ECG Flashcards
describe the passage of blood through the heart
deoxygenated blood from the body arrives from cranial vena cava
right atrium
tricuspid valve
right ventricle
pulmonary valve
pulmonary artery to the lungs
pulmonary vein from the lungs
left atrium
mitral valve
left ventricle
aortic valve
aorta to systemic circulation
what is the purpose of the heart beating?
pump blood around the body and lungs
what is myocardium made up of?
cardiac muscle
is heart contraction governed by nerve impulse?
no - contracts automatically
what is the process of heart contraction controlled by?
electrical impulses
what relating to the heart is controlled by the autonomic nervous system?
heart rate
what part of the nervous system controlls heart rate?
autonomic
what are the 2 branches of the autonomic nervous system?
sympathetic
parasympathetic
what effect does the sympathetic nervous system have on heart rate?
increases HR
what effect does the parasympathetic nervous system have on heart rate?
slows
how does the parasympathetic nervous system slow heart rate?
release of acytylcholine
how does the sympathetic nervous system increase heart rate?
releases catecholamines to accelerate HR
what catecholamines increase HR?
adrenaline
noradrenaline
what are the 2 types of cardiac cells?
electrical cells
myocardial cells
what is the role of electrical cells within the heart?
conduction system of the heart
spontaneously generate and respond to electrical impulses
transmit electrical impulses
how are electrical cells distributed throughout the heart?
orderly fashion throughout the heart
where are myocardial cells found?
within the walls of the atrium and ventricles
what is the role of myocardial cells?
responsible for contraction and stretch of the heart
what is required for the heart to function properly?
coordinated contraction of both atria and ventricles
what is coordinated atrioventricular contraction?
coordinated contraction of both atria and ventricles to expel blood into aorta and pulmonary artery
what do cardiac muscle cells require to contract?
electrical stimulus
what state are cardiac cells in when relaxed?
polarised
what happens to cardiac cells when stimulated by an electrical impulse?
cells start to depolarise
what area of the heart must be depolarised first in order to allow the heart to function properly?
two atria
what part of the heart is depolarised after the atria?
ventricles
what must the heart do between beats?
repolarise (relax) and return to resting potential
why must the heart repolarise (relax) and return to resting potential between beats?
to allow appropriate filling during dyastole ready for the next contraction
what is the sinoatrial (SA) node?
small area of cardiac muscle cells that are specialised found in the wall of the right atrium
where is the SA node located?
wall of the right atrium
what is the role of the SA node?
initiation of heart beat
why is the SA node the initiator of the heart beat?
fastest area to generate electrical activity
what is the role of the SA node?
pacemaker of the heart
controls HR
what is the SA node influenced by?
autonomic tone
what effect will increased sympathetic tone have on the SA node?
increase HR
what effect will increased parasympathetic tone have on the SA node?
decrease HR
how does the SA node lead to atrial systole?
SA node fires electrical impulse which causes depolarisation to spread through atrial muscle cells
impulse spreads over atria causing both to contract
what is caused by creation of electrical impulse by SA node?
atrial systole
where is the atrioventricular (AV) node located?
top of the interventricular septum
what happens to the nerve impulse after it moves across the atria?
passes through AV node
how rapidly does the electrical impulse from the SA node spread through the AV node?
more slowly
what is the purpose of the slow conduction through the AV node?
slows electrical impulse before it reaches the ventricles to ensure that ventricular contraction is correctly coordinated following atrial contraction
atria can fully contract before ventricles
is the myocardium of atrial walls in continuity with myocardium of ventricular walls?
no
how does electrical impulse pass from atria to ventricles?
through AV ring to bundle of His
what is the bundle of His?
specialised nerve tissue fibres
where is the bundle of His located?
interventricular septum
what does the bundle of His divide into?
right and left bundle branches
where are bundle branches found?
right and left ventricles
what does the left bundle branch divide into?
anterior and posterior fascicles
what does the bundle of His connect to?
