patrick hegge. anatomy heart location and size the electrocardiogram note: do not use this...

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  • 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