Transcript Welcome to Renton Technical College

Patrick Hegge
Anatomy

Heart location and size
The electrocardiogram
Note: Do not use this illustration for measuring PR interval.
Conduction system review
Consists of:
Contraction of the atriums – P wave
Contraction of the ventricles –QRS Complex
The electrocardiogram
Note: Do not use this illustration for measuring PR interval.
Rhythms that if you see on the monitor you will know
and can help the surgical team.
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
Sinus bradycardia
 Same criteria as NSR except heart rate is less
than 60 bpm
Sinus tachycardia
 Same as NSR except heart rate is between 100160 bpm.
 P waves are sometimes absent at higher rates.
. . . . . . . . . . .
A ventricular rhythm occurs when the SA and AV nodes
are not firing or are too slow to be effective.
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
SYMPTOMS OF V TACH
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.
V Tach
Does it have a P wave?
Is the QRS > 0.12 seconds?
Is it big and wide?
Is the rate > 150 BPM?
Here’s another one
Does it have a P wave?
Is the QRS > 0.12 seconds?
Is it big and wide?
Is the rate > 150 BPM?
IDIOVENTRICULAR
20 to 40 BPM
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 QRS’s
with no pattern)
Is there any regularity – or is it chaotic?
End
V Fib vs V Tach
Ventricular fibrillation
 Rapid chaotic rhythm which lacks a pattern
 Rate =>300 bpm (350-450 bpm – DD)
 Life threatening rhythm – call a code!
Asystole
 Either a straight line EKG or chaotic imprint
 Life threatening – call a code!
Junctional Rhythms
Junctional Rhythms
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.
Rules for Junctional Rhythms
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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

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

< 40 BPM
Idio Junctional
40 to 60 BPM
Junctional Rhythm
61 to 99 BPM
Accelerated Junctional Rhythm
> 100 PBM Junctional Tachycardia
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?
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?
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?
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?
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?
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?
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?
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?
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?
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
 40 to 60 BPM
 61 to 150 BPM
Idio Junctional
Junctional Rhythm
Accelerated Junctional Rhythm
or Junctional Tachycardia
ATRIAL RHYTHMS
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
ATRIAL FIBRILLATION
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 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.
RULES FOR
ATRIAL
FIBRILLATION
(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
A FIB DOESN’T ALWAYS LOOK THE SAME
Let’s 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?
Don’t forget < 60 BPM still called A Fib
> 100 BPM - Rapid A Fib
Is there a P wave?
Is there a PR interval?
Is the QRS ≤ 0.12 seconds?
Is it regular or regularly irregular?
Don’t forget < 60 BPM still called A Fib
> 100 BPM - Rapid A Fib
Is there a P wave?
Is there a PR interval?
Is the QRS ≤ 0.12 seconds?
Is it regular or regularly irregular?
Don’t forget < 60 BPM still called A Fib
> 100 BPM - Rapid A Fib
Is there a P wave?
Is there a PR interval?
Is the QRS ≤ 0.12 seconds?
Is it regular or regularly irregular?
Don’t forget < 60 BPM still called A Fib
> 100 BPM - Rapid A Fib
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.
VENTRICULAR
RHYTHMS
A ventricular rhythm occurs when the SA and AV nodes
are not firing or are too slow to be effective.
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)
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
Ventricular Rhythm
40 – 150 BPM
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.
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
V Tach
Does it have a P wave?
Is the QRS > 0.12 seconds?
Is it big and wide?
Is the rate > 150 BPM?
Here’s another one
Does it have a P wave?
Is the QRS > 0.12 seconds?
Is it big and wide?
Is the rate > 150 BPM?
Last one Does
it have a P wave?
Is the QRS > 0.12 seconds?
Is it big and wide?
Is the rate > 150 BPM?
RULES FOR VENTRICULAR FIBRILLATION
V FIB - A LETHAL RHYTHM
No P wave
Varied amplitude of QRS or indiscernible
No PR interval
No regularity – chaotic
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 QRS’s
with no pattern)
Is there any regularity – or is it chaotic?
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 QRS’s
with no pattern)
Is there any regularity – or is it chaotic?
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
QRS’s with no pattern)
Is there any regularity – or is it chaotic?
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 QRS’s
with no pattern)
Is there any regularity – or is it chaotic?
End
V Fib vs V Tach
Any Final
Questions…………………………………………