CURS 03-EKG Patologic

8/20/2019 CURS 03-EKG Patologic

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Basics of ElectrocardiogramBasics of Electrocardiogram


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CHAMBER ENLARGEMENTCHAMBER ENLARGEMENT


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Chamber EnlargementChamber Enlargement

The ECG criteria for diagnosing right or leftThe ECG criteria for diagnosing right or left

ventricular hypertrophy areventricular hypertrophy are very insensitivever

y insensitive i!e!"i!e!"

sensitivity #$%&" 'hich means that #$%& ofsensitivity #$%&" 'hich means that #$%& of

patients 'ith ventricular hypertrophy cannot (epatients 'ith ventricular hypertrophy cannot (erecogni)ed (y ECG criteria*! Ho'ever" therecogni)ed (y ECG criteria*! Ho'ever" the

criteria arecriteria are very specificver

y specific i!e!" specificity +,%&"i!e!" specificity +,%&"

'hich means if the criteria are met" it is very'hich means if the criteria are met" it is very

li-ely that ventricular hypertrophy is present*!li-ely that ventricular hypertrophy is present*!


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LVH - 1LVH - 1

. in /0 1 R in /$ or /2. in /0 1 R in /$ or /2 ++ 3$ mm3$ mm

R in a/LR in a/L ++00 mm00 mm or or " if" if left a4is deviationleft a4is deviation""R in a/LR in a/L ++03 mm03 mm plus

plus . in 555. in 555 ++0$ mm0$ mm

C6RNELLC6RNELL /oltage Criteria for L/H/oltage Criteria for L/Hsensitivity 7 88&" specificity 7 ,$&*sensitivity 7 88&" specificity 7 ,$&*

. in /3 1 R in a/L + 89 mm men*. in /3 1 R in a/L + 89 mm men*

. in /3 1 R in a/L + 8% mm 'omen*. in /3 1 R in a/L + 8% mm 'omen*


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LVH - 2LVH - 2

E.TE. Criteria for L/HE.TE. Criteria for L/H

:diagnostic:":diagnostic:" ++$ points;$ points;

:pro(a(le:" 9 points*:pro(a(le:" 9 points*

ECG Criteria Points

R or . in lim( leads

+ 8%mm

. in /0 or /8 + 3%mm

R in /$ or /2 + 3%mm

Any criteria positive

3 points

.T < T a(normalities

=ithout digo4in

=ith digo4in

3 points

0 point

Left Atrial Enlargementin/0

3 points

Left A4is >eviation 8 points

?R. duration %!%,sec 0 point

>elayed intrinsicoid

deflection in /$ or /2+ %!%$.EC

0 point


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RVHRVH

/0 Lead@/0 Lead@

R. ratio + 0 R. ratio + 0 andand negative T 'avenegative T 'ave

R + 2 mm" R + 2 mm" or or . 8mm". 8mm"

r.RD 'ith RD +0% mm r.RD 'ith RD +0% mm

R in /0 1 . in /$ or /2* + 0% mmR in /0 1 . in /$ or /2* + 0% mm

/$ or /2/$ or /2

R. ratio in /$ or /2 0 R. ratio in /$ or /2 0 R in /$ or /2 $ mm R in /$ or /2 $ mm . in /$ or /2 + mm . in /$ or /2 + mm


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LAELAE

.ensitivity 7 $%&; .pecificity 7 ,%&.ensitivity 7 $%&; .pecificity 7 ,%&

F 'ave durationF 'ave duration ++ %!08s in frontal plane usually%!08s in frontal plane usually

lead 55*lead 55*

Terminal F negativity in lead /0 i!e!" :FterminalTerminal F negativity in lead /0 i!e!" :Fterminal

force:* durationforce:* duration ++%!%9s" depth%!%9s" depth ++0 mm!0 mm!


