Student ECG Cardiac Rhythms
|
|
- Betty Ross
- 7 years ago
- Views:
Transcription
1 Student ECG Cardiac Rhythms 1
2 SUPRAVENTRICULAR RHYTHMS Rhythms originating in the sinus node, atria, or AV node 2
3 Rhythms Contents SUPRAVENTRICULAR Normal Sinus Rhythm 6 Sinus Tachycardia 7 Sinus Bradycardia 7 Sinus Arrhythmia 8 Ectopic Atrial Rhythm 10 Wandering Atrial Pacemaker 13 Multifocal Atrial Tachycardia 16 VENTRICULAR Idioventricular Rhythm 48 Accelerated Idioventricular Rhythm 50 Ventricular Tachycardia 52 Torsades de Pointes 56 Ventricular Fibrillation 61 Asystole 63 PVCs 64 Pacemaker Rhythms 67 Atrial Flutter 18 Atrial Fibrillation 23 SVT(AVNRT) 29 Junctional Rhythm 36 Wolf Parkinson White 40 PACs 45 3
4 Sinus Node Rhythms 4
5 Normal Sinus Rhythm Normal sinus rhythm is the normal heart rhythm characterized by p waves emanating from the sinus node, upright in II, III, and avf, and at a rate from 60 to 100. Under normal circumstances there is slight irregularity due to autonomic fluctuation with respiration. Loss of this variability could signify autonomic dysfunction. 5
6 Sinus Tachyardia and Bradycardia Sinus tachycardia is defined as a sinus rhythm at a rate greater than 100. It can get as high as 200 bpm with exercise, but otherwise rarely exceeds 150 bpm. Causes are numerous; treatment is aimed at the underlying cause. Sinus bradycardia is a sinus rhythm at a rate less than 60. It may be physiologic, such as during sleep, with highly trained athletes, from numerous medications. In general treatment may be necessary if the heart rate while awake is < 40 or if >40 and the patient has symptoms 6
7 Sinus Arrhythmia Normally the heart rate accelerates with inspiration and slows with expiration due to autonomic fluctuation. If the irregularity is exaggerated, it is called sinus arrhythmia. In sinus arrhythmia, the P waves are normal, but the rhythm is regularly irregular--this is not uncommon in children and occ. adults. 7
8 Atrial Rhythms 8
9 Ectopic Atrial Rhythm The focus of depolarization is somewhere in the atrium, not the sinus node. Therefore the p-wave axis is usually abnormal. On the ECG, P waves are often inverted in II, III, and avf, where they are normally upright, yet they are constant and regular. The PR interval may be short as the focus is often close to the AV node. 9
10 Ectopic Atrial Rhythm P waves are inverted in II, III, avf, but the PR interval is constant and the rhythm is regular 10
11 Ectopic Atrial Rhythm Cause: Usually increased automaticity in the atria (Increased spontaneous depolarization). Symptoms: none usually Treatment: none 11
12 Wandering Atrial Pacemaker In wandering atrial pacemaker, there are differing foci of depolarization in the atrium other than the sinus node. On the ECG the P waves will be of varying morphologies: some pointed, double peaked, inverted, etc. There should be at least 3 different morphologies apparent. Because of differing distances from the AV node, the P-R intervals will also vary. The rhythm is irregular with a rate less than
13 Wandering Atrial Pacemaker Note differing P waves; rhythm is irregular but rate is less than
14 Wandering Atrial Pacemaker Cause: usually occurs in patients with sinus node dysfunction, atrial abnormalities, increased vagal tone to the SA node, and in normals during sleep. Symptoms: may notice irregular heartbeat, but usually none. Treatment: none; may be transient. 14
15 Multifocal Atrial Tachycardia MAT is similar to wandering atrial pacemaker, except the rate is above 100 bpm. Sometimes the atrial depolarizations will come early and be blocked due to the refractory period of the AV node. They may also be buried in the prior T wave, causing changes in its morphology. 15
16 Multifocal Atrial Tachycardia Different P Wave morphologies Very early P wave hidden in T wave 16
17 Multifocal Atrial Tachycardia MAT is most often seen in patients with severe pulmonary disease (COPD), CHF, especially during exacerbations. Treatment: treat underlying disorder. 17
18 Atrial Flutter This is usually a reentrant type of arrhythmia that occurs in the atria. Instead of discreet p waves, flutter or F waves are seen, typically at a rate close to 300. They are best seen in leads II, III, avf, and they are conducted to the ventricles at a slower rate due to the longer refractory period of the AV node. Typical conduction is 2:1, 3:1, 4:1, etc. The flutter waves are usually sharp and saw-toothed. 18
19 Atrial Flutter Saw-toothed flutter waves, best seen in lead II or III 19
20 What is the rhythm? Same patient: Always look at leads II, III and avf to see P waves more clearly. 20
21 2 to 1 Atrial Flutter Atrial Rate = 300; Ventricular Rate=150(initially) f f f f f f f The rhythm starts out with a 2:1 atrial flutter, then the ratio changes. Every other flutter wave is buried in a QRS. Atrial flutter may be regular or irregular. 21
22 Atrial Flutter Symptoms: if ventricular rate fast, may have dyspnea, angina, etc. Treatment: usually AV blocking meds to control ventricular rate if fast, then cardioversion either electrically or by medications. Arrhythmia focus can be ablated by EP cardiologist. 22
23 Atrial Fibrillation This rhythm results from chaotic random depolarization of the atria. The most common associations are with ischemic, rheumatic, hypertensive heart disease, thyrotoxicosis, heart failure, and aging. 23
24 Atrial Fibrillation Chaotic, uncoordinated atrial activity on ECG Atrial fibrillation may be coarse, with very visible chaotic atrial activity, or fine, even to the point of almost no baseline activity. The ventricular conduction may be fast or slow, but shows an irregularly irregular pattern. 24
