Transcript PowerPoint Presentation - McGraw Hill Higher Education

5
Regularity
Fast & Easy ECGs, 2nd E – A SelfPaced Learning Program
Fast & Easy ECGs, 2E
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Rhythm
• Another initial step of analyzing an ECG
rhythm is determining its rhythm or regularity
Q
Fast & Easy ECGs, 2E
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Rhythm
• Normally the heart beats in a regular, rhythmic
fashion
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Fast & Easy ECGs, 2E
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Rhythm
• Irregularities in the heart rhythm are
considered abnormal and can indicate serious
conditions or deteriorate into deadly cardiac
dysrhythmias
Fast & Easy ECGs, 2E
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Determining Regularity
• The regularity of a rhythm can be determined
by looking at the R-R intervals and P-P
intervals
Fast & Easy ECGs, 2E
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Determining Regularity
• If the distance of the R-R intervals and P-P
intervals is the same the rhythm is regular
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Determining Regularity
• If the distance differs, the rhythm is irregular
Fast & Easy ECGs, 2E
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Determining Regularity
• Several methods can be used to determine
rhythm regularity including:
– Paper and Pen Method
– Caliper Method
– Counting the Small Squares Method
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Paper and Pen Method
• Simple and quick and requires no
special tools. To perform:
– Place the straight edge of a piece
of paper above or over the ECG
tracing so that the intervals are still
visible
– Identify a starting point and place a
mark on paper in the
corresponding position above it
– Find peak of the next consecutive R
wave or P wave and place a mark
on the paper in the corresponding
position above it.
– Move the paper across the ECG
tracing, aligning the two marks
with succeeding R-R intervals or PP intervals
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Caliper Method
• Requires special, easy to use tool.
To perform:
– Place ECG tracing on a flat surface
– Position one point of caliper on a
starting point
– Open calipers by pulling the other
leg until the point is positioned on
the next R wave or P wave
– With the calipers open in that
position and keeping the point
positioned over the second P
wave or R wave rotate the calipers
across to the peak of the next
consecutive P waves or R waves
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Counting the Small Squares Method
• Requires no special tools but is time consuming. To perform:
– Count the number of small squares between the peaks of two
consecutive R waves (or P waves) and then compare to the other R-R
(or P-P) intervals
– If the number is the same, the rhythm is regular, if it isn’t it is irregular
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Practice Makes Perfect
• For this tracing, determine if the rhythm is
regular or irregular
I
Fast & Easy ECGs, 2E
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© 2013 The McGraw-Hill Companies, Inc. All rights reserved.
Practice Makes Perfect
• For this tracing, determine if the rhythm is
regular or irregular
I
Fast & Easy ECGs, 2E
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© 2013 The McGraw-Hill Companies, Inc. All rights reserved.
Practice Makes Perfect
• For this tracing, determine if the rhythm is
regular or irregular
I
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Types of Irregularity
• An irregularity in the rhythm can range from
being occasionally irregular to being totally
irregular
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Occasionally Irregular
• An occasionally irregular rhythm is mostly
regular but from time to time there is an area
of irregularity
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Very Irregular
• A very irregular rhythm has many areas of
irregularity
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Slightly Irregular
• May appear to
change only slightly
as the P-P intervals
and R-R intervals
vary just a bit
• One cause is a
pacemaker that
changes location
from site to site
Q
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Sudden Changes in Heart Rate
• A normal rate
that suddenly
accelerates to a
rapid rate or
slows abruptly
produce an
irregularity in the
rhythm
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Totally Irregular
• There is no
consistency to
the irregularity
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Patterned Irregularity
• Also referred to
as regularly
irregular, this
type of regularity
repeats itself in a
cyclic fashion
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Varying Conduction Ratio Irregularity
• Is seen when
the number of
atrial impulses
preceding the
ventricular
impulses varies
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Practice Makes Perfect
• For this tracing, determine the regularity
I
Fast & Easy ECGs, 2E
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© 2013 The McGraw-Hill Companies, Inc. All rights reserved.
Practice Makes Perfect
• For this tracing, determine the regularity
I
Fast & Easy ECGs, 2E
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© 2013 The McGraw-Hill Companies, Inc. All rights reserved.
Practice Makes Perfect
• For this tracing, determine the regularity
I
Fast & Easy ECGs, 2E
25
© 2013 The McGraw-Hill Companies, Inc. All rights reserved.
Practice Makes Perfect
• For this tracing, determine the regularity
I
Fast & Easy ECGs, 2E
26
© 2013 The McGraw-Hill Companies, Inc. All rights reserved.
Practice Makes Perfect
• For this tracing, determine the regularity
I
Fast & Easy ECGs, 2E
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© 2013 The McGraw-Hill Companies, Inc. All rights reserved.
Summary
• Determining regularity is an initial step of
analyzing an ECG rhythm
• Irregular rhythms are considered abnormal
and can be caused by a variety of conditions
• If the distance of the R-R intervals or P-P
intervals is the same, the rhythm is regular – if
the distance differs, the rhythm is irregular
Fast & Easy ECGs, 2E
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© 2013 The McGraw-Hill Companies, Inc. All rights reserved.
Summary
• Several methods can be used to determine
rhythm regularity, including using calipers,
marking a paper with a pen, and counting the
small squares between each R-R interval
• Irregularity may be occasionally irregular, very
irregular, or slightly irregular
• A normal rate that suddenly accelerates to a
rapid rate or slows suddenly produces an
irregular rhythm
Fast & Easy ECGs, 2E
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Summary
• A totally irregular rhythm has no consistency
to the irregularity
• Patterned irregularity is where the irregularity
repeats in a cyclic fashion
• Irregularity can also be seen in dysrhythmias
that have a varying atrial-to-ventricular
conduction ratio
Fast & Easy ECGs, 2E
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© 2013 The McGraw-Hill Companies, Inc. All rights reserved.