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RAERAE

F 'ave amplitude +8!$ mm in 55 andor +0!$ mmF 'ave amplitude +8!$ mm in 55 andor +0!$ mm

in /0 .ensitivity 7 $%&; .pecificity 7 ,%&*in /0 .ensitivity 7 $%&; .pecificity 7 ,%&*

?R. voltage in /0 is $ mm?R. voltage in /0 is $ mm andand /8/0/8/0

voltage ratio is +2 .ensitivity 7 $%&;voltage ratio is +2 .ensitivity 7 $%&;

.pecificity 7 ,%&*.pecificity 7 ,%&*Criteria derived from the ?R. comple4 areCriteria derived from the ?R. comple4 are

due to (oth the high incidence of R/Hdue to (oth the high incidence of R/H

'hen RAE is present" and the R/'hen RAE is present" and the R/displacement (y an enlarged right atrium!displacement (y an enlarged right atrium!


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BN>LE BRANCH BL6C.BN>LE BRANCH BL6C.


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Left Bundle Branch Bloc-Left Bundle Branch Bloc-

Electrocardiographic CriteriaElectrocardiographic Criteria

0!The ?R. duration is + 08% ms0!The ?R. duration is + 08% ms

8!Leads /$"/2 and A/L sho' (road and notched8!Leads /$"/2 and A/L sho' (road and notched

or slurred R 'avesor slurred R 'aves

3!=ith the possi(le e4ception of lead A/L" the ?3!=ith the possi(le e4ception of lead A/L" the ?'ave is a(sent in leftsided leads'ave is a(sent in leftsided leads

9!Reciprocal changes in /0 and /89!Reciprocal changes in /0 and /8$!Left a4is deviation may (e present$!Left a4is deviation may (e present


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Right Bundle Branch Bloc-Right Bundle Branch Bloc-

The diagnostic criteria includeThe diagnostic criteria include

0!?R. duration is + 08% ms0!?R. duration is + 08% ms8!An rsrI"rsRI or r.RI pattern in lead /0 or8!An rsrI"rsRI or r.RI pattern in lead /0 or

/8 and occasionally a 'ide and notched R/8 and occasionally a 'ide and notched R

'ave!'ave!3!Reciprocal changes in /$"/2"5 and A/L3!Reciprocal changes in /$"/2"5 and A/L


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08 Lead ECG Basics08 Lead ECG Basics

Bundle Branch Bloc-Bundle Branch Bloc-

Step 1. Determine that the rhythm isStep 1. Determine that the rhythm issupraventricular in origin and has a QRSsupraventricular in origin and has a QRSthat is > 0.12 secs in lead Vthat is > 0.12 secs in lead V11 or MCor MC11 ..

Step 2. ocate the " point in the #C$ cycleStep 2. ocate the " point in the #C$ cycle%end o& the QRS and 'eginning o& the S().%end o& the QRS and 'eginning o& the S().

Step *. Dra+ a line 'ac,+ard into theStep *. Dra+ a line 'ac,+ard into theterminal component o& the QRS.terminal component o& the QRS.

Step -. Shade in the triangle created 'y thisStep -. Shade in the triangle created 'y thisline and the terminal component o& theline and the terminal component o& theQRS.QRS.


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Step . /& the triangleStep . /& the trianglepoints up then it ispoints up then it isaa Right BBBRight BBB..

Shade this areaShade this area


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Step . /& theStep . /& the

triangle pointstriangle points

do+n then it is ado+n then it is a

Left BBBLeft BBB..

Shade this areaShade this area


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Left Anterior Jascicular Bloc-Left Anterior Jascicular Bloc-

Left a4is deviation " usually 9$ to ,% degreesLeft a4is deviation " usually 9$ to ,% degrees

?R. duration usually %!08s unless coe4isting RBBB?R. duration usually %!08s unless coe4isting RBBB

Foor R 'ave progression in leads /0/3 and deeper .Foor R 'ave progression in leads /0/3 and deeper .'aves in leads /$ and /2'aves in leads /$ and /2

There is R. pattern 'ith R 'ave in lead 55 + lead 555There is R. pattern 'ith R 'ave in lead 55 + lead 555

. 'ave in lead 555 + lead 55. 'ave in lead 555 + lead 55

?R pattern in lead 5 and A/L"'ith small ? 'ave?R pattern in lead 5 and A/L"'ith small ? 'ave

No other causes of left a4is deviationNo other causes of left a4is deviation


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Left Fosterior Jascicular Bloc-Left Fosterior Jascicular Bloc-