25 Atrial Fibrillation From coarse(a) to fine(c) QRS complexes QRS complexes 25
26 Fine Atrial Fibrillation Look closely; sometimes atrial fibrillation is very fine and can be confused with a junctional rhythm. 26
27 Atrial Fibrillation Symptoms: like atrial flutter if ventricular rate fast. Increased risk of stroke, depending on age, htn, etc. Treatment: rate control, anticoagulation vs conversion to sinus electrically or via medications. 27
28 AV Nodal Rhythms Supraventricular Tachycardia (AVNRT) Junctional Rhythm Accelerated Junctional Rhythm 28
29 Supraventricular Tachycardia (SVT) Most are AV nodal reentrant tachycardias (AVNRT), occurring in or around the AV node. Mechanism: when a PAC hits the AV node at the right moment, it can initiate a re-entrant circuit resulting in AVNRT. Usually conduction proceeds down a fast pathway and back up a slow pathway, which has a unidirectional block of antegrade impulses that is variably present. 29
30 AVNRT Mechanism 1. Atrial Impulse 2. PAC enters 3. Re-entry (PAC) AV Node Fast pathway then recovers and conducts retrograde (final common pathway) Slow Pathway blocked Slow pathway recovers first; fast still refractory 30
31 AVNRT Less frequently conduction proceeds in the reverse order Reentrant circuits can occur with pathways outside the AV node. 31
32 SVT (AVNRT) ECG manifestations: Narrow complex regular tachycardia usually > 160 bpm but can be P waves may: Be absent (most) Just follow the QRS-often inverted Just precede the QRS(unusual) 32
33 SVT (AVNRT) Carotid Massage Usual AVNRT with a rapid, narrow complex QRS and no discernable P waves. Conversion to NSR occurs with carotid massage. 33
34 SVT (AVNRT) Notice the small impulse just after the QRS, which is a retrograde P wave 34
35 SVT- Treatment Symtoms: palpitations, dyspnea, angina Acute treatment is with vagal maneuvers like carotid massage or valsalva Drug therapy-adenosine, verapamil, beta blockers, sometimes other antiarrhythmics AV nodal ablation is definitive therapy and may be the therapy of choice as meds are only modestly effective. 35
36 Junctional Rhythm AV nodal tissue can take over as the pacemaker of the heart, especially in the event of sinus node dysfunction. A junctional rhythm is regular, and usually no p waves will be seen. They may be: buried in the QRS complex, occur afterwards during the ST segment, or be superimposed on the T waves. just precede the QRS (rare). 36
37 Junctional Rhythm 37
38 Junctional Rhythm The QRS width is narrow as conduction proceeds normally down the bundle branches, and the rate is approx At higher rates, it is referred to as an accelerated junctional rhythm. When the rate is about 120 or greater, it is probably SVT. Junctional rhythm is not re-entry like AVNRT, but is due to failure of the SA node or increased automaticity (accelerated junctional rhythm). Treatment: atropine for JR if HR inadequate. Usually no treatment for accelerated JR. 38
39 Miscellaneous Supraventricular Rhythms Wolf Parkinson White PACs 39
40 Wolf-Parkinson-White In WPW there is an accessory bypass tract that directly connects the atrium to the ventricle. It is known as the bundle of Kent, and conducts without the delay seen in the AV node. This is know as pre-excitation. 40
41 WPW The ECG manifestations are as follows: 1. Short PR interval 2. Delta wave (early abnormal ventricular depolarization). 3. Widened QRS (due to the delta wave). 41
42 WPW 42
43 WPW 43
44 WPW Patients are prone to supraventricular arrhythmias that can conduct rapidly down the accessory pathway at very fast rates leading to ventricular fibrillation and death. This, however, occurs rarely. Definitive treatment is ablation of the accessory pathway. 44
45 PACs Common extra beats where the atrium depolarizes spontaneously before the next sinus beat should appear. They often have premature and abnormal looking P waves The QRS usually looks like the other QRS complexes. The following R-R interval is usually the same as the sinus beats (or close). 45
46 PACs Notice the early impulse with the unusual P wave that precedes the QRS. The P wave will be buried in the T wave if the beat comes very early. 46
47 VENTRICULAR ARRHYTHMIAS 47
48 Idioventricular Rhythm A focus in the ventricle takes over as the pacemaker of the heart This may be due to failure of pacemaker function from the SA node and AV node. On the ECG there are wide, bizarre QRS complexes at a rate of 20-40, often associated with t-wave inversions. If this rhythm is seen in with a heart block, it is know as a ventricular escape rhythm. 48
49 Idioventricular Rhythm 49
50 Accelerated Idioventricular Rhythm (AIVR) Accelerated idioventricular rhythm (AIVR) is a variant of idioventricular rhythm with a rate of , and often occurs in short bursts after an MI or may be seen with digoxin toxicity. It is from increased automaticity. AIVR is usually transient and benign, and does not carry the same prognosis as ventricular tachycardia. It usually does not require treatment. 50
51 AIVR in a patient 2 days post MI 51
52 Ventricular Tachycardia A potentially dangerous rhythm that is often a re-entrant ventricular arrhythmia, arising from a site of abnormal ventricular tissue, often due to ischemia, fibrosis, cardiomyopathy, etc. It also can be precipitated by hypo or hyperkalemia, severe hypocalcemia, hypomagnesemia, severe illness with high catecholamine states, and congenital causes. 52
53 Ventricular Tachycardia ECG findings: Rapid, wide, bizarre looking QRS complexes at a rate usually above The rhythm may be regular or irregular. Sometimes p-waves that are unrelated to the QRS complexes are seen (AV dissociation), usually confirming the diagnosis of v-tach. 53
