EKG

Sinus Tachycardia

ENOUGH OF SINUS

Sinus ArrhythmiaRate: 60-100 beats/minRhythm: irregularP waves: uniform in appearance, upright,one precedes each QRSPR interval: 0.12 - 0.20 sec and constantQRS duration: < 0.12 sec

Sinus Arrhythmia Unless symptomatic !

Sinus Arrest/PauseRate: usually normal but varies due to thearrestRhythm: irregular; the arrest is ofundetermined lengthP waves: uniform in appearance, upright,one precedes each QRSPR interval: 0.12 - 0.20 sec and constantQRS duration: < 0.12 sec

Sinus Arrest/Pause

Sinoatrial Exit BlockRate: varies due to the pauseRhythm: irregular; each pause is the sameas the distance between two other P-PintervalsP waves: uniform in appearance, upright,one precedes each QRSPR interval: 0.12 - 0.20 sec and constantQRS duration: < 0.12 sec

Sinoatrial Exit Block

Atrial Dysrhythmias

Atrial DysrhythmiasPremature Atrial Complexes (PACs)Supraventricular Tachycardia (SVT)Atrial FlutterAtrial Fibrillation (A-Fib)

Premature Atrial Complexes (PACs)Rate: depends on underlying rhythmRhythm: regular with premature beatsP waves: premature (earlier than expected)and may differ in shape from sinus P wavesPR interval: 0.12 - 0.20 sec and constantQRS duration: < 0.12 sec Note: Ectopic complex

Premature Atrial Complexes (PACs)

Supraventricular Tachycardia (SVT/PSVT) Rate: 120-250 beats/min Rhythm: regular P waves: not present PR interval: not measurable QRS duration: < 0.12 sec Note: PSVT is an SVT that starts/ends suddenly

Supraventricular Tachycardia (SVT)

Atrial FlutterRate: atrial rate 250-450 beats/min;ventricular rate will not usually exceed180 beats/minRhythm: atrial regular; ventricularregular or irregularP waves: saw-toothed “flutter” wavesPR interval: not measurableQRS duration: < 0.12 sec

Atrial Flutter

Atrial Fibrillation (A-fib)Rate: variableRhythm: irregularly irregularP waves: no identifiable P wavesPR interval: not measurableQRS duration: < 0.12 sec

Atrial Fibrillation (A-fib)

JunctionalRhythms

Junctional RhythmsPremature Junctional Complex (PJC)Junctional RhythmAccelerated Junctional RhythmJunctional Tachycardia

Premature Junctional Complexes (PJC)Rate: usually normal but depends on theunderlying rhythmRhythm: regular with premature beatsP waves: may occur before, during or afterthe QRS (inverted if visible)PR interval: if P visible, < or = to 0.12 secQRS duration: < 0.12 sec Note: Ectopic complex

Premature Junctional Complexes (PJC)

Junctional RhythmRate: 40-60 beats/minRhythm: regularP waves: not present or may occurbefore, during or after the QRS (inverted ifpresent)PR interval: not measurable, but ifpresent usually ≤ to 0.12 secQRS duration: < 0.12 sec

Junctional Rhythm

Junctional Rhythm

Accelerated Junctional Rhythm Rate: 61-100 beats/min Rhythm: regular P waves: not present or may occur before, during or after the QRS (inverted if present; may be notched or S waved) PR interval: not measurable, but if present usually ≤ to 0.12 sec QRS duration: < 0.12 sec

Accelerated Junctional Rhythm

Junctional TachycardiaRate: 101-180 beats/minRhythm: regularP waves: not present or may occur before,during or after the QRS (inverted if present)PR interval: not measurable, but if presentusually ≤ to 0.12 secQRS duration: < 0.12 sec

Junctional Tachycardia

Ventricular Rhythms

Ventricular RhythmsPremature Ventricular Complexes (PVC's)Idioventricular RhythmVentricular Tachycardia (VT)Torsades de Pointes (TdP)Ventricular Fibrillation (VF)Asystole

Premature Ventricular Complexes (PVC's)Rate: depends on underlying rhythmRhythm: regular with premature beatsP waves: absentPR interval: noneQRS duration: > 0.12 sec, wide andbizarre! Note: Ectopic complex

Premature Ventricular Complexes (PVC's) Note – Complexes not Contractions

PVC’sUniformed/MultiformedCouplets/Salvos/RunsBigeminy/Trigeminy/Quadrageminy

Uniformed PVC’s

R on T Phenomena Why is this patient lucky ?

Multiformed (Multifocal) PVC’s

PVC Couplets

PVC Salvos and Runs

Bigeminy PVC’s

Trigeminy PVC’s

Quadrageminy PVC’s

Ventricular Escape BeatsRate: depends on underlying rhythmRhythm: regular with late beats; occurs afterthe next expected sinus beatP waves: absentPR interval: noneQRS duration: > 0.12 sec. wide and bizarre Note: Ectopic complex

Ventricular Escape Beats

Idioventricular RhythmRate: 20-40 beats/minRhythm: regularP waves: absentPR interval: noneQRS duration: > 0.12 sec Note: “Wide and Slow, (Oh No!) it’s Idio”

Idioventricular Rhythm

Ventricular Tachycardia (VT)Rate: 101-250 beats/minRhythm: regularP waves: absentPR interval: noneQRS duration: > 0.12 sec. often difficult todifferentiate between QRS and T wave Note: Monomorphic - same shape and amplitude

Ventricular Tachycardia (VT)

V Tach

Torsades de Pointes (TdeP)Rate: 150-300 beats/minRhythm: regular or irregularP waves: nonePR interval: noneQRS duration: > 0.12 sec. gradualalteration in amplitude and direction of theQRS complexes