>iagnostic Criteria include>iagnostic Criteria include

0!?R. duration 0%% 08% ms0!?R. duration 0%% 08% ms

8!No .T segment or T 'ave changes8!No .T segment or T 'ave changes

3!Right a4is deviation 0%% degree*3!Right a4is deviation 0%% degree*

9!?R pattern in inferior leads 55"555"A/J* small K9!?R pattern in inferior leads 55"555"A/J* small K

'ave'ave

$!R. patter in lead lead 5 and A/Lsmall R 'ith$!R. patter in lead lead 5 and A/Lsmall R 'ithdeep .*deep .*

2!No other causes of right a4is deviation2!No other causes of right a4is deviation


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Bifascicular Bundle BranchBifascicular Bundle Branch

Bloc-Bloc- RBBB 'ith either left anterior or left posteriorRBBB 'ith either left anterior or left posterior

fascicular (loc-fascicular (loc-

>iagnostic criteria>iagnostic criteria

0!Frolongation of the ?R. duration to %!08 second0!Frolongation of the ?R. duration to %!08 secondor longer or longer

8!R.RI pattern in lead /0"'ith the RI (eing (road8!R.RI pattern in lead /0"'ith the RI (eing (road

and slurredand slurred3!=ide"slurred . 'ave in leads 5"/$ and /23!=ide"slurred . 'ave in leads 5"/$ and /2

9!Left a4is or right a4is deviation9!Left a4is or right a4is deviation


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Trifascicular Bloc-Trifascicular Bloc-

The combination of RBBB, LAFB and longThe combination of RBBB, LAFB and long

PR intervalPR interval

Implies that conduction is delayed in theImplies that conduction is delayed in the

third fasciclethird fascicle


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.T Elevation and non.T Elevation M5s.T Elevation and non.T Elevation M5s

=hen myocardial (lood supply is a(ruptly=hen myocardial (lood supply is a(ruptlyreduced or cut off to a region of the heart" areduced or cut off to a region of the heart" aseKuence of inurious events occur (eginningseKuence of inurious events occur (eginning

'ith ischemia inadeKuate tissue perfusion*"'ith ischemia inadeKuate tissue perfusion*"follo'ed (y necrosis infarction*" and eventualfollo'ed (y necrosis infarction*" and eventualfi(rosis scarring* if the (lood supply isnDtfi(rosis scarring* if the (lood supply isnDtrestored in an appropriate period of time!restored in an appropriate period of time!

The ECG changes over time 'ith each ofThe ECG changes over time 'ith each ofthese eventsthese events


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E

INFARCTION INJURY ISCHAEMIA


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INFARCE! "#$CAR!I%"INFARCE! "#$CAR!I%"

&SE"I'&SE"I'

myocardium electrically deadmyocardium electrically dead

The electrode lying over the area ofThe electrode lying over the area ofinfarction has the effect of loo-ing throughinfarction has the effect of loo-ing through

the infarcted area as a 'indo'! Thisthe infarcted area as a 'indo'! This

therefore 'ill detect and record potentialstherefore 'ill detect and record potentials

from the myocardium directly opposite!from the myocardium directly opposite!


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IN(%RE! "#$CAR!I%"IN(%RE! "#$CAR!I%"

myocardium is never completely polari)edmyocardium is never completely polari)ed

The electrode lying over the area of inuryThe electrode lying over the area of inury'ill record .T .egment elevation on the'ill record .T .egment elevation on the

ECG (ecause of the myocardium retainingECG (ecause of the myocardium retaining

its polarity!its polarity!


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ISCHAE"IC "#$CAR!I%"ISCHAE"IC "#$CAR!I%"

myocardium e4hi(its impairedmyocardium e4hi(its impaired

repolarisationrepolarisation

The electrode lying over the area ofThe electrode lying over the area of

ischaemia 'ill record T 'ave changes onischaemia 'ill record T 'ave changes on

the ECGthe ECG

.TAGE 0.TAGE 0


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.TAGE 0.TAGE 0 ACTE .TAGE H6R. 6L> ACTE .TAGE H6R. 6L>

