4 lead ECG Rules/ Practice Flashcards
5 Rules to reading 4 Lead ECG ?
- Rate
- Regularity
- P Wave 1:1 QRS:P wave ratio
- PRI
- QRS
Sinus Rhythm
Rate 60-100
Regular
P wave: Upright 1:1
PRI 0.12-0.20
QRS 0.10- 0.12 Narrow
Sinus Tachycardia
Rate +100 Regular
P wave: Upright 1:1
PRI 0.12-0.20
QRS 0.10- 0.12 Narrow
Sinus bradycardia
Rate Less than 60 BPM
Regular
P wave: Upright 1:1
PRI 0.12-0.20
QRS 0.10- 0.12 Narrow
Name the Atrial Rhythms
- Atrial Pacemaker,
- Atrial Flutter
- Atrial Fibrillation
- Supraventricular Tachycardia
Atrial Pacemaker
WAP/MAT
Rate 60-159
Usually Regular
P wave: Varying P wave morphology
QRS:P wave ratio- 1:1
PRI 0.12-0.20
QRS 0.10- 0.12 Narrow
Note:
HR 60-100 Wandering Atrial Pacemaker (WAP)
HR 100+ Multifocal atrial tachycardia (MAT)
Atrial Flutter
Rate Any 100+ RVR
Regular or Regularly Irregular
P wave: Flutter (F) wave morphology
QRS:F wave ratio- Varying 1:2 + Ratio
PRI: N/A
QRS 0.10- 0.12 Narrow
Note: Over 100+ HR is Atrial Flutter with RVR
Over HR 150+ Normally need treatment
Atrial Fibrillation
Rate Any 100+ RVR
Irregularly Irregular
P wave: Fibrillation-Waving baseline
PRI: N/A
QRS 0.10- 0.12 Narrow
Note: Over 100+ HR is Atrial Fibrillation with RVR
Over HR 150+ Normally need treatment
Supraventricular Tachycardia
Rate HR +150
Very Regularly Regular
P wave:Upright or hidden in the T wave 1:1 Ratio
PRI: 0.12 -0.20
QRS 0.10- 0.12 Narrow
What are the Ventricular Rhythms?
- Ventricular escape rhythm,
- Accelerated idioventricular rhythm,
- Ventricular tachycardia (Mono/Poly),
- Ventricular Fibrillation
- Asystole
Ventricular escape rhythm
(Idioventricular Rhythm)
Rate Under 40 BPM
Regular
P wave:No P Waves
PRI: N/A
QRS Over 0.12 Wide
Accelerated idioventricular rhythm
Rate 40 -100 BPM
Regular
P wave:No P Waves
PRI: N/A
QRS Over 0.12 Wide
Ventricular tachycardia
Rate Over 100 BPM
Regular
P wave:No P Waves
PRI: N/A
QRS Over 0.12 Wide
Run of VT - is 4 or more beats with wide QRS
Monopohmic- One waveform
Polymophic -Variable QRS morphology-Torsades de Pointes
Ventricular Fibrillation
Rate Not Discernible
N/A
P wave:No P Waves
PRI: N/A
QRS Not Discernible -Waving basline
Base line of Fibrillation
Asystole/Agonal
Rate Not Discernible
N/A
P wave:No P Waves
PRI: N/A
QRS Not Discernible - Flat line or P waves
P wave Asystole - Just P wave no QRS
Pulseless electrical activity (PEA)
Pulseless electrical activity occurs when a patient has cardiac electrical activity but no pulse.
Use of cardiac ultrasound,auscultation heart tone, and Arterial Line waveforms can be used at tool to assess for PEA .
What are the AV Blocks?
- 1st Degree AV Block
- 2nd Degree Type 1 AV Block
- 2nd Degree Type 2 AV Block
- 3rd Degree AV Block
1st Degree AV Block
PR interval +0.20 every time/ Same PRI with every beat
Rhythm otherwise identical to underlying rhythm
2nd Degree Block – Type I
Other names Wenkebach or Mobitz I
PRI varying “ long longer Drop” with a droped QRS Complexs
2nd Degree Block – Type II
Other name Mobitz II
Same PRI with a droped QRS Complexs
3rd Degree Block
Complete heart block
P wave are dissortited with the QRS complexs
Regular P wave and QRS
QRS Wide
What are the Junctional Rhythms?
- Junctional Rhythms
- Accelerated Junctional
- Junctional Tachycardia
Junctional Rhythms
Rate 40-60
Very Regularly Regular
P wave: Inverted,Biphasic, Not present 1:1 Ratio
PRI: Narrow less than 0.12
QRS 0.10- 0.12 Narrow
Accelerated Junctional
Rate 60-100
Very Regularly Regular
P wave: Inverted,Biphasic, Not present 1:1 Ratio
PRI: Narrow less than 0.12
QRS 0.10- 0.12 Narrow
Junctional Tachycardia
Rate Over 100 Bpm
Very Regularly Regular
P wave: Inverted,Biphasic, Not present 1:1 Ratio
PRI: Narrow less than 0.12
QRS 0.10- 0.12 Narrow
What are the Premature Contractions?
- Premature Atrial Contraction (PAC)
- Premature Junctional Contraction (PJC)
- Premature Ventricular Contraction (PVC)
Premature Atrial Contraction (PAC)
Premature beat with narrow QRS and narrow/normal PRI with diffrent morphology
Morphologically like a sinus or atrial beat, but is out-of-place with regards to rhythm. P wave may look different from the others
Premature Junctional Contraction (PJC)
Premature beat with a narrow QRS and a Inverted,absent or biphasic P wave
Looks similar to a sinus beat, but is out-of-place with regards to rhythm and has an inverted, absent, or biphasic P wave
Premature Ventricular Contraction (PVC)
Premature beat with a wide QRS
Wide, bizarre QRS, out-of-place beat