ECG Rhythm recognition.

LEARNING OUTCOMES.

• To recognise and understand the ‘Normal’ heart rhythm and what it represents.

• To perform a step by step basic rhythm strip analysis.

• To recognise common cardiac arrhythmias.

Conduction system of the heart.

Normal sinus rhythm

7 Questions to ask.

1. Is the rhythm fast or slow?2. Are all the P waves alike?3. Are all the QRS complexes alike?4. Is there a P wave in front of every QRS?5. Is the PR interval constant or does it vary?6. Is the PR interval too short or too long?7. Is the QRS complex widened?

Common Rhythms?

TachycardiaBradycardiaAFHeart Blocks

12 lead ECG may be required to confirm a diagnosis.

Common Rhythms.

Atrial Fibrillation

Atrial Flutter

First degree heart block

Second degree heart block

Complete heart Block/Third degree heart block.

Look back at the conduction picture and consider where these blocks are!

Ectopic beats.

Atrial Ectopic - Premature atrial conduction

Ventricular Ectopic - Premature ventricular conduction.

Discuss possible causes of a cardiac arrhythmia.

What symptoms may your patient present with if they experience a change is heart Rhythm?

POP QUIZ!

1. Which stage of Normal sinus rhythm represent ATRIAL DEPOLARISATION?

2. What does the T wave on ECG represent?3. Describe how to measure HR on 12 Lead ECG.4. Which Heart Block presents with a prolonged P-R interval?5. How can you tell the difference between an atrial or a ventricular

premature conduction?6. What HR may be on the cardiac monitor if patient is in PEA?7. What is the normal length of time for the P-R interval?8. What does the term Paroxysmal mean?

There is a prize for the winning team!!

Further reading and references.

• J. R. Levick (2003) 4th ed. An introduction to cardiovascular Physiology.

• ECG Interpretation made incredibly easy.(2011) 5th ed - Available as PDF online.

• http://www.youtube.com/cardiacconduction• http://www.nhlbi.nih.gov/health/health-

topics/topics/arr