Acute stage of inury < The myocardium is Acute stage of inury < The myocardium is

not yet dead and unless rapid interventionnot yet dead and unless rapid intervention

is possi(le then death of the affected areais possi(le then death of the affected area

of muscle 'ill certainly follo'! 5n the caseof muscle 'ill certainly follo'! 5n the caseof rapid intervention then the area of deathof rapid intervention then the area of death

may (e reduced although even 'ithmay (e reduced although even 'ith

treatment some necrosis 'ill ta-e placetreatment some necrosis 'ill ta-e place


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The typical shape of the ECG leads 'hich areThe typical shape of the ECG leads 'hich are

positioned directly over the inured area ofpositioned directly over the inured area of

myocardium 'ill sho' significant .T segmentmyocardium 'ill sho' significant .T segmentelevation of greater than 8 mm" there may alsoelevation of greater than 8 mm" there may also

(e a reduction in the si)e of the R 'ave!(e a reduction in the si)e of the R 'ave!

There 'ill (e .T segment depression in theThere 'ill (e .T segment depression in the

areas of myocardium opposite the inured areaareas of myocardium opposite the inured area

these are -no'n asthese are -no'n as RECIPR$CAL CHANGESRECIPR$CAL CHANGES

SAGE 2SAGE 2


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SAGE 2SAGE 2LATER FATTERN >A. 6L>LATER FATTERN >A. 6L>

5n stage 8 the inured myocardium is no'5n stage 8 the inured myocardium is no'

starting to necrose and this results in ?starting to necrose and this results in ?

'aves (eginning to appear on the ECG'aves (eginning to appear on the ECG

'hich are representations of'hich are representations ofdepolari)ation on the opposite 'all of thedepolari)ation on the opposite 'all of the

heart" this is due to the 'indo' effect overheart" this is due to the 'indo' effect over

the area of dead myocardiumthe area of dead myocardium


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The electrode is loo-ing through theThe electrode is loo-ing through the

electrical 'indo' 'here no electrical activityelectrical 'indo' 'here no electrical activity

occursoccurs

The .T segment elevation 'ill lessen as theThe .T segment elevation 'ill lessen as the

area of inury either (ecomes 5schaemic orarea of inury either (ecomes 5schaemic ordiesdies

T 'aves no' (egin to appear representingT 'aves no' (egin to appear representingthe area of ischaemia 'hich is surroundingthe area of ischaemia 'hich is surrounding

the infarcted musclethe infarcted muscle

SAGE )SAGE )


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SAGE )SAGE )LATE FATTERN =EE. 6L>LATE FATTERN =EE. 6L>

5n stage three" the )one of inury has no'5n stage three" the )one of inury has no'evolved into infarcted myocardiumevolved into infarcted myocardium

There is a pathological ? 'ave seen on theThere is a pathological ? 'ave seen on theECG due to the electrical 'indo' (eingECG due to the electrical 'indo' (eing

presentpresentThe .T segment has no' returned toThe .T segment has no' returned tonormal5soelectric line (ecause the inurednormal5soelectric line (ecause the inuredarea has no' necrosed or (ecome ischaemicarea has no' necrosed or (ecome ischaemic

There is no' a symmetrically inverted T 'aveThere is no' a symmetrically inverted T 'avepresent on the ECG 'hich representspresent on the ECG 'hich representspersistent ischaemia surrounding the area ofpersistent ischaemia surrounding the area ofinfarctinfarct


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SAGE *SAGE *


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SAGE *SAGE *6L> 5NJARCT M6NTH. T6 EAR.6L> 5NJARCT M6NTH. T6 EAR.

5n stage 9 the )one of ischaemia has recovered5n stage 9 the )one of ischaemia has recoveredand the ECG returns to almost normaland the ECG returns to almost normal

Ho'ever there are changes 'hich allo' us toHo'ever there are changes 'hich allo' us to

identify a previous infarct on the ECGidentify a previous infarct on the ECG

The pathological ? 'ave is considered theThe pathological ? 'ave is considered the

finger print for life of a previous myocardialfinger print for life of a previous myocardial

infarctioninfarction

The R 'ave height is reduced in the leadsThe R 'ave height is reduced in the leadspositioned directly over the area of infarctpositioned directly over the area of infarct