Purkinje fibres
what are Purkinje fibres?
network of specialised neurons organised into fine branches
where are Purkinje fibres found?
spread out through the myocardium of the ventricles
where does the wave of depolarisation begin in the ventricles?
apex of the heart (the bottom)
where does the contraction of the ventricles move once initiated at the apex of the heart?
upwards through muscle of the ventricles
what is contraction of the ventricles known as?
ventricular systole
what happens once the heart cells repolarise?
SA node fires another impulse and the cycle begins again
what is measured by an ECG?
changing electrical activity of the heart
what is used to measure electrical activity of the heart?
ECG using positive and negative electrodes
what is electrocardiography?
process of recording changing potential differences within the heart
what is the most common method of electrocardiography?
leads placed on limbs or chest
what is ECG essential for the diagnosis of?
cardiac rhythm disturbance
what is detected by an ECG machine?
depolarisation wave travelling across the heart from the SA node across the atria in the direction of the ventricles
what charge of electrodes does the electrical impulse of the heart travel between?
negative to positive
what does the ECG machine record the electrical wave as?
deflections
what are negative ECG deflections displayed as on an ECG machine?
downward strokes
what are positive ECG deflections displayed as on an ECG machine?
upward strokes
what is created when parts of the atria nearest the SA node are depolarised?
electrical potential difference
what is the electrical potential difference detected by ECG between?
depolarised atria and parts still in a resting state
when are ECGs used?
diagnosis of arrhythmia
triage
anaesthesia
patient monitoring
pulse deficits
CPR
metabolic or electrolyte abnormalities
pericardiocentesis / central line placement to detect and arrhythmias caused
hands off monitoring during blood transfusion
where are ECG leads placed?
red - right fore
yellow - left fore
green - left hind
(black - right hind, if used)
what are the 2 common types of ECG electrode?
crocodile clips
ECG pads
what position should an ECG be obtained in ideally?
right lateral
what needs to be removed from the area where an ECG is being performed to ensure accurate ECG reading?
anything that may create interference (e.g. mobile)
what are the main types of ECG equipment?
multiparameter
paper-trace recording
Holter monitor
telemetry
what are papertrace ECGs used for?
diagnosis of arrhythmia
what are Holter monitors used for?
longer term monitoring so patient can go home
what should be checked if the ECG is not working?
settings
battery
are leads attached
are leads on correct legs
minimal patient movement
ideally right lateral
is patient panting / purring
check contact and apply spirit
change if not sticking
clip more fur
what are the phases of an ECG complex?
P
QRS
T
what does the P wave represent?
atrial electrical activity
why are P waves small?
muscle mass of atria relatively small so associated electrical changes are also small
when are P waves seen?
atrial depolarisation
what type of deflection is atrial depolarisation wave?
+
what else is depolarised along with the atria?
AV node
what does the P-R interval represent?
time between atrial depolarisation and ventricular depolarisation
how is the P-R interval measured?
distance between onset of the P wave and onset of the R wave
what does a normal P-R interval mean?
electrical impulse is travelling at the correct speed between the atria and the ventricles
what happens to the depolarisation wave once it has passed through the AV node?
travels through bundle of His and Purkinjie fibres
what is the first part of the ventricles to depolarise?
ventricular septum
what is the Q wave?
small depolarisation wave seen when the ventricular septum depolarises
what shape is the Q wave?
downward wave (negative deflection) on the ECG trace
what sort of deflection is the Q wave?
negative
what direction does the Q wave travel?
away from the positive electrode
when does the R wave occur?
when the majority of the ventricles are depolarised
what direction does the depolarisation of the R wave travel?
towards the positive electrode creating a positive deflection
what is the largest wave on the EGC trace?