54 Ventricular Tachycardia Here, a PVC landing on T wave initiates V Tach 54
55 Ventricular Tachycardia 55
56 Ventricular Tachycardia Treatment: If stable, D/C cardioversion, IV amiodarone, occasionally lidocaine. If unstable (severe dyspnea, chest pain, hypotension)-defibrillation. 56
57 Torsades de Pointes (Twisting of the Points) This is a form of polymorphic ventricular tachycardia that is caused from prolongation of the QT interval (many drugs, low Mg, etc.). On the ECG it looks like v-tach, but the axis shifts 180 degrees, so the complexes shift from positive to negative over several beats. Treatment is with IV magnesium, or pacing to shorten the QT interval. 57
58 Torsades de Pointes 58
59 Torsades de Pointes The Axis shifts 180 degrees 59
60 Torsades de Pointes Treatment: IV Magnesium 2g bolus Defibrillation if sustained/unstable Pacing, isoproterenol to increase HR and shorten QT. 60
61 Ventricular Fibrillation This is a lethal rhythm resulting from chaotic,random depolarization of the ventricle. It is the usual cause of sudden death. There is an undulating, disorganized rhythm without distinct QRS complexes on the ECG, which may be coarse or fine. Treatment is immediate electrical defibrillation. 61
62 Ventricular Fibrillation Coarse Fine 62
63 Asystole No visible electrical actvity Flatline ECG Need to be sure it is not fine v-fib. 63
64 PVCs Premature ventricular contractions are very common, and may be found in up to 40% of normal individuals. Their prognostic importance depends on the underlying condition and presence of structural heart disease. 64
65 PVCs On the ECG they appear as early, wide, bizarrelooking complexes with a different morphology than the underlying rhythm. They typically have an abnormal repolarization pattern, often with ST segment depression and T wave inversion. Ventricular bigeminy refers to the pattern of every other beat being a PVC; trigeminy is where every third beat is a PVC. PVCs grouped in 2s are referred to as couplets. 65
66 PVCs Note the compensatory pause that occurs because the next cycle comes during the PVC or when the ventricle is refractory. 66
67 Pacemaker-Ventricular The ventricular lead is in the right ventricle, and the resultant complex is wide, often with T wave inversions. Notice the spikes just preceding the QRS. 67
68 Dual Chamber Pacemaker (a) (v) Note both atrial(a) and ventricular(v) pacing occur, depending on the need. 68
69 Dual Chamber Pacemaker 69
70 Supraventricular Arrhythmia Algorithm (use for narrow complex QRS). Is Rhythm Regular Or Irregular? Regular Irregular P Waves Present P Waves Absent (Occasionally follow or precede QRS) P Waves Present P Waves Absent or indiscernable HR<100 HR>100 HR HR HR>120 HR<100 HR>100 Atrial Fibrillation Flutter Waves Inverted in II, III, avf Upright in II, III, avf Sinus Tachycardia Atrial Tachycardia (P waves may be inverted) Flutter Waves Junctional Rhythm Accelerated Junctional SVT(us AVNRT) P Wave morphology constant P wave morphology changes Flutter Waves Present MAT, Sinus Tach with PACs or PVCs Flutter Waves Present Atrial Flutter Ectopic Atrial Rhythm or Occasional Junctional Normal Sinus/ Sinus Brady Atrial Flutter Sinus dysrhythmia Wandering Atrial Pacemaker, NSR with PACs Atrial Flutter Atrial Flutter 70
71 Ventricular Arrhythmia Algorithm (Use for Wide Complex QRS) Look at Relationship b/t P Waves and QRS P Waves Absent or unrelated to QRS P Waves Present Before QRS HR <100 HR > Supraventricular Rhythm with Aberrancy (BBB, etc) Idioventricular (HR 20-40); AIVR if HR Complete Heart Block- consider if more P's than QRS Ventricular Tachycardia Ventricular Fibrillation (Chaotic depolarization) Think Torsades if Axis is Shifting 180 Degrees 71
Atrial & Junctional Dysrhythmias
Atrial & Junctional Dysrhythmias Atrial & Junctional Dysrhythmias Atrial Premature Atrial Complex Wandering Atrial Pacemaker Atrial Tachycardia (ectopic) Multifocal Atrial Tachycardia Atrial Flutter Atrial
More informationMULTIPLE CHOICE. Choose the one alternative that best completes the statement or answers the question.
Exam Name MULTIPLE CHOICE. Choose the one alternative that best completes the statement or answers the question. 1) What term is used to refer to the process of electrical discharge and the flow of electrical
More informationBy the end of this continuing education module the clinician will be able to:
EKG Interpretation WWW.RN.ORG Reviewed March, 2015, Expires April, 2017 Provider Information and Specifics available on our Website Unauthorized Distribution Prohibited 2015 RN.ORG, S.A., RN.ORG, LLC Developed
More informationNEONATAL & PEDIATRIC ECG BASICS RHYTHM INTERPRETATION
NEONATAL & PEDIATRIC ECG BASICS & RHYTHM INTERPRETATION VIKAS KOHLI MD FAAP FACC SENIOR CONSULATANT PEDIATRIC CARDIOLOGY APOLLO HOSPITAL MOB: 9891362233 ECG FAX LINE: 011-26941746 THE BASICS: GRAPH PAPER
More informationHTEC 91. Topic for Today: Atrial Rhythms. NSR with PAC. Nonconducted PAC. Nonconducted PAC. Premature Atrial Contractions (PACs)
HTEC 91 Medical Office Diagnostic Tests Week 4 Topic for Today: Atrial Rhythms PACs: Premature Atrial Contractions PAT: Paroxysmal Atrial Tachycardia AF: Atrial Fibrillation Atrial Flutter Premature Atrial
More informationQRS Complexes. Fast & Easy ECGs A Self-Paced Learning Program
6 QRS Complexes Fast & Easy ECGs A Self-Paced Learning Program Q I A ECG Waveforms Normally the heart beats in a regular, rhythmic fashion producing a P wave, QRS complex and T wave I Step 4 of ECG Analysis
More informationNormal Sinus Rhythm. Sinus Bradycardia. Sinus Tachycardia. Rhythm ECG Characteristics Example (NSR) & consistent. & consistent.