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S Ele+ation In,artionS Ele+ation In,artion

Here.s a diagram de/iting an e+ol+ing in,artion0

A! Normal A! Normal ECG prior to M5ECG prior to M5

B! 5schemiaB! 5schemia from coronary artery occlusionfrom coronary artery occlusion

results in .T depression not sho'n* andresults in .T depression not sho'n* andpea-ed T'avespea-ed T'aves

C! 5nfarctionC! 5nfarction from ongoing ischemia results infrom ongoing ischemia results inmar-ed .T elevationmar-ed .T elevation

>E! 6ngoing infarction>E! 6ngoing infarction 'ith appearance of'ith appearance ofpathologic ?'aves and T'ave inversionpathologic ?'aves and T'ave inversion

J! Ji(rosisJ! Ji(rosis months later* 'ith persistent ?months later* 'ith persistent ?'aves" (ut normal .T segment and T'aves" (ut normal .T segment and T'aves'aves


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.T Elevation 5nfarction.T Elevation 5nfarction

Here.s an ECG o, an in,erior "I0

Loo- at theLoo- at the

inferior leadsinferior leads

55" 555" a/J*!55" 555" a/J*!

?uestion@

=hat ECG

changes do

you seeO

.T elevation

and ?'aves

E4tra credit@ =hat is the

rhythmO Atrial fi(rillation irregularly irregular 'ith narro' ?R.*P


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.T Elevation 5nfarction.T Elevation 5nfarction

Here.s an ECG o, an in,erior "I later in time0

No' 'hat doNo' 'hat do

you see in theyou see in the

inferior leadsOinferior leadsO

.T elevation"

?'aves and

T'aveinversion


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Non.T Elevation 5nfarctionNon.T Elevation 5nfarction

S de/ression -a+e in+ersionS de/ression -a+e in+ersion

he ECG hanges seen ith a non-S ele+ation in,artion are0

Before inury Normal ECG

S de/ression -a+e in+ersion

S ret3rns to baseline4 b3t -a+e

in+ersion /ersists

5schemia

5nfarction

Ji(rosis


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Non.T Elevation 5nfarctionNon.T Elevation 5nfarction

Here.s an ECG o, an e+ol+ing non-S ele+ation "I0

Note the .TNote the .T

depressiondepression

and T'aveand T'aveinversion ininversion in

leads /leads /88//22!!

?uestion@ =hat area of

the heart is

infarctingO

Anterolateral

ECGECG


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ECGECG

ECGECG


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ECGECG

ECGECG


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ECGECG


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ECGECG


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ECGECG

ECGECG


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ECGECG

ECGECG


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ECGECG

ECGECG


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ECGECG


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Rhythm disordersRhythm disorders


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Normal .inus RhythmNormal .inus Rhythm

Rate 2%0%%(pm

P-P Reg3larit5 Regular

R-R Reg3larit5 Regular

P a+e FresentP06RS Ratio 0@0" associated

PR Inter+al Normal

6RS 7idth Normal


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.inus Bradycardia.inus Bradycardia

Rate Less than 2%(pm



P a+e Fresent

P06RS Ratio 0@0" associated

PR Inter+al Normal" gradually lengthens 'ith HR decrease

6RS 7idth Normal


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.inus Tachycardia.inus Tachycardia

Rate Greater than 0%%(pm" Gradual onset



P a+e Fresent

P06RS Ratio 0@0" associatedPR Inter+al Normal" gradually shortens 'ith HR increase

6RS 7idth Normal


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.inus Arrhythmia.inus Arrhythmia

Rate 2%0%%(pm

P-P Reg3larit5 5rregular

R-R Reg3larit5 5rregular

P a+e Fresent


PR Inter+al Normal

6RS 7idth Normal


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.inus FauseArrest.inus FauseArrest

Rate /aries



P a+e Fresent" e4cept during pause


PR Inter+al Normal

6RS 7idth Normal


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.inus Node E4it Bloc-.inus Node E4it Bloc-

Rate /aries



P a+e Fresent" e4cept during dropped (eats


PR Inter+al Normal

6RS 7idth Normal

.inus Rhythm ' FAC.inus Rhythm ' FAC


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.inus Rhythm ' FAC.inus Rhythm ' FACFremature Atrial Contraction*Fremature Atrial Contraction*