R wave
what makes the R wave the largest wave on the ECG?
large mass of tissue in the ventricles creating the largest positive deflection
when does the S wave occur?
following depolarisation of the majority of the ventricles
where does the final depolarisation of the ventricles occur?
base of the heart
what direction does the wave of depolarisation that forms the S wave travel in?
away from the positive electrode creating a negative deflection
why is the S wave small?
small tissue mass so small electrical deflection
what is represented by the QRS complex?
depolarisation of the ventricles followed by ventricular muscle contraction
what happens to the electrical potential difference once the atria are depolarised?
no longer an electrical potential difference
what is the PR segment?
area of the ECG between the P wave and the Q wave
what is occurring during the PR segment?
slow impulse conduction through the AV node
when does the ST segment occur?
once the ventricles are depolarised
what does the ST segment represent?
interval between ventricular depolarisation and repolarisation
what is represented by the T wave?
repolarisation of the ventricles following depolarisation and contraction
what does the T wave mark the beginning of?
ventricular relaxation and repolarisation
what is created during the T wave phase?
potential difference across the ventricular myocardium until the ventricles are completely repolarised
how may the T wave appear on ECG?
positive deflection
negative deflection
mixed deflection
what are the main areas to look at when interpreting an ECG?
rate
all expected waves present (P, QRS,T)
any arrhythmias
what can be assessed about the rate of ECG?
tachycardia
bradycardia
what can be assessed about the presence of all ECG complexes?
are they all present
are all complexes identical
is there a P wave for every QRS and vice versa
what can be assessed about the presence arrhythmia on ECG?
regularly irregular
regularly regular
irregularly irregular
intermittent or continuous
sinus, ventricular or supraventricular
what is included within arrhythmias?
abnormailities in:
rate
electrical impulse conduction
ectopia
what can cause arrhythmias to occur?
when other areas of the heart begin to generate their own electrical activity which overrides pacing of the SA node
what are the main sinus rhythms?
normal sinus
sinus arrhythmia
what are the main bradyarrhythmias?
sinus bradycardia
sick sinus syndrome
atrioventricular beats
escape beats
hyperkalaemia
what are the main tachyarrhythmias?
sinus tachycardia
supraventricular tachycardia
atrial fibrillation
ectopic beats
accelerated idioventricular rhythm
ventricular tachycardia
R-on-T phenomenon
what are they main cardiac arrest rhythms?
ventricular fibrillation
pulseless ventricular tachycardia
pulseless electrical activity
asystole
describe sinus rhythm on an ECG
P, QRS, T all present
P for every QRS
all complexes identical
what is heard on auscultation of a patient with sinus rhythm?
regular heart sounds
HR normal for age, breed and species
are pulse deficits seen with sinus rhythm?
no
what does the ECG trace look like with sinus arrhythmia?
normal P for every QRS-T
describe sinus arrhythmia
impulse originates from SA node
a regular variation in HR which coincides with respiration
what is sinus arrhythmia also known as?
respiratory sinus arrhythmia
what is sinus arrhythmia thought to be caused by?
increase in parasympathetic activity (vagal tone) on the SA node
when is sinus arrhythmia seen?
normal and common in dogs as long as HR in normal range
rare in cats
what is occurring when sinus bradycardia is seen?
SA node impulse and corresponding depolarisation occurs more slowly than normal
describe sinus bradycardia
normal sinus rhythm
P wave for every QRS-T
HR inappropriately slow for age breed and species
pulse for every beat
regularly regular rhythm
what are the main causes of sinus bradycardia?
normal in some breeds (e.g. giant breeds or very fit animals)
issue with SA node
secondary to other disease process which increases vagal tone
what diseases which increase vagal tone may cause sinus bradycardia?
hypoadrenocorticism
BOAS
raised ICP
vaso-vagal reaction
hypocalcaemia
hyperkalaemia
hypothermia
hypoglycaemia
hypothyroidism
how is sinus bradycardia treated?
underlying cause treated
anticholinergic to increase HR
what may be used to temporarily treat sinus bradycardia?
anticholinergic
atropine or glyco
what may be used to treat sinus bradycardia if anticholinergic is unsuccessful?
positive inotrope
what are examples of positive inotropes that may be used to treat sinus bradycardia?
dopamine
dobutamine
what is sick sinus syndrome caused by?
problem with SA node function which means there is an issue with discharge of the electrical impulse
what are the signs of sick sinus syndrome?
severe bradycardia (<30 bpm)
may see periods of asystole for several seconds without escape beats
SA node will restart but sinus arrest common
what is sinus arrest?
periods of asystole
in what animals is sick sinus syndrome seen?
older (6-10 years)
common in WHWT, spaniels and schnauzers
rare in cats
how is sick sinus syndrome treated?
pacemaker
rarely responds to medical management well
how long do most pacemakers last for?
