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
&
Block?
Clogged blood vessels
= ioxygen to the
heart = heart attack
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
Normal Values
Heart Rate:
60-100 beats per minute
PR Interval:
.12-.20 seconds
QRS Interval:
< .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?
SINUS
3. What is the HEART RATE?
ATRIAL
JUNCTIONAL
4. What is the PR interval?
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
PVC
PJC
PAC
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
exits
enters
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 (PJC)
• 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
1°AVB
•Second Degree
Wenkebach
Mobitz II
•Third Degree
3°AVB
Premature Atrial Contraction (PAC)
• Early beat
• Normal PR interval
The alarm clock
Always goes off
PREMATURELY!!
Triplet
Which rhythms are a
CODE Blue?
•
•
•
•
•
VT
VFib
Asystole
Torsades
PEA
WAY TO GO!
You’re catching on!