Normal Sinus Rhythm (NSR) Rate: 60-100 per minute Rhythm: R- R = P waves: Upright, similar P-R: 0.12-0.20 second & consistent P:qRs: 1P:1qRs Sinus Tachycardia Exercise Hypovolemia Medications Fever Hypoxia
More informationBASIC CARDIAC ARRHYTHMIAS Revised 10/2001
BASIC CARDIAC ARRHYTHMIAS Revised 10/2001 A Basic Arrhythmia course is a recommended prerequisite for ACLS. A test will be given that will require you to recognize cardiac arrest rhythms and the most common
More informationAn Introduction to Tachyarrhythmias R. A. Seyon MN, NP, CCN(C) & Dr. R. G. Williams
Arrhythmias 1 An Introduction to Tachyarrhythmias R. A. Seyon MN, NP, CCN(C) & Dr. R. G. Williams Things to keep in mind when analyzing arrhythmias: Electrical activity recorded in 12 and 15 leads Examine
More informationTachyarrhythmias (fast heart rhythms)
Patient information factsheet Tachyarrhythmias (fast heart rhythms) The normal electrical system of the heart The heart has its own electrical conduction system. The conduction system sends signals throughout
More informationPRO-CPR. 2015 Guidelines: PALS Algorithm Overview. (Non-AHA supplementary precourse material)
PRO-CPR 2015 Guidelines: PALS Algorithm Overview (Non-AHA supplementary precourse material) Please reference Circulation (from our website), the ECC Handbook, or the 2015 ACLS Course Manual for correct
More informationACLS RHYTHM TEST. 2. A 74-year-old woman with chest pain. Blood pressure 192/90 and rates her pain 9/10.
ACLS RHYTHM TEST Name Date Choose the best answer for each of the following questions. Each of the following strips is 6 seconds in length. 1. Identify the following rhythm a. Sinus bradycardia with 2
More informationElectrophysiology Daymar College. Lisa H. Young, RN, BSN, MAE 2011
Electrophysiology Daymar College Lisa H. Young, RN, BSN, MAE 2011 Electrical Conduction Pathway Chemical Basis for Impulse Formation Cardiac Action Potential Phases http://www.youtube.com/watch?v=oqpffilde0e
More informationINTRODUCTORY GUIDE TO IDENTIFYING ECG IRREGULARITIES
INTRODUCTORY GUIDE TO IDENTIFYING ECG IRREGULARITIES NOTICE: This is an introductory guide for a user to understand basic ECG tracings and parameters. The guide will allow user to identify some of the
More informationUnderstanding the Electrocardiogram. David C. Kasarda M.D. FAAEM St. Luke s Hospital, Bethlehem
Understanding the Electrocardiogram David C. Kasarda M.D. FAAEM St. Luke s Hospital, Bethlehem Overview 1. History 2. Review of the conduction system 3. EKG: Electrodes and Leads 4. EKG: Waves and Intervals
More informationthe basics Perfect Heart Institue, Piyavate Hospital
ECG INTERPRETATION: the basics Damrong Sukitpunyaroj MD Damrong Sukitpunyaroj, MD Perfect Heart Institue, Piyavate Hospital Overview Conduction Pathways Systematic Interpretation Common abnormalities in
More informationPresenter Disclosure Information
2:15 3 pm Managing Arrhythmias in Primary Care Presenter Disclosure Information The following relationships exist related to this presentation: Raul Mitrani, MD, FACC, FHRS: Speakers Bureau for Medtronic.
More informationRAPID INTERPRETATION OF. EKG s
Personal Quick Reference Sheets 333 (pages 333 to 346) There is no need to remove these reference pages from your book. To download and print them in full color, go to: www.themdsite.com Reference Sheets
More information22 Arrhythmias. C. Scharf and F. Duru. Siegenthaler, Differential Diagnosis in Internal Medicine (ISBN9783131421418), 2007 Georg Thieme Verlag
22 22 Arrhythmias C. Scharf and F. Duru 22 712 Arrhythmias 22.1 Differential Diagnosis of Arrhythmias 714 Medical History 714 Clinical Examination 714 Electrocardiogram (ECG) 715 Additional Tools for the
More informationDiagnosis Code Crosswalk : ICD-9-CM to ICD-10-CM Cardiac Rhythm and Heart Failure Diagnoses
Diagnosis Code Crosswalk : to 402.01 Hypertensive heart disease, malignant, with heart failure 402.11 Hypertensive heart disease, benign, with heart failure 402.91 Hypertensive heart disease, unspecified,
More informationBasic Cardiac Rhythms Identification and Response
Basic Cardiac Rhythms Identification and Response Module 1 ANATOMY, PHYSIOLOGY, & ELECTRICAL CONDUCTION Objectives Describe the normal cardiac anatomy and physiology and normal electrical conduction through
More informationGUIDELINE 11.9 MANAGING ACUTE DYSRHYTHMIAS. (To be read in conjunction with Guideline 11.7 Post-Resuscitation Therapy in Adult Advanced Life Support)
AUSTRALIAN RESUSCITATION COUNCIL GUIDELINE 11.9 MANAGING ACUTE DYSRHYTHMIAS (To be read in conjunction with Guideline 11.7 Post-Resuscitation Therapy in Adult Advanced Life Support) The term cardiac arrhythmia
More informationIntroduction to Electrophysiology. Wm. W. Barrington, MD, FACC University of Pittsburgh Medical Center
Introduction to Electrophysiology Wm. W. Barrington, MD, FACC University of Pittsburgh Medical Center Objectives Indications for EP Study How do we do the study Normal recordings Abnormal Recordings Limitations
More informationCatheter Ablation. A Guided Approach for Treating Atrial Arrhythmias
Catheter Ablation A Guided Approach for Treating Atrial Arrhythmias A P A T I E N T H A N D B O O K This brochure will provide an overview of atrial arrhythmias (heart rhythm problems affecting the upper
More informationCurrent Management of Atrial Fibrillation DISCLOSURES. Heart Beat Anatomy. I have no financial conflicts to disclose
Current Management of Atrial Fibrillation Mary Macklin, MSN, APRN Concord Hospital Cardiac Associates DISCLOSURES I have no financial conflicts to disclose Book Women: Fit at Fifty. A Guide to Living Long.
