Basic Dysrhythmia

Interpretation

Objectives

To understand the Basic ECG

To understand the meaning of Dysrhythmia

To describe the normal heart conduction system.

To describe the normal impulse pathways.

To interpret Sinus Rhythm strips accurately.

To interpret the Atrial Rhythms strips accurately.

To interpret AV Blocks strips accurately.

To interpret the Ventricular Rhythm strips Accurately

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Basic ECG

P wave represents atrial activation

PR interval is the time from onset of

atrial activation to onset of ventricular

activation.

QRS complex represents ventricular

activation

QT interval is the duration of

ventricular activation and recovery

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ECG - Analysis

Use a consistent method to analyze an ECG Rate

Rhythm

Assess P wave

Assess P wave to QRS ratio 1=1

Interval duration

Identify abnormalities

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Normal Conduction pathways

SA Node (60 -100)

AV Node (40 – 60)

Ventricles (20 - 40)

Tachycardia >100

Bradycardia < 60

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Lets Have A Deal …!!!!

Normal P, normal P-R, normal QRS, normal P:QRS ratio = Sinus ……

Problem in the P wave = Atrial ………

Problem in the QRS = Ventricular ………

More P waves than QRS = 2nd or 3rd Degree AV Block.

Fibrillation = always irregular

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Sinus Rhythm

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1- Sinus Rhythm ( the only normal one )

Rate 60-100 bpm

Regular

P-R interval Normal

Normal identical P waves

Each P followed by a QRS

Normal QRS

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PR interval

Normal QRS

2- Sinus Tachycardia

Same as SR but the rate is > 100

Regular

P-R interval Normal

Normal identical P waves

Each P followed by a QRS

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3- Sinus Bradycardia

Same as SR but the rate is < 60

Regular

P-R interval Normal

Normal identical P waves

Each P followed by a QRS

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Atrial

Arrhythmias

Abnormal P WAVE. Or …

Multiple foci. Or ..

Regular or irregular

Fast most of the time

Normal QRS ALWAYS

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1- Atrial Fibrillation

Always irregular

No P wave ( can not be determined )

Normal QRS

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Unequal R-R = irregular

2- Atrial Flutter

Mostly regular, but it can be irregular

No P wave but saw-toothed wave ( F wave )

Normal QRS

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S wave

Normal QRS

3- Atrial Tachycardia

Some times it is called Supraventricular Tachycardia (SVT).

Very fast rate > 150 bpm.

Normal QRS.

No P wave.(Shaped like an umbrella )

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No P wave

Normal QRS

Very fast

Ventricular

Rhythms

Wide QRS.

NO P wave

Mostly very fast

Could be Lethal

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1- Premature Ventricular Contraction (PVC)

Premature = comes early with bizarre shape.

Most of the time accompany sinus rhythm.

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PVCs

( early,

wide and bizarre)

PVCs … continued

2- unifocal vs. multifocal

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multifocal

Unifocal

PVCs … continued

3- Couplets

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Couplets

PVCs … continued

4- Bigeminy

every other beat is PVC

PVCs … continued

5- Trigeminy

every second beat is PVC

6- Ventricular Tachycardia ( V-tach.)

A whole strip with PVCs. (Wide QRS)

No P waves.

If there is no pulse, it is lethal

Always check the Pulse and BP

7- ventricular Fibrillation

No P waves, No QRS, only electrical activity present.

Lethal, always check Pulse and BP

1- Idioventricular Rhythm

Regular

No P wave

Wide QRS

Rate 20-40

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Wide QRS

No P wave

AV Blocks

Prolonged P-R interval or more P waves than QRS

Block means DELAY.

1- 1st Degree AV Block

It looks like the sinus rhythm but with prolonged P-R interval..

Normal and identical P waves. Each P is Followed by a QRS

Normal QRS.

P-R interval is > 0.20 sec.

Prolonged P-R interval

2- 2nd Degree AV Block

a- Mobitz I

Normal QRS.

Identical P waves.

P-R interval progressively prolongs until there is P not followed by a

QRS

P without QRS

2- 2nd Degree AV Block

a- Mobitz II

Identical P waves, Not

every P is followed by a

QRS.

When there is a QRS, it

has to be preceded by

a P wave

Atrial rate is regular.

Check BP immediately.

Every QRS preceded by a

P waves

Identical P waves

4- 3rd Degree AV Block (Complete Heart

Block)

No relationship between P waves and QRS complexes

Check the BP immediately

Pulseless Electrical Activity

No electrical Activity

(Asystole ) or Ventricular Standstill

No QRS, no electrical activity, P waves may present.

Artifact

Artifact occurs when something causes a disruption in monitoring.

Some common causes are:

AC interference

Muscle tremors

Respiratory artifact-wandering baseline

Loose electrode

Broken lead wire

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