Slide 1

Patrick Hegge

Slide 2

Anatomy Heart location and size

Slide 3

The electrocardiogram Note: Do not use this illustration for measuring PR interval.

Slide 4

Slide 5

Conduction system review

Slide 6

Consists of: Contraction of the atriums P wave Contraction of the ventricles QRS Complex

Slide 7

The electrocardiogram Note: Do not use this illustration for measuring PR interval.

Slide 8

Rhythms that if you see on the monitor you will know and can help the surgical team.

Slide 9

Normal sinus rhythm (NSR) P waves are normal and identical P wave precedes each QRS, QRS for every P PR intervals are constant Heart rate is 60-100 bpm

Slide 10

Sinus bradycardia Same criteria as NSR except heart rate is less than 60 bpm

Slide 11

Sinus tachycardia Same as NSR except heart rate is between 100- 160 bpm. P waves are sometimes absent at higher rates............

Slide 12

A ventricular rhythm occurs when the SA and AV nodes are not firing or are too slow to be effective.

Slide 13

RULES FOR VENTRICULAR TACHYCARDIA (V Tach) A LETHAL RHYTHM No P wave QRS > 0.12 seconds Big and wide Rate - fast > 150 PBM Usually regular but can be slightly irregular

Slide 14

Chest discomfort (angina) feels like something heavy sitting on their chest. Fainting (syncope) Light-headedness or dizziness Sensation of feeling the heart beat (palpitations) Shortness of breath (dyspnea) Note: Symptoms may start and stop suddenly. In some cases, there are no symptoms. SYMPTOMS OF V TACH

Slide 15

V Tach Does it have a P wave? Is the QRS > 0.12 seconds? Is it big and wide? Is the rate > 150 BPM?

Slide 16

Heres another one Does it have a P wave? Is the QRS > 0.12 seconds? Is it big and wide? Is the rate > 150 BPM?

Slide 17

IDIOVENTRICULAR 20 to 40 BPM

Slide 18

last one Does it have a P wave? Is there a PR Interval? Do you see a QRS? (or do you see varied amplitude of possible QRSs with no pattern) Is there any regularity or is it chaotic?

Slide 19

V Fib vs V Tach End

Slide 20

Ventricular fibrillation Rapid chaotic rhythm which lacks a pattern Rate =>300 bpm (350-450 bpm DD) Life threatening rhythm call a code!

Slide 21

Asystole Either a straight line EKG or chaotic imprint Life threatening call a code!

Slide 22

Junctional Rhythms

Slide 23

Slide 24

Junctional rhythm is an abnormal heart rhythm resulting from impulses coming from an area of the atrioventricular node the "junction" between atria and ventricles. The SA node is not working.

Slide 25

Rules for Junctional Rhythms No P wave or inverted P wave in lead II Not 1:1 (if no P wave) can be 1:1 if inverted P wave QRS tight 0.12 PR interval if there is one is between 0.12 and 0.20 Regular < 40 BPM Idio Junctional 40 to 60 BPM Junctional Rhythm 61 to 99 BPM Accelerated Junctional Rhythm > 100 PBM Junctional Tachycardia

Slide 26

Question Time Is there a P wave? Is there an inverted P wave? If so, is it 1:1? If there is a PR interval, is it between 0.12 and 0.20 seconds? Is the QRS 0.12 seconds? Is it regular? What is the rate?

Slide 27

Is there a P wave? Is there an inverted P wave? If so, is it 1:1? If there is a PR interval, is it between 0.12 and 0.20 seconds? Is the QRS 0.12 seconds? Is it regular? What is the rate?

Slide 28

Is there a P wave? Is there an inverted P wave? If so, is it 1:1? If there is a PR interval, is it between 0.12 and 0.20 seconds? Is the QRS 0.12 seconds? Is it regular? What is the rate?

Slide 29

Is there a P wave? Is there an inverted P wave? If so, is it 1:1? If there is a PR interval, is it between 0.12 and 0.20 seconds? Is the QRS 0.12 seconds? Is it regular? What is the rate?

Slide 30

Is there a P wave? Is there an inverted P wave? If so, is it 1:1? If there is a PR interval, is it between 0.12 and 0.20 seconds? Is the QRS 0.12 seconds? Is it regular? What is the rate?

Slide 31

Is there a P wave? Is there an inverted P wave? If so, is it 1:1? If there is a PR interval, is it between 0.12 and 0.20 seconds? Is the QRS 0.12 seconds? Is it regular? What is the rate?

Slide 32

Is there a P wave? Is there an inverted P wave? If so, is it 1:1? If there is a PR interval, is it between 0.12 and 0.20 seconds? Is the QRS 0.12 seconds? Is it regular? What is the rate?

Slide 33

Is there a P wave? Is there an inverted P wave? If so, is it 1:1? If there is a PR interval, is it between 0.12 and 0.20 seconds? Is the QRS 0.12 seconds? Is it regular? What is the rate?

Slide 34

Is there a P wave? Is there an inverted P wave? If so, is it 1:1? If there is a PR interval, is it between 0.12 and 0.20 seconds? Is the QRS 0.12 seconds? Is it regular? What is the rate?