More informationCardiac Arrhythmias. Introduction. Sinus Rhythms. Premature Beats. Secondary article. John A Kastor, University of Maryland, Baltimore, Maryland, USA
John A Kastor, University of Maryland, Baltimore, Maryland, USA Cardiac arrhythmias are disturbances in the rhythm of the heart manifested by irregularity or by abnormally fast rates ( tachycardias ) or
More informationTOP 5. The term cardiac arrhythmia encompasses all cardiac. Arrhythmias in Dogs & Cats. Sinus Arrhythmia. TOP 5 Arrhythmias Seen in Dogs & Cats
Top 5 ardiology Peer reviewed TOP 5 rrhythmias in Dogs & ats shley Jones, DVM mara Estrada, DVM, DVIM (ardiology) University of Florida The term cardiac arrhythmia encompasses all cardiac rhythms other
More informationEquine Cardiovascular Disease
Equine Cardiovascular Disease 3 rd most common cause of poor performance in athletic horses (after musculoskeletal and respiratory) Cardiac abnormalities are rare Clinical Signs: Poor performance/exercise
More informationElectrolyte Physiology. Something in the way she moves
Electrolyte Physiology Something in the way she moves me Electrolyte Movement CONCENTRATION GRADIENT ELECTRICAL GRADIENT DRIVING FORCE NERNST NUMBER (E-ion) CONDUCTANCE (G-ion) PERMEABILITY CHANNELS: small
More informationIntroduction to Electrocardiography. The Genesis and Conduction of Cardiac Rhythm
Introduction to Electrocardiography Munther K. Homoud, M.D. Tufts-New England Medical Center Spring 2008 The Genesis and Conduction of Cardiac Rhythm Automaticity is the cardiac cell s ability to spontaneously
More informationBanner Staff Service ECG Study Guide
Banner Staff Service ECG Study Guide Edited by Larry H. Lybbert, MS, RN Table of Contents ECG STUDY GUIDE... 3 ECG INTERPRETATION BASICS... 4 EKG GRAPH PAPER...4 RATE MEASUREMENT...9 The Six Second Method...9
More information8 Peri-arrest arrhythmias
8 Peri-arrest arrhythmias Introduction Cardiac arrhythmias are relatively common in the peri-arrest period. They are common in the setting of acute myocardial infarction and may precipitate ventricular
More informationRecurrent AF: Choosing the Right Medication.
In the name of God Shiraz E-Medical Journal Vol. 11, No. 3, July 2010 http://semj.sums.ac.ir/vol11/jul2010/89015.htm Recurrent AF: Choosing the Right Medication. Basamad Z. * Assistant Professor, Department
More informationCopyright 2006 Blaufuss Multimedia. All rights reserved. Page 1
Copyright 2006 Blaufuss Multimedia. All rights reserved. Page 1 002 Sinus Rhythm, atrial rate 90 Mobitz II AVB, Ventricular rate 50 Left Atrial Enlargement Left Ventricular Hypertrophy RBBB a) Long R-R
More informationSchool of Health Sciences
School of Health Sciences Cardiology Teaching Package A Beginners Guide to Normal Heart Function, Sinus Rhythm & Common Cardiac Arrhythmias Welcome This document extends subjects covered in the Cardiology
More informationElectrophysiology Heart Study - EPS -
Electrophysiology Heart Study - EPS - What is an EPS? EPS is short for ElectroPhysiology heart Study. This procedure looks at the electrical system of your heart. An EPS will show if you have a heart rhythm
More informationCOVERAGE GUIDANCE: ABLATION FOR ATRIAL FIBRILLATION
COVERAGE GUIDANCE: ABLATION FOR ATRIAL FIBRILLATION Question: How should the EGBS Coverage Guidance regarding ablation for atrial fibrillation be applied to the Prioritized List? Question source: Evidence
More information12-Lead EKG Interpretation. Judith M. Haluka BS, RCIS, EMT-P
12-Lead EKG Interpretation Judith M. Haluka BS, RCIS, EMT-P ECG Grid Left to Right = Time/duration Vertical measure of voltage (amplitude) Expressed in mm P-Wave Depolarization of atrial muscle Low voltage
More informationThe abbreviation EKG, for electrocardiogram,
CLIN PEDIATR OnlineFirst, published on January 28, 2010 as doi:10.1177/0009922809336206 Simplified Pediatric Electrocardiogram Interpretation Clinical Pediatrics Volume XX Number X Month XXXX xx-xx 2009
More informationThe Patient s Guide to the Electrophysiologic Study (EPS) and Catheter Ablation
The Patient s Guide to the Electrophysiologic Study (EPS) and Catheter Ablation 2 P a g e Table of Contents Introduction How the Heart Works 3 How the Heart s Electrical System Works 3 Commonly Used Heart
More informationInterpreting a rhythm strip
3 Interpreting a rhythm strip Just the facts In this chapter, you ll learn: the components of an ECG complex and their significance and variations techniques for calculating the rate and rhythm of an ECG
More informationElectrocardiography Review and the Normal EKG Response to Exercise
Electrocardiography Review and the Normal EKG Response to Exercise Cardiac Anatomy Electrical Pathways in the Heart Which valves are the a-v valves? Closure of the a-v valves is associated with which heart
More informationEpisode 20 Atrial fibrillation Prepared by Dr. Lucas Chartier
Episode 20 Atrial fibrillation Prepared by Dr. Lucas Chartier Most common dysrhythmia seen in ED, and incidence increasing with ageing population Presentation Common presentations: younger patients often
More informationACLS PHARMACOLOGY 2011 Guidelines
ACLS PHARMACOLOGY 2011 Guidelines ADENOSINE Narrow complex tachycardias or wide complex tachycardias that may be supraventricular in nature. It is effective in treating 90% of the reentry arrhythmias.
