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

I~~'I~~~. I
~~
f---.'t
L

- 0.2 sec-

- .04 sec-

1
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:

---t-

~-.-

--I---+-!

NORMALPRI :

"

S
I,

R.,-~'

-. r" i
V

L
Resting Depolarization Repoianzanon .. Resting

NORMALQRS:

- \
S
t'

--:.~~>-=-L
V I
Resting

Depolarization

R epolarizalion ._--- Resting

NORMAL STSEGMENT:

s
/\

R -..-

'v: ,
I

L
Resting

Depolarization

Ae polanzalion- . Resting

EGG deflections

Atrial depolarjzation VentrrcuIar.. 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. 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.

SINUS RHYTHM

Normal, Healthy, Synchronized Allows time for all chambers to fill with blood and pumps it efficiently to the body.

RATE:
RHYTHM: PWave: PRI: QRS:

SINUS BRADYCARDIA

Slow but not always harmful, depends on the individual'; May be left alone, treated with medication or a pacemaker.

RATE: RHYTHM:
PWave: PRl: QRS:

SINUS TACHYCARDIA

Fast but in synch, can be caused by exercise, stress, temperature, disease or fear. Usually short term and returns to normal rate when cause is gone. Ifprolonged, tires the heart and deprives the body of efficient rhythmic pumping. RATE: RHYTHM: P Wave: PRI: QRS:

ATRIAL FIBRILLATION

Most common abnormal rhythm, regularly irregular, inefficient but tolerable. Causes heart chambers not to work in synchronization and therefore not efficient pumping of blood to body.

RATE: RHYTHM: P Wave: PRI: QRS:

ATRlAL FLUTTER

Irregular and the atrium is pumping more often than the ventricle, therefore, does not allow for efficient blood movement through the heart and to the body. Treatment consists of medications, ablation or cardioversion, thus, converts the irregular rhythm back to normal sinus.

RATE: RHYTHM: PWave: PRl: QRS:

SVT& PSVT

: '~' J[[ : U-J!U

p~;_

.~
. ' ,
t,
I "

r'-

II

1,,'1

V' <-1.

:1Ii IlilllIlIl-~

Ii ~ 11-0

ill

"VERY fast rhythm, works the heart too much, the heart will tire out" Depending on the underlying rhythm, it may resolve on its own, if not, medical interventions such as medications or cardioversion may have to take place to correct the rate. RATE: RHYTIIM: PWave: PRI: QRS:

PREMATURE ATRIAL COMPLEXES

-e-e-

~H.

Fm;p,,'''''t .ill ......

'1~'

1T
1~

.rn m..:t!:
'''-+-

"ThT+t H1"

' FHH+ III

..

,..,--,."

. I....
.: '

t:il'" .u. >,-,1

~. -~;t, "':-~" ..;. lr.i; I IU:t r f"- ,H ?,+

-e-r+r-

tin

"l1'~
,.jt '.. '.
~~

-+-f-

fFj~-l .fIg r
-+

.~1:~~)-.-,
Z' ~.-

:J TjJ
'-;'+;4
'..

ffit fml+f ~ ..

. ..-:+
.

, "

ttn --+-~:' 1
:W

+;-'- ~.!+ --.. i~-" ,--

mt

H~

.++.,;.
l::!:

it'

EEi;::;:;';' ~ _i.-:-<
+

-.i-II~
;J..,f~

,+'H1H

7""""""'"

-,
~

.'

, .~ ,,'. 't" ..

'.. _

~ ..;1:: i:f'.+t:;:;~

.
.

1"

1
..

+--+
~--+

.. ~:~.2 ~
:1+<11

r-

~'"

r
j
t
M::,

I i

~
-. pi:o.~

't'f.

,"1-0- ...
t

ffi ;

~b'1+" r:n 1 r; "~l iiL 1';.: ff nIT ilp!1l I 1t ;.,L.,I~~t

:t-

-+

.~ ~- :: :~t::mF

~.-1-_

;'T-++
+

1tt

~'

rrt....

Tr,tlj li~n:;:lli'L:tt
t

' 1.,

IT

t~ .

.:,.,...+!+

~.;:........

-. ~

"

j IH

1 ill
t.~1

L t11~,

]ili:fir
,
l.w

, I-.ici=f. 'Wt-';'_'. .
,-.j.

:-++t.lB. J!:~ r.~fi

1--':
~
" -.d:rtt.
J

:.:11]#' i.tu u
t

~ 1fdrt~jE4 -,+1.
" 1 I
___ !..ll

rtt

nP~~
'.,;.

I f+r,~~! ,. . fer.. tit

.... .a..a.!

" Irregular Rhythm, Not uniformed with early contractions and decreases function of the heart". RATE: RHYTHM: PWave: PRI: QRS:

PREMATURE VENTRICULAR COMPLEXES

" Irregular Rhythm, Not uniformed with early contractions and may lead to further cardiac complications". PVCs on their own my not be a concern, but when they occur frequently or have runs of 4 or more, treatment is strongly indicated. RATE: RHYTHM: P Wave: PRI: QRS:

@NCTIONAL

RHYTHM

" Electrical impulses down the heart from top to bottom and may be delayed". RATE: RHYTHM: P Wave: PRI: QRS:

F~STDEGREEHEARTBLOCK

--!-.--

--~

--t=.;.:

" 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. RATE: RHYTHM: PWave: PRI: QRS:

?)(J

>.2

SECOND DEGREE HEART BLOCK TYPE I

r.

'-

-'-1--

.. -:

-- .:{.-~
~-' ,
-It -

~---i= =-r=- c=:=~.i~. - =FT - ... . --~ --.-- i -i . -:-:- ';-:.~ --.:..: :---=t-:-. --- --r--11""""-- I-- -.. --1-

..":

.1:-=. '----'--I
f t

1--1'- .. -+r -.

-;

i'~-.,- -.
T
~
"t

i' .

,-1:;:---

-~-"~-

t ~

'.-

--

::::t ~

t,

-"
-

-.:::-.-=-.. -~
j

-- 1-::::::t:. ~~+-~I---lrI

I'

.:-;.~'1t- -'--1--4 "~-= I .- i--- - "-=1

1". t .....:-+::

I'

t!_
+--

3'- _.' ::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, the more serious the problem. RATE: RHYTHM: PWave: PRI: QRS:

..

SECOND DEGREE HEART BLOCK TYPE II

"The communication between the Atrium and the Ventricle is normal, but exhibits random drops of Ventricular beats". Serious rhythm, required immediate treatment, usually artificial electrical stimulation "pacemaker"

RATE: RHYTHM: PWave: PRI: QRS:

TIllRD DEGREE HEARTBLOCK

1.

1:-=

I --+-

--

"There is no communication between the Atrium and the Ventricle, therefore beats are missed frequently, will require external source for impulse production and control. i. e. Pacemaker"

RATE: RHYTHM: PWave:

PR1:
QRS:

VENTRICULAR FIDRILLATION

" A lethal rhythm, the entire heart is quivering, thus no circulation is present, requires immediate interventions"

RATE: RHYTHM: PWave:

PR1:
QRS:

IDIOVENTRICULAR

RHYTHM

" A lethal rhythm, rate is very slow with minimal to no circulation, requires immediate interventions" RATE: RHYTHM: PWave: PRI: QRS:

VENTRICULAR TACHYCARDIA

" A lethal rhythm, the heart beat fa idly but with less than adequate circulation, requires immediate / interventions"
I

RATE:

ASYSTOLE

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