ECG CHANGES IN:

INTRA VENTRICULAR CONDUCTION

ABNORMALITIES,ARRYTHMIAS,INJURY,
INFARCTION,ELECTROLYTE
IMBALANCE,ATRIAL AND VENTRICULAR
ENLARGEMENT.

PRESENTED BY
DEEPIKA.R
M.SC(N) II YEAR
COLLEGE OF NURSING
MMC,CHENNAI-03
ECG
Sinus Rhythm and Sinus Arrhythmia
• Normal sinus rhythm is a regular rhythm between 60 and 100
beats/min, with a P wave before each QRS complex and a QRS after
each P wave.
• A faster rate defines tachycardia and a slower rate, bradycardia.
• The term sinus indicates that the rhythm originates in the sinoatrial
(SA) node, that there is atrial depolarization (a P wave before each
QRS), and that atrial contraction precedes ventricular contraction
Arrhythmia
• An arrhythmia refers to an irregular heartbeat. It occurs when the
heart’s rhythm or speed deviates from the normal pattern.
• The term arrhythmia can be broken down as follows:
• “A” prefix: Indicates a lack or absence of something.
• “Rhythm”: Refers to the regular pattern of heartbeats.
• In essence, arrhythmia means “without rhythm”.
• Causes of arrhythmia include changes in the electrical
signals controlling the heart or alterations in heart tissues.
• Symptoms can vary and may include fluttering sensations, skipped
beats, weakness, dizziness, fatigue, shortness of breath, and rapid
heartbeat.
Dysrhythmia
• Dysrhythmia is essentially synonymous
with arrhythmia. Both terms describe
an abnormal heart rhythm.
• The key difference lies in the linguistic
origin:
• “Dys” prefix: Implies something
is difficult or not working properly.
• “Rhythm”: Still refers to the heart’s regular
pattern.
• Therefore, dysrhythmia literally
means “bad rhythm”.
Dysrhythmias by heart rate
IRREGULARITY ALORITHM
SINUS RHYTHM
SINUS BRADYCARDIA
SINUS BRADYCARDIA
SINUS TACHYCARDIA
SINUS TACHYCARDIA
SINUS DYSRHYTHMIA
SINUS DYSRHYTHMIA
SINUS ARREST
SINUS ARREST
WANDERING ATRIAL PACEMAKER
WANDERING ATRIAL PACEMAKER
PREMATURE ATRIAL COMPLEXES
PREMATURE ATRIAL COMPLEXES
PREMATURE ATRIAL COMPLEXES
Compensatory pause
Trigeminal and quadrigeminal
ATRIAL TACHYCARDIA
ATRIAL TACHYCARDIA
MULTIFOCAL ATRIAL TACHYCARDIA
ATRIAL FLUTTER
ATRIAL FIBRILLATION
 Characteristics common to junctional dysrhythmias
• Arise from the AV junction, the area around the
AV node, or the bundle of His.
• P’ wave may be inverted (when they would
otherwise be upright) with a short P’R interval
(less than 0.12 seconds in duration).
• Alternatively, the P’ wave may be absent (as it is
buried by the QRS complex), or it may follow
the QRS complex. If the P’ wave is buried in the
QRS complex it can change the morphology of
the QRS complex.
• If present, P’R intervals are shortened.
• QRS complexes are normal (unless there is an
interventricular conduction defect or aberrancy)
PREMATURE JUNCTIONAL COMPLEXES
PREMATURE JUNCTIONAL COMPLEXES
JUNCTIONAL ESCAPE RHYTHM
JUNCTIONAL ESCAPE RHYTHM
ACCELERATED JUNCTIONAL RHYTHM
ACCELERATED JUNCTIONAL RHYTHM
JUNCTIONAL TACHYCARDIA
JUNCTIONAL TACHYCARDIA
Ventricular dysrhythmias
• Characteristics common to ventricular dysrhythmias.
• Arise from the ventricles below the bundle of His.
• QRS complexes are wide (greater than 0.12 seconds in duration) and
bizarre looking.
• Ventricular beats have T waves in the opposite direction of the R
wave.
• P waves are not visible as they are hidden in the QRS complexes
PREMATURE VENTRICULAR COMPLEXES
PREMATURE VENTRICULAR COMPLEXES
PREMATURE VENTRICULAR COMPLEXES
PREMATURE VENTRICULAR COMPLEXES
IDIOVENTRICULAR RHYTHM
IDIOVENTRICULAR RHYTHM
ACCELERATED IDIOVENTRICULAR RHYTHM
ACCELERATED IDIOVENTRICULAR RHYTHM
VENTRICULAR TACHYCARDIA
VENTRICULAR TACHYCARDIA
Torsades De Pointes
• Torsade de pointes is an uncommon and distinctive form of polymorphic
ventricular tachycardia (VT) characterized by a gradual change in the
amplitude and twisting of the QRS complexes around the isoelectric line .
• Unlike the normal pulse rate of 60 to 100 beats per minute, TdP results in a
ventricular heartbeat exceeding 100 beats per minute, sometimes reaching 150
to 300 beats per minute.
AV BLOCK
1st-DEGREE AV BLOCK
1st-DEGREE AV BLOCK
2nd-DEGREE AV BLOCK
2nd-DEGREE AV BLOCK
2nd- AV HEART BLOCK,TYPE II
2nd- AV HEART BLOCK,TYPE II
3rd-DEGREE AV BLOCK
2nd- AV HEART BLOCK,TYPE II
RIGHT ATRIAL ENLARGEMENT
LEFT ATRIAL ENLARGEMENT
RIGHT VENTRICULAR HYPERTROPHY
RBBB
LBBB
Left anterior hemiblock (LAHB)
• Left anterior hemiblock (LAHB) or left
anterior fascicular block (LAFB) is
a cardiac condition that occurs when a
cardiac impulse spreads first through
the left posterior fascicle, causing a
delay in activation of the anterior and
upper parts of the LV.
• This results in a delay in the activation of
the anterior region of the left ventricle,
which produces an initial, small wave.
• This wave is opposite to the direction of
the blocked area, causing small r waves
in inferior leads and small q waves in
lateral leads
Wolff–Parkinson–White syndrome (WPWS)
• Wolff–Parkinson–White
syndrome (WPWS) is a disorder
due to a specific type of problem
with the electrical system of
the heart involving an accessory
pathway able to conduct
electrical current between the
atria and the ventricles, thus
bypassing the atrioventricular
node
ECG changes associated with ischemia, injury, and infarction
• Identifying the location of myocardial ischemia, injury, and infarction
• ∞ Anterior
• ∞ Septal
• ∞ Lateral
• ∞ Inferior
• ∞ Posterior