More informationPatient Information Sheet Electrophysiological study
Patient Information Sheet Electrophysiological study Your doctor has recommended performing an electrophysiological study (also called EPS). EPS is a diagnostic procedure designed to test and evaluate
More informationAtrial Fibrillation The Basics
Atrial Fibrillation The Basics Family Practice Symposium Tim McAveney, M.D. 10/23/09 Objectives Review the fundamentals of managing afib Discuss the risks for stroke and the indications for anticoagulation
More informationPRACTICAL APPROACH TO SVT. Graham C. Wong MD MPH Division of Cardiology Vancouver General Hospital University of British Columbia
PRACTICAL APPROACH TO SVT Graham C. Wong MD MPH Division of Cardiology Vancouver General Hospital University of British Columbia CONDUCTION SYSTEM OF THE HEART SA node His bundle Left bundle AV node Right
More informationWide-Complex Tachycardias in the ED: Myths and Pitfalls
Wide-Complex Tachycardias in the ED: Myths and Pitfalls, FACEP, FAAEM Professor and Vice Chair Director, Emergency Cardiology Fellowship Department of Emergency Medicine University of Maryland School of
More informationEvaluation and Initial Treatment of Supraventricular Tachycardia
T h e n e w e ngl a nd j o u r na l o f m e dic i n e clinical practice Evaluation and Initial Treatment of Supraventricular Tachycardia Mark S. Link, M.D. This Journal feature begins with a case vignette
More informationACLS Rhythms for the ACLS Algorithms
ACLS Rhythms for the ACLS Algorithms The Basics 1. Anatomy of the cardiac conduction system: relationship to the ECG cardiac cycle. A, Heart: anatomy of conduction system. B, P-QRS-T complex: lines to
More informationTable of Contents Error! Bookmark not defined.
Table of Contents EKG TRACING...1 Figure 1 - EKG Tracing... Error! Bookmark not defined. STEP 1...1 Rate... 1 Figure 2 - Determining the Rate... 1 Step 2...2 Rhythm... 2 Figure 3 - Determining the Rhythm
More informationBIPOLAR LIMB LEADS UNIPOLAR LIMB LEADS PRECORDIAL (UNIPOLAR) LEADS VIEW OF EACH LEAD INDICATIVE ECG CHANGES
BIPOLAR LIMB LEADS Have both a distinctive positive and negative pole. Lead I LA (positive) RA (negative) Lead II LL (positive) RA (negative) Lead III LL (positive) LA (negative) UNIPOLAR LIMB LEADS Have
More informationAtrial Fibrillation Peter Santucci, MD Revised May, 2008
Atrial Fibrillation Peter Santucci, MD Revised May, 2008 Atrial fibrillation (AF) is an irregular, disorganized rhythm characterized by a lack of organized mechanical atrial activity. The atrial rate is
More informationVCA Veterinary Specialty Center of Seattle
An electrocardiogram (ECG) is a graph of the heart`s electrical current, which allows evaluation of heart rate, rhythm and conduction. Identification of conduction problems within the heart begins with
More informationTrust Guideline for the Management of New-born Babies with abnormal heart rhythm
A clinical guideline recommended for use In: Blakeney Ward, Delivery Suite, Neonatal Unit By: For: Key words: Written by: Supported by: Approved by: Neonatal Medical Staff (SHOs, registrars, consultants)
More informationHow To Understand What You Know
Heart Disorders Glossary ABG (Arterial Blood Gas) Test: A test that measures how much oxygen and carbon dioxide are in the blood. Anemia: A condition in which there are low levels of red blood cells in
More informationInterpreting AV (Heart) Blocks: Breaking Down the Mystery
Interpreting AV (Heart) Blocks: Breaking Down the Mystery 2 Contact Hours Copyright 2012 by RN.com. All Rights Reserved. Reproduction and distribution of these materials is prohibited without the express
More informationGuideline for the management of arrhythmias
Guideline for the management of arrhythmias The following guideline is approved only for use at University College London Hospitals NHS Foundation Trust. It is provided as supporting information for the
More informationIntroduction 2/9/2015
Thomas Haffey, D.O. FACC, FACOI, FNLA, CSOM February, 2015 Atrial Tachycardias Diagram summarizing types of atrial tachycardias often encountered in patients with a history of AF, including those seen
More informationPotential Causes of Sudden Cardiac Arrest in Children
Potential Causes of Sudden Cardiac Arrest in Children Project S.A.V.E. When sudden death occurs in children, adolescents and younger adults, heart abnormalities are likely causes. These conditions are
More informationAmerican Heart Association ACLS Pre-Course Self Assessment Dec., 2006. ECG Analysis. Name the following rhythms from the list below:
American Heart Association ACLS Pre-Course Self Assessment Dec., 2006 ECG Analysis This pre-test is exactly the same as the pretest on the ACLS Provider manual CD. This paper version can be completed in
More informationBradycardia CHAPTER 12 CODE SCENARIO
Senecal-12.qxd 14/04/2005 09:44 AM Page 69 CHAPTER 12 Bradycardia CODE SCENARIO A code is called for a 78-year-old man who was admitted to the hospital for syncope of unknown etiology. He was resting comfortably
More informationThe P Wave: Indicator of Atrial Enlargement
Marquette University e-publications@marquette Physician Assistant Studies Faculty Research and Publications Health Sciences, College of 8-12-2010 The P Wave: Indicator of Atrial Enlargement Patrick Loftis
