Transcript EKGs - KentuckyOne Health
Name That Rhythm!
Sinus Bradycardia (SB) • Normal except HR<60
V-paced Spike before the QRS
What’s the Difference Between Heart Blockage Clogged
blood
vessels = i oxygen to the heart = heart attack & Block?
Electricity
blocked from traveling normally = arrhythmia
Idioventricular Rhythm • Ventricular beats, but… at a slow rate Your patient is Going down the Drain if he stays In this rhythm very Long!
Pulseless Electrical Activity (PEA) • Normal rhythm, but… * No Pulse* Gabriel is blowing his horn!!
Call Code!
Mobitz I: Wenkebach • PR interval gradually longer until a QRS is dropped • Pattern repeats normal longer longer dropped QRS
Bigeminy Every second beat is a PVC Geminy Cricket!
Atrial Fibrillation (Afib) • Irregular • No definable P waves
unable to count the # of waves
Premature Ventricular Contraction (PVC) •Early ventricular beat
Heart Rate: PR Interval: QRS Interval: Normal Values 60-100 beats per minute .12-.20 seconds < .11 seconds
Couplet
Failure to Capture • Pacer spike is fired, but no beat follows
Mobitz II • PR interval consistent except some QRS missing Blocked QRS
Example PR intervals:
.16 – B - .16 – B - .16 - .16 - B
Normal Sinus Rhythm (NSR) • Rhythm is normal • Rate normal 60-100 • PR normal .12-.20
• QRS normal < .11
Junctional Rhythm • No P wave or PR < .12
Pause • Period of no electrical activity, then resumes
6 Beats of VT
Paroxysmal Atrial Tachycardia (PAT) • Sudden rate change > 150 bpm • QRS shape is similar before & after rate change QRS look
similar
in shape
1 º AVB
PR interval >.20
PR intervals:
.24 - .24 - .24 - .24 - .24
Sinus Tachycardia (ST) • Normal except HR >100 bpm
Ventricular Tachycardia (VT) • Ventricular beats (wide QRS’s) • Rate > 150 bpm Call Code!
Sinus Arrhythmia (SA) • Normal except irregular
Asystole • No electrical activity Call Code!
My heart may stop if This guy was swimming With me!!!
Trigeminy Every 3rd beat is a PVC
3rd Degree AV Block (3º AVB) Atria & ventricles act independently • Regular P waves • Regular QRS complexes But…P waves and QRS not working together • PR interval varies (but not in Wenkebach pattern) • Harmful -- patient needs a pacemaker soon!
blocked normal blocked blocked short blocked normal blocked
Example PR intervals:
.14 – B - .20 – B – B - .12 – B - .44 - .32 - B
Torsades de Pointes • A form of VTach which looks like the rhythm strip is twisting Call CODE!
Steps to Interpret Rhythms
1. Are the beats at regular or irregular intervals apart?
2. Do you see P, QRS, T pattern?
3. What is the HEART RATE ?
4. What is the PR interval?
SINUS ATRIAL JUNCTIONAL VENTRICULAR
5. What is the QRS interval?
A-paced A spike before the P wave site
Mobitz II
PR regular except some QRS are dropped
PR intervals:
.12 – B - .12 - .12 – B - .12 – B
QRS
Atrial Flutter • Numerous P waves that you can count
Premature Beats P
V
C P
J
C P
A
C Wide QRS PR<.12
PR=.12-.20
Wenkebach
PR gradually longer until QRS dropped
PR intervals:
.12 - .18 - .24 – B - .12 - .18 - .24 – B
Ventricular Fibrillation (VF) • Squiggly line Call CODE!
Failure to Sense • Heart is beating just fine, but pacemaker fires anyway • Spikes are not in a consistent place before P or QRS --seen in many different places
ST Elevation
QRS exits higher than it starts enters exits
Wandering Atrial Pacemaker (WAP) • P waves vary in shape (at least 3 different P waves)
3º AVB
PR interval varies, but not in Wenkebach pattern
PR intervals:
.12 – B - .20 – B – B - .16 - .44 – B - .32
Premature Beats
3 Types
Premature
Atrial
Contraction (PAC) Premature
Junctional
Contraction (PJC) Premature
Ventricular
Contraction (PVC)
Bundle Branch Blocks (BBB) QRS >.11
AV-paced Spikes before the P wave site & QRS
Premature Junctional Contraction (P J C) • Early beat • No P wave or PR interval is <.12
First Degree AV Block (1º AVB) • PR interval > .20
A // V Example PR intervals:
.28 - .28 - .28 - .28 - .28 - .28
ST Depression
QRS exits lower than it starts enters exits
Paroxysmal Supraventricular Tachycardia (PSVT) • Sudden rate change >150 bpm • QRS may look different after rate change QRS look
different
in shape
• Types of AV Blocks •
First Degree
•Second Degree
Third Degree
1°AVB
Wenkebach Mobitz II
3°AVB
Premature Atrial Contraction (P A C) • Early beat • Normal PR interval The alarm clock Always goes off PREMATURELY!!
Triplet
Which rhythms are a CODE Blue?
• • • • •
VT VFib Asystole Torsades PEA