EKG Primer2woEKGs (1)

7/30/2019 EKG Primer2woEKGs (1)

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EKGPrimer

Seminar

Brumfield


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Roadmap Paper and measurements

Rate

Rhythm

Axis

Intervals

Bundle Branch Blocks Ischemia and infarctions

Sample EKGs


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PaperAt standard speed of 25 mm/s

1 little box is 0.04 seconds

5 little boxes is 0.20 seconds (5 x 0.04s = 0.20s)

5 big boxes is 1 second


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Rate Nml 60 to 100

Estimate by (or Cycles in 6sec of strip x 10)


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Rhythm Start with 3 questions

Nml, Too Fast or Too Slow

Ventricular or Supraventicular

Regular or Irregular

MORE LATER


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Axis Nml 0

0+90

0

Right axis deviation +900+180

0

Left axis deviation-

30

0

-

90

0

Indeterminate/Extreme axis deviation -900-180

0


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Intervals

PR interval: Nml 0.12 0.2 seconds

QRS interval: Nml


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Bundle Branch Blocks (BBB) Left BBB (QRS complex 0.12 sec)

Broad tall R wave (can be mildly notched) in lead Iand V6

QS or rS wave in lead V1


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Bundle Branch Blocks (BBB) Right BBB (QRS complex 0.12 sec)

rSR Complex (M) in lead V1, V2 or V3

Wide S wave in lead I and V6


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Waveforms and Ischemia Pathologic Q waves

Need to be 0.04 sec wide and 1mm deep (1 small

box wide and 1 small box deep) Indicate prior infarction

ST segment abnormalities

Elevation (infarction) or depression (ischemia)

T wave abnormalities

Inversion (suggests ischemia)


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Ischemia/Infarction Localization Anterior: ST changes in Leads I and V2-4

(Proximal LAD)

Anterior-lateral: ST changes in Leads I, aVLand V1-6 (Proximal LAD)

Lateral: ST changes in Leads I, aVL and V5-6(Distal LAD)

Inferior-lateral: ST changes in Leads II, III,aVF and V5-6 (Proximal RCA)

Inferior: ST changes in Leads II, III and aVF(Distal RCA)


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Rhythm


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Rhythm Start with 3 questions

Nml, Too Fast (>100) or Too Slow (


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Rhythm Then ask four more:

Is:

there a P before every QRS?

there a QRS after every P?

the PR interval prolonged?

the QRS prolonged?


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Bradycardia Rate below 60

Causes:

Sinus node dysfunction (sick sinus syndrome issymptomatic chronic inappropriate bradycardia)

AV blocks:

First Degree

Second Degree Mobitz type I

Mobitz type II First Degree

Third Degree (complete heart block)


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AV blocks

First Degree

Prolonged PR interval (>0.2 sec)

Usually asymptomatic and no interventionneeded


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AV blocks (cont)

Second Degree

Mobitz type I (Wenckebach)

Progressive prolongation of the PR interval before ablocked beat

Usually high AV node block with Narrow QRS

Usually asymptomatic and no intervention needed


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AV blocks (cont)

Second Degree

Mobitz type II First Degree

Has a fixed PR interval with dropped QRS

Low AV nodal or HIS-purkinje system block

QRS is usually wide (LBBB or bifascicular block)

Need pacemaker


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AV blocks (cont)

Third Degree (complete heart block)

Complete lack of AV conduction with

escape rhythm producedAV nodal or HIS-purkinje system block

No Ps produce QRS complexes (escaperate)


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Tachycardia

Narrow Complex

Wide Complex


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Narrow Complex Tachycardia (NCT)

Regular Rhythm Sinus Tachycardia (ST)

Atrial Flutter (AFl) (discuss) Paroxysmal Supraventricular Tachycardia (PSVT)

AV nodal reentrant Tachycardia (AVNRT) is mostcommon

Irregular Rhythm Sinus Arrhythmia

Atrial Fibrillation (AF) (discuss)

Multifocal Atrial Tachycardia (MAT)


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Atrial Fibrillation

Most common cardiac arrhythmia

Irregular rhythm

Irregular fibrillatory waves to flat (no P waves)

QRS narrow(unless conduction defect)


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Atrial Flutter

Rapid, regular rhythm with atrial rates of 250350bpm (Narrow complex unless conduction defect)

Ventricular response rate can be 2:1, 4:1, 8:1(it isusually a 2:1 block creating the classic 150 bpm regular

ventricular rhythm) classic indenticle flutter waves (sawtooth pattern)


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Wide Complex Tachycardia (WCT)

Wide QRS are >0.12 seconds Causes of Wide Complex

Bundle branch block (BBB)

Ventricular Rhythm

Hyperkalemia

Wolff-Parkinson-White

WCT are: Ventricular Tachycardia (VT) (discuss) SVT with BBB

SVT with aberrant conduction


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Ventricular Tachycardia

Ventricular rate is 120-220 bpm

PVC-like Wide QRS

Concordance(all QRS complexes in V1-6 are either positiveor negative)


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Ventricular Fibrillation

Ventricular rate 300-600 bpm

Fibrillatory base line(cannot make out QRS

complexes)

Documents

EKG Primer2woEKGs (1)