More informationECG Filtering. Willem Einthoven s EKG machine, 1903
ECG Filtering Willem Einthoven s EKG machine, 1903 ECG Filtering Three common noise sources q Baseline wander q Power line interference q Muscle noise When filtering any biomedical signal care should be
More informationAtrial Fibrillation The High Risk Obese Patient
Atrial Fibrillation The High Risk Obese Patient Frederick Schaller, D.O.,F.A.C.O.I. Professor and Vice Dean Touro University Nevada A 56 year old male with a history of hypertension and chronic stable
More informationAtrial Fibrillation Management Across the Spectrum of Illness
Disclosures Atrial Fibrillation Management Across the Spectrum of Illness NONE Barbara Birriel, MSN, ACNP-BC, FCCM The Pennsylvania State University Objectives AF Discuss the pathophysiology, diagnosis,
More informationSystematic Approach to 12 Lead EKG Interpretation
Systematic Approach to 12 Lead EKG Interpretation Maureen Knechtel MPAS, PA-C Wellmont CVA Heart Institute Disclosure Statement of Financial Interest I, Maureen Knechtel, do not have a financial interest/arrangement
More informationECG made extra easy. medics.cc
ElectroCardioGraphyraphy ECG made extra easy Overview Objectives for this tutorial What is an ECG? Overview of performing electrocardiography on a patient Simple physiology Interpreting the ECG Objectives
More informationPresent : PGY 王 淳 峻 Supervisor: F1 王 德 皓 991109
Present : PGY 王 淳 峻 Supervisor: F1 王 德 皓 991109 Interventions to prevent cardiac arrest + Airway management + Ventilation support + Treatment of bradyarrhythmias & Tachyarrhythmias Treat cardiac arrest
More informationWhat Are Arrhythmias?
What Are Arrhythmias? Many people have questions about what the word arrhythmia means, and arrhythmias can be a difficult subject to understand. The text below should give you a better understanding of
More informationAtrial Fibrillation: The heart of the matter
Atrial Fibrillation: The heart of the matter This booklet has been written especially for people with atrial fibrillation (AF), a heart condition often described as an irregular heartbeat (also known
More informationReview of Important ECG Findings in Patients with Syncope Joseph Toscano, MD
92 Review of Important ECG Findings in Patients with Syncope Joseph Toscano, MD Abstract Guidelines recommend 12-lead ECG as an important test to perform in patients with syncope. Though the incidence
More informationSleep Heart Health Study (SHHS) ECG Protocol
Sleep Heart Health Study (SHHS) ECG Protocol SHHS 1 Electrocardiography (ECG) Baseline ECG is performed in all parent study clinic visits preceding the PSG. All sites perform a standard resting 12-lead
More informationDetecting Atrial-ventricular blocks Arrhythmia based on RR-intervals on ECG Signals
Detecting Atrial-ventricular blocks Arrhythmia based on -intervals on ECG Signals Makki Akasha abikier, Ibrahim Musa Ishag, Mohammed Izzeldin, Dong Gyu Lee, Gyoyong shon, Keun Ho Ryu Database/ioinformatics
More informationJAPI VOL. 52 NOVEMBER 2004 www.japi.org 883
Review Article Wide Complex Tachycardia : Recognition and Management in the Emergency Room IB Ray Abstract Cardiac arrhythmias often present as urgent medical conditions requiring immediate care. Patient
More informationTachyarrhythmias in the ICU
Tachyarrhythmias in the ICU ACNP/PA Critical Care Boot Camp Vanderbilt University Medical Center September 21, 2015 Ariel Kappa RN, MSN, ACNP-BC Acute Arrhythmias are the gremlins of the ICU because they
More informationAtrial fibrillation (AF) patient information
AF A Atrial fibrillation (AF) patient information Providing information, support and access to established, new or innovative treatments for Atrial Fibrillation www.atrialfibrillation-au.org Glossary Antiarrhythmic
More informationNgaire has Palpitations
Ngaire has Palpitations David Heaven Cardiac Electrophysiologist/Heart Rhythm Specialist Middlemore, Auckland City and Mercy Hospitals Auckland Heart Group MCQ Ms A is 45, and a healthy marathon runner.
More information«Δυσλειτουργία βηματοδότη. Πως μπορούμε να την εκτιμήσουμε στο ιατρείο.» Koσσυβάκης Χάρης Καρδιολογικό Τμήμα Γ.Ν.Α. «Γ. ΓΕΝΝΗΜΑΤΑΣ
«Δυσλειτουργία βηματοδότη. Πως μπορούμε να την εκτιμήσουμε στο ιατρείο.» Koσσυβάκης Χάρης Καρδιολογικό Τμήμα Γ.Ν.Α. «Γ. ΓΕΝΝΗΜΑΤΑΣ Diagnostic tools History: symptoms, physical examination 12 leads ECG,
More informationTABLE 1 Clinical Classification of AF. New onset AF (first detected) Paroxysmal (<7 days, mostly < 24 hours)
Clinical Practice Guidelines for the Management of Patients With Atrial Fibrillation Deborah Ritchie RN, MN, Robert S Sheldon MD, PhD Cardiovascular Research Group, University of Calgary, Alberta Partly
More informationThe heart then repolarises (or refills) in time for the next stimulus and contraction.
Atrial Fibrillation BRIEFLY, HOW DOES THE HEART PUMP? The heart has four chambers. The upper chambers are called atria. One chamber is called an atrium, and the lower chambers are called ventricles. In
More information2 ECG basics. Leads and planes. Leads. Planes. from different perspectives, which are called leads and planes.
