basic dysrhythmia interpretation - ksacpr.org.saksacpr.org.sa/gsshyd-dt5381/uploaddata/course... ·...
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Basic Dysrhythmia
Interpretation
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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
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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
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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
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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
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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)
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PVCs … continued
2- unifocal vs. multifocal
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multifocal
Unifocal
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PVCs … continued
3- Couplets
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Couplets
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PVCs … continued
4- Bigeminy
every other beat is PVC
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PVCs … continued
5- Trigeminy
every second beat is PVC
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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
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7- ventricular Fibrillation
No P waves, No QRS, only electrical activity present.
Lethal, always check Pulse and BP
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1- Idioventricular Rhythm
Regular
No P wave
Wide QRS
Rate 20-40
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Wide QRS
No P wave
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AV Blocks
Prolonged P-R interval or more P waves than QRS
Block means DELAY.
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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
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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
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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
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4- 3rd Degree AV Block (Complete Heart
Block)
No relationship between P waves and QRS complexes
Check the BP immediately
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Pulseless Electrical Activity
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No electrical Activity
(Asystole ) or Ventricular Standstill
No QRS, no electrical activity, P waves may present.
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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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“
”Any Questions ??
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Thank you