Quick Clinical Analysis ECG INTERPRETATION

We will learn to quickly identify 18 rhythms.

We will focus only on identification not causes ,

pathophysiology or treatment. See examples in your handout

OVERVIEW

1)  P-waves and T-waves are upright

2)  P-waves precede all QRS complexes

3)  QRS complexes are narrow less than 0.12 milliseconds

4)  P-R intervals are less than 0.20 milliseconds

5)  The J-Point is isoelectric

6)  The heart rate is between 60-100 beats per minute

1-NORMAL SINUS RHYTHM

1) All the features of NSR except rate is less than 60 beats per minute

2-SINUS BRADYCARDIA

1) Same as NSR except rate over 100 beats per minute

3) SINUS TACHYCARDIA/SUPERVENTRICULAR TACHCARDIA

1)  No P-waves

2)  Irregularly irregular pattern of QRS complexes

3)  multiple undulations between normal width QRS complexes ( less than 0.12 ms)

4-ATRIAL FIBRILLATION

1) Identifiable saw-tooth pattern between regular QRS complexes( less than 0.12 ms)

5-ATRIAL FLUTTER

1-fixed prolonged P-R interval( over 0.20 ms /5 small boxes)

6-1ST DEGREE AV BLOCK

1) Progressive prolongation of the P-R interval until a beat/QRS is dropped/missed and the the cycle repeats.

7-2ND DEGREE AV BLOCK TYPE 1

Fixed prolonged P-R interval with dropped beats/QRS complexes

8-2ND DEGREE AV BLOCK TYPE 2

1)  p-waves are regularly spaced but have no relationship to the QRS complexes

2)  QRS Complexes are wide ( over 0.12 ms)

3)  The P-waves seem to be marching through the QRS complexes

9-THIRD DEGREE AV BLOCK

1)-there are no P-waves

2)-can look like sinus rhythm but P-wave is absent

3) Can be wide QRS complexes without P-waves

10-JUNCTIONAL RHYTHMS

1)-regular wide QRS complexes with a rate over 100 beats per minute

2) No P-waves are seen

11-VENTRICULAR TACHYCARDIA

1) No P-waves or QRS complexes seen but there is electrical activity

12-VENTRICULAR FIBRILLATION

1) No electrical activity is seen even though baseline often wanders

13-ASYSTOLE

1)  No P-waves or QRS complexes are seen but electrical activity is present and so is a form of ventricular fibrillation.

2)  There is a characteristic sine wave pattern

14-TORSADES DE POINTS( TWISTING POINTS)

The J-point is elevated

15-ST ELEVATION

1) The J-point is depressed

16-ST DEPRESSION

1) Wide QRS complexes that occur before the next QRS complex is due

17-PVC’S ( PREMATURE VENTRICULAR CONTRACTIONS)

1)  You see a new P, QRS and T-wave prior to when the next is expected

2)  often get a compensatory pause in the cycle after the PAC and the regular rhythm resumes.

3)  However there may be no pause.

18- PAC ( PREMATURE ATRIAL CONTRACTIONS)