558302.qxp 3/14/12 10:47 PM Page 12 2 ECG basics One of the most valuable diagnostic tools available, an electrocardiogram (ECG) records the heart s electrical activity as waveforms. By interpreting these
More informationOfficial Online ACLS Exam
\ Official Online ACLS Exam Please fill out this form before you take the exam. Name : Email : Phone : 1. Hypovolemia initially produces which arrhythmia? A. PEA B. Sinus tachycardia C. Symptomatic bradyarrhythmia
More informationPalpitations & AF. Richard Grocott Mason Consultant Cardiologist THH NHS Foundation Trust & Royal Brompton & Harefield NHS Foundation Trust
Palpitations & AF Richard Grocott Mason Consultant Cardiologist THH NHS Foundation Trust & Royal Brompton & Harefield NHS Foundation Trust Palpitations Frequent symptom Less than 50% associated with arrhythmia
More informationElectrodes placed on the body s surface can detect electrical activity, APPLIED ANATOMY AND PHYSIOLOGY. Circulatory system
4 READING AND INTERPRETING THE ELECTROCARDIOGRAM Electrodes placed on the body s surface can detect electrical activity, which occurs in the heart. The recording of these electrical events comprises an
More informationRUSSELLS HALL HOSPITAL EMERGENCY DEPARTMENT
RUSSELLS HALL HOSPITAL EMERGENCY DEPARTMENT CLINICAL GUIDELINE ATRIAL FIBRILLATION March 2011 For quick links to AF algorithms: UNSTABLE PATIENT STABLE PATIENT - 1 - Introduction Atrial fibrillation is
More informationACLS PRE-TEST ANNOTATED ANSWER KEY
ACLS PRE-TEST ANNOTATED ANSWER KEY June, 2011 Question 1: Question 2: There is no pulse with this rhythm. Question 3: Question 4: Question 5: Question 6: Question 7: Question 8: Question 9: Question 10:
More informationINFORMATION FOR PATIENTS AND FAMILIES A Patient s Guide to Living with Atrial Fibrillation
INFORMATION FOR PATIENTS AND FAMILIES A Patient s Guide to Living with Atrial Fibrillation 30 Bond Street, Toronto, ON M5B 1W8 Canada 416.864.6060 stmichaelshospital.com Form No. XXXXX Dev. XX/XXXX GOALS
More informationElectrophysiology study (EPS)
Patient information factsheet Electrophysiology study (EPS) The normal electrical system of the heart The heart has its own electrical conduction system. The conduction system sends signals throughout
More informationCardioversion for. Atrial Fibrillation. Your Heart s Electrical System Cardioversion Living with Atrial Fibrillation
Cardioversion for Atrial Fibrillation Your Heart s Electrical System Cardioversion Living with Atrial Fibrillation When You Have Atrial Fibrillation You ve been told you have a heart condition called atrial
More informationECG Measurments and Interpretation Programs
ECG Measurments and Interpretation Programs Physician s Guide Distributed by Welch Allyn 4341 State Street Road, PO Box 220 Skaneateles Falls, NY 13153-0220 www.welchallyn.com Sales and Service information:
More informationCARDIAC ELECTROPHYSIOLOGY, ARRHYTHMIAS AND PACING. Medical Knowledge. Goals and Objectives PF EF MF LF Aspirational
Know the histology and gross anatomy of the normal sinoatrial node, atrial conduction pathways, atrioventricular (AV) junction and nod, His bundle, conduction fascicles and terminal intra-ventricular conduction
More informationBasics of Pacing. Ruth Hickling, RN-BSN Tasha Conley, RN-BSN
Basics of Pacing Ruth Hickling, RN-BSN Tasha Conley, RN-BSN The Cardiac Conduction System Cardiac Conduction System Review Normal Conduction Conduction QRS QRS Complex Complex RR PP ST ST segment segment
More informationArrhythmia Monitoring Algorithm
Arrhythmia Monitoring Algorithm Application Note Introduction The ST/AR (ST and Arrhythmia) algorithm is an ECG algorithm that the HeartStart MRx and XL+ monitor/defibrillators utilize for basic and cardiotach
More informationHEART HEALTH WEEK 3 SUPPLEMENT. A Beginner s Guide to Cardiovascular Disease HEART FAILURE. Relatively mild, symptoms with intense exercise
WEEK 3 SUPPLEMENT HEART HEALTH A Beginner s Guide to Cardiovascular Disease HEART FAILURE Heart failure can be defined as the failing (insufficiency) of the heart as a mechanical pump due to either acute
More informationHow to read the ECG in athletes: distinguishing normal form abnormal
How to read the ECG in athletes: distinguishing normal form abnormal Antonio Pelliccia, MD Institute of Sport Medicine and Science www.antoniopelliccia.it Cardiac adaptations to Rowing Vagotonia Sinus
More informationQuiz 4 Arrhythmias summary statistics and question answers
1 Quiz 4 Arrhythmias summary statistics and question answers The correct answers to questions are indicated by *. All students were awarded 2 points for question #2 due to no appropriate responses for
More informationPremature Ventricular Contractions. Ralph Augostini, MD FACC FHRS
Premature Ventricular Contractions Ralph Augostini, MD FACC FHRS Orlando, Florida October 7-9, 2011 Premature Ventricular Contractions: ACC/AHA/ESC 2006 Guidelines for Management of Patients With Ventricular
More informationEKG Abnormalities. I. Early repolarization abnormality:
I. Early repolarization abnormality: EKG Abnormalities A. A normal variant. Early repolarization is most often seen in healthy young adults. Look for ST elevation, tall QRS voltage, "fishhook" deformity
More informationAtrioventricular (AV) node ablation
Patient information factsheet Atrioventricular (AV) node ablation The normal electrical system of the heart The heart has its own electrical conduction system. The conduction system sends signals throughout
More information