ECG Rhythm Interpretation ECG Basics

No Slide Title ECG Rhythm Interpretation ECG Basics vipin wilson Objectives ? To recognize the normal rhythm of the heart “Normal Sinus Rhythm ” To recognize the most common rhythm disturbances Normal.

ECG Rhythm Interpretation ECG Basics vipin wilson Objectives ? • To recognize the normal rhythm of the heart - “Normal Sinus Rhythm.” • To recognize the most common rhythm disturbances Normal Impulse Conduction Sinoatrial node AV node Bundle of His Bundle Branches Purkinje fibers The “PQRST” • P wave - Atrial depolarization • QRS - Ventricular depolarization • T wave - Ventricular repolarization The PR Interval Atrial depolarization + delay in AV junction (AV node/Bundle of His) (delay allows time for the atria to contract before the ventricles contract) Pacemakers of the Heart • SA Node - Dominant pacemaker with an intrinsic rate of 60 - 100 beats/minute • AV Node - Back-up pacemaker with an intrinsic rate of 40 - 60 beats/minute • Ventricular cells - Back-up pacemaker with an intrinsic rate of 20 - 45 bpm The ECG Paper • Horizontally – One small box - 0.04 s – One large box - 0.20 s • Vertically – One large box - 0.5 mV 12 Lead ECG Basics The leads of the 12 lead ECG are divided into Limb Leads and Precordial or Chest Leads 12 Lead ECG Basics Limb Leads Lead I II III P wave uprigh t uprigh t uprigh t QRS uprigh t uprigh t uprigh t T wave uprigh t uprigh t uprigh t Tachy-Arrhythmias Narrow QRS tachycardia Broad QRS tachycardia Narrow QRS Tachycardia Broad QRS tachycardia • Narrow vs Wide Complex Tachycardias • NCT implies normal conduction through the AV Node and His-Purkinje System These SVTs are the most common arrhythmias • • • • Sinus Tachycardia Atrial Tachycardia AVNRT Orthodromic AVRT Narrow QRS Tachycardia (Rate > 100) Rhythm Irregular Regular Rate < 150 Rate > 150 Sinus tachycardia SVT Saw tooth waves – Atrial flutter Atrial fibrillation Atrial fibrillation Irregularly Irregular • WCT typically originate in the ventricles (VT) • Exceptions: • SVT with aberrancy • Pre-excited Tachycardias (in WPW syndrome) Antidromic AVRT • Broad QRS Tachycardia Ventricular Tachycardia (80%) SVT with Aberration (20%) • All Practical Purposes consider any Broad QRS Tachycardia as VT • You may be correct 80% of time…!!! The last word is update your knowledge… • With a smile… THANK YOU ... 20 - 45 bpm The ECG Paper • Horizontally – One small box - 0.04 s – One large box - 0.20 s • Vertically – One large box - 0.5 mV 12 Lead ECG Basics The leads of the 12 lead ECG are divided into... Chest Leads 12 Lead ECG Basics Limb Leads Lead I II III P wave uprigh t uprigh t uprigh t QRS uprigh t uprigh t uprigh t T wave uprigh t uprigh t uprigh t Leads 1, 2, 12 Lead ECG Basics Augmented...Objectives ? • To recognize the normal rhythm of the heart - “Normal Sinus Rhythm. ” • To recognize the most common rhythm disturbances Normal Impulse Conduction Sinoatrial