 small boxes)
STEP 5: determine QRS DURATION
o REMEMBER: Normal is <0.12s (<3 small boxes)
 ARRHYTHMIAS
SINUS RHYTHMS and ARRHYTHMIAS
PREMATURE BEATS
NON-SA BRADYARRYTHMIAS
NON-SINUS TACCHYARRHYTHMIAS
o Supraventricular or Ventricular
AV JUNCTIONAL BLOCKS
 SINUS ARRHYTHMIAS
SINUS BRADYCARDIA
SINUS TACHYCARDIA
SINUS PAUSE/ARREST
 Sinus Bradycardia

Rate: 30 bpm
Regularity: Regular
P waves: Normal
PR interval: 0.12s (normal)
QRS duration: 0.10s (normal)
 Sinus Tachycardia

Rate: 130 bpm

Regularity: Regular
P waves: Normal
PR interval: 0.16s (normal)
QRS duration: 0.08s (normal)
 Sinus Arrest

Rate: 82 bpm
Regularity: Occasionally irregular
P waves: none in arrow
PR interval: 0.16s (normal)
QRS duration: 0.08s (normal), none in arrow
 PREMATURE BEATS
Premature Atrial Contraction(PAC)
Premature Ventricular Contraction (PVC)
Premature Atrial Contraction

Rate: 70 bpm
Regularity: Occasionally irregular
P waves: 2/7 Different Contour
PR interval: 0.14s (normal)
QRS duration: 0.08s (normal)
Premature Vent. Contraction

Rate: 60 bpm
Regularity: Occasionally irregular
P waves: none for the 4th QRS
PR interval: 0.14s (normal)
QRS duration: 0.08s (normal) except last 0.4s (wide)
 NON-SA NODE
BRADYARHYTHMIAS
JUNCTIONAL RHYTHM
IDIOVENTRICULAR RHYTHM
 Junctional Rhythm

Rate: 50 bpm
Regularity: Regular
P waves: inverted P waves
PR interval: n/a
QRS duration: 0.10s (normal)
 Idioventricular Rhythm

Rate: 15 bpm
Regularity: Regular
P waves: absent
PR interval: n/a
QRS duration: 0.60s (wide)
 NON-SINUS
TACHYARRHYTMIAS
Tachycardia

Narrow QRS
Wide QRS
(Supraventricular
(Ventricular)
)

Ventricular
Ventricular
Regular Rhythm Irregular Rhythm Tachycardia (>3
Fibrillation
PVC)

Multifocal Atrial
Atrial Flutter Atrial Fibrillation
SVT (no P) Tachycardia (>3 P
(flutter waves) (no P)
morphology)
 Generic Supraventricular
Tachycardia

Rate: 150 bpm

Regularity: Regular
P waves: absent
PR interval: n/a
QRS duration: 0.12s (normal)
 Atrial Flutter

Rate: ~70bpm, reality 300bpm

Regularity: Regularly irregular
P waves: flutter waves
PR interval: n/a
QRS duration: 0.08s (normal)
Multifocal Atrial Tachycardia

Rate: 150bpm
Regularity: Irregular
P waves: >3 different P waves, sometimes none
PR interval: variable
QRS duration: 0.10s (normal)
 Atrial Fibrillation

Rate: ~100bpm, reality indistinguishable

Regularity: Irregularly irregular
P waves: indistinguishable
PR interval: n/a
QRS duration: 0.10s (normal)
 Ventricular Tachycardia

Rate: 160bpm
Regularity: Regular
P waves: None
PR interval: n/a
QRS duration: 0.40s (wide)
 Ventricular Fibrillation

Rate: ?
Regularity: ?
P waves: ?
PR interval: ?
QRS duration: ? Wide if distinguishable
 AV Junctional Blocks
Primary AV Block
Secondary AV Block
Tertiary AV Block
 Primary AV Block

Rate: 60bpm
Regularity: regular
P waves: Normal
PR interval: 0.4s (elongation)
QRS duration: 0.08s (normal)
 Secondary AV Block, Type I

Rate: 50bpm
Regularity: regularly irregular
P waves: Normal, 1 w/o QRS (dropped beat)
PR interval: incremental increase before QRS drop
QRS duration: 0.08s (normal)
Secondary AV Block, Type II

Rate: 40bpm
Regularity: regular
P waves: Present (periodic absent QRST)
PR interval: 0.10s (normal)
QRS duration: 0.08s (normal)
 Tertiary AV Block
(aka Complete AV block)

Rate: SA 90bpm, ventricle ~20bpm

Regularity: regular
P waves: present but no relation to QRS
PR interval: n/a
QRS duration: 0.40s (wide)
 Key Points to Remember
Always remember to check for Rate, Rhythm, P waves,
PR interval, and QRS duration
If you feel lost, check RATE first then PQRST forms
If sinus, assess for arrests (absent PQRST or Premature
contractions)
If not sinus, proceed to the ff:
o If Tachy, check QRS if wide (magic number 3 small boxes = 0.12s) or normal or
malabo
If narrow, SUPRAVENTRICULAR lahat nang may Atrial or
Supraventricular
If wide, Vtach na yun
If malabo, malamang V-Fib na yun
o If severe brady, check QRS if wide or normal
If normal, Junctional Rhythm (w/ inverted P)
If wide, Idioventricular Rhythm
If none satisfied, check RHYTHM of P wave only (if
regular, then it must be an AV block determine type na
lang)
Identify Rhythm
Identify Rhythm
Identify Rhythm
Identify Rhythm
Identify Rhythm
Identify Rhythm
THANK YOU!
Eh Kasi Ganun (EKG) yun!