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Electrocardiography
a comprehensive course
s so n
Le
1
Lead II aVL V2 V5
Lead I aVR V1 V4
Lead II aVL V2 V5
Lead I aVR V1 V4
high lateral septal anterior
Lead II aVL V2 V5
inferior high lateral septal low lateral
The patient age and gender should always be entered into the
12-lead monitor.
12-Lead Basics
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Rate & Rhythm
Sinus Tach P
MAT P
Ectopic A-Tach P
Junctional P
AVNRT/AVRT P
A-Flutter F F F F
P
P-Wave F
Flutter Wave
Premature Ventricular
Contraction
Rate: Determine underlying rhythm
Rhythm: Irregular
P wave: None with PVC
P:QRS ratio: None
PR-interval: None
QRS Width: > 120 ms (0.12 sec) WIDE
Premature Ventricular Contraction
Polymorphic
More than one one shape of QRS complex
Multifocal
More than one focus or site of initial
impulse.
Premature Ventricular Contraction
1 2
Ventricular Escape Beat
Rate: Determine underlying rhythm
Rhythm: Irregular
P wave: None with PVC
P:QRS ratio: None
PR-interval: None
QRS Width: > 120 ms (0.12 sec) WIDE
Ventricular Rhythms
Idioventricular Rhythm
Rate: 20 - 40 bpm
Rhythm: Regular
P wave: None
P:QRS ratio: None
PR-interval: None
QRS Width: > 120 ms (0.12 sec) WIDE
Idioventricular Rhythm
Accelerated Ventricular Rhythm
Rate: 40 - 100 bpm
Rhythm: Regular
P wave: None
P:QRS ratio: None
PR-interval: None
QRS Width: > 120 ms (0.12 sec) WIDE
Ventricular Tachycardia
Rate: 100 - 200 bpm
Rhythm: Regular
P wave: None, complete AV disassociation
P:QRS ratio: None
PR-interval: None
QRS Width: > 120 ms (0.12 sec) WIDE
Ventricular Tachycardia
Torsade de Pointes
Rate: 200 - 250 bpm
Rhythm: Irregular
P wave: None
P:QRS ratio: None
PR-interval: None
QRS Width: > 120 ms (0.12 sec) WIDE
Ventricular Fibrillation
Rate: Indeterminate
Rhythm: Chaotic
P wave: None
P:QRS ratio: None
PR-interval: None
QRS Width: None
1st Degree Heart Block
Rate: Identify underlying rate
Rhythm: Regular
P wave: Present
P:QRS ratio: 1 to 1
PR-interval: > 200 ms (0.20 sec)
QRS Width: < 120 ms (0.12 sec)
1st Degree Heart Block
2nd Degree Heart Block - Type I
Rate: Identify underlying rate
Rhythm: Regularly-Irregular
P wave: Present
P:QRS ratio: Variable
PR-interval: Variable (going, going, gone)
QRS Width: < 120 ms (0.12 sec)
2nd Degree Heart Block - Type I
1st Degree AVB 2nd Degree AVB - Type I
2nd Degree Heart Block - Type II
Rate: Identify underlying rate
Rhythm: Regularly-Irregular
P wave: Present
P:QRS ratio: x:x - 1
PR-interval: Normal *Dropped QRS
QRS Width: < 120 ms (0.12 sec)
3rd Degree Heart Block
Rate: Atrial & Ventricular rates differ
Rhythm: Regular
P wave: Present
P:QRS ratio: Variable
PR-interval: No pattern
QRS Width: Normal or WIDE
3rd Degree Heart Block
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3rd Degree Heart Block
AV Blocks
Is the PR-interval a constant length?
Yes No
Dropped QRS? P-wave for every QRS?
Yes No Yes No
2nd Degree Type II 1st Degree 2nd Degree Type I 3rd Degree
Interpretation Pearl
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The Golden Rule
End of Lesson 1
Lesson 2 will include axis determination