Académique Documents
Professionnel Documents
Culture Documents
Espada
Clinical Clerk
ELECTROCARDIOGRAM
Na+ - fast
QRS complex
Ventricular contraction
ST segment horizontal, flat
T wave ventricular repolarization
K+ leaving the myocytes
VENTRICULAR
SYSTOLE
QRS to end of T wave (QT interval)
spans depolarization and repolarization
of ventricles
Ion movement pic p 33
RECORDING
Pic p 34, 37
LEADS
Leads p 39
AUGMENTED LEADS
I. Rate
II. Rhythm
III. Axis
IV. Hypertrophy
V. Infarction
Normal Values
P wave <0.12 (3 small boxes)
PR interval 0.12 0.2 (3-5 small
boxes)
QRS duration <0.11 to 0.12 (3 small
boxes)
Corrected QT interval 0.35 to 0.43;0.45
I. RATE
SA Node 60-100/min
AV Node (AV junction) 40-60/min
His bundle (Purkinje fibers) 20-40/min
*automaticity foci
RATE
Regular rhythm
Heart rate = 1500/# of small squares from
R to R
Irregular rhythm
HR = # of QRS complexes within 30 large
boxes x 10
II. RHYTHM
Sinus Rhythm
There is a P wave before every QRS
Distances between R-R intervals should
be equal
Sinus bradycardia - <60 bpm
Sinus tachycardia - >100 bpm
ARRHYTHMIAS
Irregular rhythm
A.Escape
B.Premature beats
C.Tachyarrythmias
IRREGULAR RHYTHM
Wandering Pacemaker
Multifocal Atrial Tachycardia
Atrial Fibrillation
Pic p 111
COPD
HR >100
Continuous rapid firing of multiple atrial automaticity foci
Occasional, random atrial depolarization that reaches the AV node to be
conducted to the venricles, producing irregular QRS rhythm
A. ESCAPE
B. PREMATURE BEATS
AV Node unreceptive to premature atrial depolarization stimulus
because it reached the AV node prematurely (while AV node is still in
refractory period), resulting in a non-conducted PAB
Bigeminy PAB couples to the end of a normal cycle and repeats this process by
coupling a PAB to the end of each successive normal cycle
Trigeminy fires after 2 normal cycles
Occur early in the cycle
Great width and enormous amplitude
Usually the opposite the polarity of the normal QRS
Depolarize only the ventricles
Pause not caused by resetting of SA Node
Ventricles are still repolarizing
6 or more PVCs per minute is considered pathological!
Hypoxic
If VT lasts longer than 30 seconds, it is called
sustained VT
Severe cardiac hypoxia
C. TACHYARRYTHMIA
Coronary insufficiency (ischemia) or other causes of
hypoxia
Caused by low K, meds that block K channels, or congenital problems
Rate: 250-350
Baseline is lost between back-to-back flutter, saw tooth
An abnormal, accessory AV conduction pathway, the bundle of
Kent, can short circuit the usual delay of ventricular conduction
in the AV node
Blocks retard or prevent the conduction of depolarization
Can occur in the SA node, AV node, or in the larger divisions of
the ventricular conduction system
No P wave
PR interval greater than .2 second
PR prolongation is consistent in every cycle
Occurs in AV node
PR interval gradually lengthens in successive cycles but the last
P wave of the series fails to conduct to to the ventricles (final P
lacks a QRS, then series repeats)
Totally blocks a number of paced atrial depolarizations (P
waves) before conduction to the ventricles is successful,
producing 2:1 P:QRS AV ratios. The series repeats.
One ventricle depolarizes slightly later than the
other, causing two joined QRS
III. AXIS