Slide 35

Rules for Junctional Rhythms No P wave or inverted P wave in lead II Not 1:1 (if no P wave) can be 1:1 if inverted P wave QRS tight 0.12 PR interval if there is one is between 0.12 and 0.20 Regular < 40 BPM Idio Junctional 40 to 60 BPM Junctional Rhythm 61 to 150 BPM Accelerated Junctional Rhythm or Junctional Tachycardia

Slide 36

ATRIAL RHYTHMS

Slide 37

Atrial rhythm resembles sinus rhythm, but originates from a different atrial focus. It can be recognized by the abnormal configuration of the p-wave. An atrial ectopic rhythm is a rhythm where the impulse formation in the atrium is coming from the wrong place. (Ectopic means out of place or from the wrong place.) We will discuss two types: Atrial Fibrillation Atrial Flutter

Slide 38

Atrial fibrillation is an irregular and often rapid heart rate that commonly causes poor blood flow to the body. During atrial fibrillation, the heart's two upper chambers (the atria) beat chaotically and irregularly out of coordination with the two lower chambers (the ventricles) of the heart. ATRIAL FIBRILLATION

Slide 39

Slide 40

Atrial fibrillation symptoms A number of people have no symptoms. The most common symptom in people with intermittent atrial fibrillation is palpitations, a sensation of rapid or irregular heartbeat. This may make some people very anxious. Many people also describe an irregular fluttering sensation in their chests. Some become light-headed or faint. Other symptoms include weakness, lack of energy or shortness of breath (SOB) with effort, and chest pain. The biggest complication of A Fib is a blood clot caused because the blood does not move quickly enough through the heart.

Slide 41

(A-FIB) No P wave No PR interval QRS is 0.12 Is regularly irregular < 60 BPM still called A Fib > 100 BPM - Rapid A Fib RULES FOR ATRIAL FIBRILLATION

Slide 42

A FIB DOESNT ALWAYS LOOK THE SAME

Slide 43

Lets start by asking some questions. Is there a P wave? Is there a PR interval? Is the QRS 0.12 seconds? Is it regular or regularly irregular? Dont forget 100 BPM - Rapid A Fib

Slide 44

Is there a P wave? Is there a PR interval? Is the QRS 0.12 seconds? Is it regular or regularly irregular? Dont forget 100 BPM - Rapid A Fib

Slide 45

Slide 46

Slide 47

ATRIAL FLUTTER Atrial flutter occurs when the electrical impulses take an abnormal path through the atria, typically circulating around the tricuspid valve in the right atrium. The abnormal path of the impulses makes the atria contract very rapidly. These rapid contractions are slowed when they reach the AV node often with every second or third contraction reaching the ventricle. The heart beats in a regular rhythm, but it beats rapidly.

Slide 48

VENTRICULAR RHYTHMS

Slide 49

A ventricular rhythm occurs when the SA and AV nodes are not firing or are too slow to be effective.

Slide 50

RULES FOR VENTRICULAR RHYTHMS No P wave No PR interval No 1:1 QRS is wide > 0.12 Usually regular although it can be slightly irregular 20-40 BPM Idio ventricular 40- 150 BPM - Ventricular 150- 350 BPM Ventricular tachycardia (V tach)

Slide 51

Rules for Idioventricular Rhythms No P wave No PR interval No 1:1 QRS is wide > 0.12 Usually regular although it can be slightly irregular 20-40 BPM Idio ventricular

Slide 52

Ventricular Rhythm 40 150 BPM

Slide 53

Ventricular Tachycardia Ventricular tachycardia (V-tach or VT) is a tachycardia, or fast heart rhythm, that originates in one of the ventricles of the heart. This is a potentially life-threatening arrhythmia because it may lead to ventricular fibrillation, asystole, and sudden death.

Slide 54

RULES FOR VENTRICULAR TACHYCARDIA (V Tach) A LETHAL RHYTHM No P wave QRS > 0.12 seconds Big and wide Rate - fast > 150 PBM Usually regular but can be slightly irregular

Slide 55

V Tach Does it have a P wave? Is the QRS > 0.12 seconds? Is it big and wide? Is the rate > 150 BPM?

Slide 56

Heres another one Does it have a P wave? Is the QRS > 0.12 seconds? Is it big and wide? Is the rate > 150 BPM?

Slide 57

Last one Does it have a P wave? Is the QRS > 0.12 seconds? Is it big and wide? Is the rate > 150 BPM?

Slide 58

RULES FOR VENTRICULAR FIBRILLATION V FIB - A LETHAL RHYTHM No P wave Varied amplitude of QRS or indiscernible No PR interval No regularity chaotic

Slide 59

Time to ask some questions Does it have a P wave? Is there a PR Interval? Do you see a QRS? (or do you see varied amplitude of possible QRSs with no pattern) Is there any regularity or is it chaotic?

Slide 60

More practice Does it have a P wave? Is there a PR Interval? Do you see a QRS? (or do you see varied amplitude of possible QRSs with no pattern) Is there any regularity or is it chaotic?

Slide 61

Torsades de pointes Does it have a P wave? Is there a PR Interval? Do you see a QRS? (or do you see varied amplitude of possible QRSs with no pattern) Is there any regularity or is it chaotic?

Slide 62

last one Does it have a P wave? Is there a PR Interval? Do you see a QRS? (or do you see varied amplitude of possible QRSs with no pattern) Is there any regularity or is it chaotic?

Slide 63

V Fib vs V Tach End

Slide 64

Any Final Questions