Rate >epends on underlying sinus rate



P a+e Fresent" may (e different morphology during FAC


PR Inter+al Normal" varies during FAC

6RS 7idth Normal


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Atrial Tachycardia Atrial Tachycardia

Rate 0%%0Q%(pm" .udden onset



P a+e Morphology 'ill differ from sinus p'ave


PR Inter+al 5nterval of ectopic focus 'ill differ from sinus FR

6RS 7idth Normal" (ut can develop a(errant 'ide* comple4es


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Multifocal Atrial TachycardiaMultifocal Atrial Tachycardia

Rate Greater than 0%%(pm

P-P Reg3larit5 5rregularly irregular

R-R Reg3larit5 5rregularly irregular

P a+e At least 3 different p'ave morphologies


PR Inter+al /aries

6RS 7idth Normal


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Atrial Jlutter Atrial Jlutter

Atrial RateVentri3lar Rate

Atrial Rate commonly 8$%3$%(pm/entricular Rate 'ill vary 'ith conduction


R-R Reg3larit5 sually regular" (ut may (e varia(le

P a+e .a'toothS p'ave morphology

P06RS Ratio /aries" can (e 0@0" 8@0" 3@0" 9@0" etc!

PR Inter+al /aries

6RS 7idth Normal


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Atrial Ji(rillation Atrial Ji(rillation

Rate /aries" ventricular response can (e fast or slo'

P-P Reg3larit5 Chaotic atrial activity

R-R Reg3larit5 5rregularly irregular

P a+e No discerna(le p'aves

P06RS Ratio None

PR Inter+al None

6RS 7idth Normal" (ut can develop a(errant 'ide* comple4es


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unctional Rhythmunctional Rhythm

Rate 9%2%(pm

P-P Reg3larit5 None" or Regular if antegrade or retrograde


P a+e /aria(le none" antegrade" or retrograde*

P06RS Ratio None" or 0@0 if antegrade or retrogradePR Inter+al None" short" or retrograde

6RS 7idth Normal

.upraventricular Tachycardia.upraventricular Tachycardia


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.upraventricular Tachycardia.upraventricular Tachycardia

./T*./T*

Rate 2%0%%(pm Accelerated unctional Rhythm*Greater than 0%%(pm .upraventricularTachycardia*

P-P Reg3larit5 None" or Regular if antegrade or retrograde


P a+e /aria(le none" antegrade" or retrograde*P06RS Ratio None" or 0@0 if antegrade or retrograde

PR Inter+al None" short" or retrograde

6RS 7idth Normal

.inus Rhythm ' F/C.inus Rhythm ' F/C


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.inus Rhythm ' F/C.inus Rhythm ' F/CFremature /entricular Contraction*Fremature /entricular Contraction*

Rate >epends on underlying sinus rate



P a+e No F'aves 'ith the F/C

P06RS Ratio No F'aves 'ith the F/C

PR Inter+al None

6RS 7idth =ide comple4 +7 %!08sec*!


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/entricular Rhythm/entricular Rhythm

Rate 8%9%(pm

P-P Reg3larit5 None


P a+e None

P06RS Ratio NonePR Inter+al None



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Accelerated /entricular Rhythm Accelerated /entricular Rhythm

Rate 9%0%%(pm

P-P Reg3larit5 None


P a+e None

P06RS Ratio NonePR Inter+al None



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/entricular Tachycardia/entricular Tachycardia

Rate 0%%8%%(pm

P-P Reg3larit5 /aria(le


P a+e >issociated atrial rate

P06RS Ratio /aria(lePR Inter+al None



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Jast /T /entricular Jlutter*Jast /T /entricular Jlutter*

Rate 8%%3%%(pm

P-P Reg3larit5 None


P a+e None

P06RS Ratio None

PR Inter+al None



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Folymorphic /T Torsades*Folymorphic /T Torsades*

Rate 8%%8$%(pm

P-P Reg3larit5 None


P a+e None

P06RS Ratio None

PR Inter+al None

6RS 7idth /aria(le 'ith 'ide comple4es


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/entricular Ji(rillation/entricular Ji(rillation

