ECG Flashcards
Analyzing the Rhythm- Steps
Determine the regularity of R waves Calculate the heart rate Identify and examine P waves Measure the PR Interval Measure the QRS complex
ST segment - Elevated or Depressed: What does it mean?
Elevation = acute myocardial injury Depression = myocardial ischemia, hypokalemia, digitalis
Normal Sinus Rhythm
Rhythm: Regular Rate: 60 – 100 P waves: 1 P wave before each QRS Normal in appearance PR: .12 - .20 seconds QRS: < .12 seconds
Sinus Tachycardia
Rhythm: Regular Rate: 100 - 160 P waves: 1 P wave before each QRS Normal in appearance PR: .12 seconds - .20 seconds QRS: < .12 seconds
Sinus Bradycardia
Rhythm: Regular Rate: 40 - 60 P waves: 1 P wave before each QRS Normal in appearance PR: .12 seconds - .20 seconds QRS: < .10 seconds
Sinus Arrhythmia
Rhythm: Irregular Rate: 60 - 100 P waves: 1 P wave for each QRS Normal in appearance PR: .12 seconds - .20 seconds QRS: < .10 seconds
Premature Atrial Contractions (PAC)
Rhythm: Underlying rhythm regular Irregular with PAC Rate: Rate of underlying Rhythm P waves: PAC P Wave is premature Abnormal in size, shape or direction May be hidden or inverted PR: .12 seconds - .20 seconds (may be prolonged QRS: < .10 seconds
Atrial Tachycardia
Rhythm: Regular Rate: 140-250 P waves: Hidden in preceding T wave PR: Not measurable QRS: < .10 seconds
Atrial Flutter
Rhythm: Regular or irregular Rate: Atrial rate 250 – 400 Ventricular rate varies depending on AV node conduction P wave: Absent Flutter waves present PR: Not measurable QRS: < .10 seconds
Atrial Fibrillation
Rhythm: Very irregular Rate: Atrial rate 400 or more Ventricular rate varies depending on AV node conduciton P wave: Absent Fibrillatory waves present PR: Not measurable QRS: < .10 seconds
Premature Junctional Contraction (PJC)
Rhythm: Underlying rhythm usually regular
Irregular with PJC
Rate: Rate of underlying rhythm
P wave: P wave with PJC will be inverted
May be before, during, or after QRS
PR: < .10 seconds
QRS: < .10 seconds
Junctional Rhythm
Rhythm: Regular Rate: 40 - 60 P wave: Inverted, may occur before, during or after QRS PR: < .10 seconds QRS: < .10 seconds
Accelerated Junctional Rhythm
Rhythm: Regular Rate: 60 - 100 P wave: Inverterd, May occur before, during or after QRS PR: < .10 seconds QRS: < .10 seconds
Paroxysmal Junctional Tachycardia
Rhythm: Regular Rate: > 100 P wave: Inverted, May occur before during or after QRS PR: < .10 seconds QRS: < .10 seconds
Supraventricular Tachycardia (SVT)
Generic term meaning a rapid heart rate above the ventricle Sinus Tachycardia Atrial Tachycardia Atrial flutter with a 2 to 1 conduction Junctional tachycardia
First Degree Heart Block
Rhythm: Regular Rate: Same as underlying rhythm P wave: 1 sinus P wave for each QRS PR: Prolonged > .20 seconds QRS: < .10 seconds
Second Degree Heart Block Type I (Mobitz 1 or wenckebach)
Rhythm: Atrial – Regular
Ventricular - Irregular
Rate: Atrial – same as underlying rhythm
Ventricular – less than atrial: dependent
on AV conduction
P wave: Sinus
PR: Progressively lengthens until a P wave
occurs without a QRS
QRS: < .10 seconds
Second Degree Heart Block Type II (Mobitz II)
Rhythm: Atrial – Regular
Ventricular - Irregular
Rate: Atrial – same as underlying rhythm
Ventricular - < than atrial: depends on
AV node conduction
P wave: Sinus: Multiple P waves for each QRS
PR: .12 - .20, May be prolonged
Remains constant
QRS: Normal to wide depending on location of block
Third Degree Heart Block
Rhythm: Atrial Regular Ventricular Regular Rate: Atrial – same as underlying rhythm Ventricular – 40 – 60 if AV paced 30 – 40 if paced by ventricle P wave: Sinus No relationship to QRS PR: No relationship QRS: < .10 seconds if AV paced > .10 if paced by ventricules
Premature Ventricular Contraction (PVC)
Rhythm: Regular Irregular with PVC Rate: Same as underlying rhythm P wave: Absent associated with PVC PR: Not measurable QRS: Premature Wide (> .12) and Bizarre
Characteristics of PVC’s
Uniform – PVC’s from the same focus Multifocal – PVC’s from multiple foci Bigeminal PVC – PVC every 2nd beat Trigeminal PVC – PVC every 3rd beat Paired or couplet – Two PVC’s together
Ventricular Tachycardia
Rhythm: Regular Rate: 140 - 250 P wave: Absent PR: Absent QRS: > .12 seconds
Ventricular Fibrillation “coarse” or “fine”
Rhythm: Chaotic Rate: 0 P wave: Absent PR: Absent QRS: Absent
Idioventricular Rhythm
Rhythm: Regular Rate: 30 - 40 P wave: Absent PR: Absent QRS: > .12 seconds
Accelerated Idioventricular Rhythm
Rhythm: Regular Rate: 50 -100 P wave: Absent PR: Absent QRS: > .12 seconds
Pulseless Electrical Activity (PEA)
Rhythm that does not generate a pulse
May be junctional bradycardia to sinus rhythm
Does the patient have a pulse with that rhythm
Causes: Tension pneumothorax, pericardial tamponade, severe internal bleeding,
pulmonary embolism, & MI
Asystole
Rhythm: Absent Rate: 0 P wave: Absent PR: Absent QRS: Absent