Rate 5ndeterminate

P-P Reg3larit5 None

R-R Reg3larit5 Chaotic Rhythm

P a+e None

P06RS Ratio None

PR Inter+al None

6RS 7idth None

.inus Rhythm.inus Rhythm


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.inus Rhythm.inus Rhythm' 0' 0stst >egree A/ Bloc->egree A/ Bloc-

Rate >epends on underlying rhythm



P a+e Fresent" Normal

P06RS Ratio 0@0" associatedPR Inter+al Frolonged" + %!8%sec

6RS 7idth Normal

.inus Rhythm

' 8nd >egree A/ Bloc- Type 5 =enc-e(ach*


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' 8nd >egree A/ Bloc- Type 5 =enc-e(ach*



R-R Reg3larit5 Regularly irregular

P a+e Fresent

P06RS Ratio /aria(le; 8@0" 3@8" 9@3" etc

PR Inter+al /aria(le" gradually lengthens until dropped

6RS 7idth Normal

.inus Rhythm

' 8nd >egree A/ Bloc- Type 55


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' 8nd >egree A/ Bloc- Type 55



R-R Reg3larit5 Regularly irregular

P a+e Fresent

P06RS Ratio /aria(le; 8@0" 3@8" 9@3" etcPR Inter+al Normal for conducted (eats

6RS 7idth Normal

.inus Rhythm

' 3rd >egree A/ Bloc- Complete Heart Bloc-*


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' 3rd >egree A/ Bloc- Complete Heart Bloc-*

Atrial RateVentri3lar Rate

Atrial rate is the underlying rhythm i!e" .inus" Atrial Ji(" etc!*/entricular rate is from the dissociated escape rhythm



P a+e FresentP06RS Ratio /aria(le" dissociated

PR Inter+al /aria(le" No pattern

6RS 7idth Normal unctional escape rhythm*=ide /entricular escape rhythm*

.inus Rhythm ' BBB

Bundle Branch Bloc-*


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Bundle Branch Bloc-*

Rate >epends on the underlying sinus rhythm



P a+e Fresent

P06RS Ratio 0@0" associatedPR Inter+al Normal

6RS 7idth =ide +%!08ms*


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no'ledge Chec-pointno'ledge Chec-point


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5dentify the Rhythm@5dentify the Rhythm@

A! A!/entricular Tachycardia/entricular Tachycardia

B!B!.inus Bradycardia.inus Bradycardia

C!C!Complete Heart Bloc-Complete Heart Bloc-

>!>! Atrial Ji(rillation Atrial Ji(rillation

E!E!/entricular Ji(rillation/entricular Ji(rillation




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5dentify the Rhythm@5dentify the Rhythm@

A! A!/entricular Tachycardia/entricular Tachycardia

B!B!.inus Bradycardia.inus Bradycardia

C!C!Complete Heart Bloc-Complete Heart Bloc->!>! Atrial Ji(rillation Atrial Ji(rillation

E!E!/entricular Ji(rillation/entricular Ji(rillation




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no'ledge Chec-pointno'ledge Chec-point5dentify the Rhythm@

A!/entricular Tachycardia

B!.inus Bradycardia

C!Complete Heart Bloc-

>!Atrial Ji(rillationE!/entricular Ji(rillation



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5dentify the Rhythm@


B!.inus Bradycardia


>!Atrial Ji(rillationE!/entricular Ji(rillation



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5dentify the Rhythm@


B!.inus Bradycardia


>!Atrial Ji(rillation

E!/entricular Ji(rillation


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PRACICE RH#H" SRIPSPRACICE RH#H" SRIPS

Fractice RhythmFractice Rhythm


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Fractice RhythmFractice Rhythm

.trips.tripsU

6n the follo'ing rhythm strips in su(seKuent slides"determine rhythm presented!

U Consider the follo'ing@

What is the atrial and ventricular rate Is it normal What is the regularity !P"P and R"R#

Are any A$ and%or Bundle branch bloc&s present

'oes the rhythm have a clinical significance

U Ans'ers can (e found in the notes section of the slides!

Fractice Rhythm .trips


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Documents

CURS 03-EKG Patologic