5-10 years
what are the risks associated with pacemakers?
infection
lead dislodgement
failure to place correctly
venous thrombosis
what are the nursing considerations for patients with pacemakers?
no walking for 48 hours post surgery
harness only
care with neck restraint
no jugular samples
what are pacemakers used to treat?
bradyarrhythmias
what is heart block?
problem with the electrical conduction system of the heart
what happens during heart block?
electrical impulses from the SA node are delayed or completely blocked from going through the AV node
what is the effect of delayed or blocked electrical impulses from the AV node?
electrical impulse may not reach the ventricles
what can AV block be caused by?
disease process
drug effect at AV node
what are the main blocks which affect the AV node?
atrioventricular block (AV block)
AV nodal block
what are the blocks which affect the left or right bundle branches?
bundle branch blocks
what happens during first degree AV block?
delayed conduction through AV node
what is seen on ECG with first degree AV block?
normal P and QRS complex
longer interval between P and corresponding QRS complex (prolonged P-R)
what happens during second degree AV block?
longer conduction delay through the AV node - some impulses not transferred at all
how may second degree AV block appear on an ECG trace?
some P waves will not have corresponding QRS complexes
QRS complexes normal in morphology
why are QRS complexes normal in morphology during 2nd degree AV block?
as there has been conduction through the AV node
what are the 2 types of 2nd degree AV block?
Mobitz type 1 (Wenckebach)
Mobitz type 2
what does the ECG look like in Mobitz type 1 (Wenckebach) AV block?
P-R interval increases in size
then a P wave will be seen without QRS
following missing QRS the rhythm returns to normal
what does the ECG look like in Mobitz type 2 AV block?
P-R interval the same each time
occasional P wave seen with no corresponding QRS complex
what happens during 3rd degree AV block?
complete lack of conduction through the AV node
ventricular escape beats (ectopics) seen to prevent death
how does 3rd degree AV block appear on ECG?
multiple P waves with no QRS
P waves occur faster
wide and bizarre escape beats seen - have no P wave attached
why are ventricular escape beats seen with 3rd degree AV block?
rescue for the heart as no conduction through the AV node and so animal would otherwise die
how are ventricular escape beats in 3rd degree AV block caused?
radondomly generated by cardiac cells
what HR is seen with 3rd degree AV block?
20-40 bpm
what are the clinical signs of AV block?
if severe (3rd degree) there will be signs of decreased CO
what are the signs of decreased CO?
syncope
lethargy
collapse
how is AV block treated?
management of any underlying conditions
vagolytic drugs
pacemaker for severe second degree and third degree
what vagolytic/anticholinergic drugs may be used in AV block?
atropine
glycopyrrolate
what arrhythmia is seen with hyperkalaemia?
bradycardia
what may be seen on an EGC of a patient with hyperkalaemia?
bradycardia
reduced or absent P waves
spiked T waves
shortened QT
prolonged QRS
what can hyperkalaemia progress to?
atrial standstill
sine wave pattern
v fib
asystole
what is the normal range for potassium?
3.5-5 mmol/l
what are the causes of hyperkalaemia?
urethral obstruction
AKI
hypoadrenocorticism
how can hyperkalaemia be managed?
calcium gluconate bolus
neutral insulin infusion
dextrose infusion
what is the role of calcium gluconate in the management of hyperkalaemia?
reduction of risk of v fib and protection of cardiac myocytes from elevated K+
what is the role of neutral insulin in the management of hyperkalaemia?
causes movement of K+ into cells
what is the role of dextrose infusion in the management of hyperkalaemia?
causes cells to increase uptake of glucose which leads to an intracellular shift of K+
prevents hypoglycaemia due to insulin admin
what causes sinus tachycardia?
SA node generates an impulse and depolarisation at a rate faster than normal
what is seen on an ECG of a patient with sinus tachycardia?
normal sinus rhythm
P-QRS-T normal
regularly regular
what may happen to pulses with extreme sinus tachycardia?
should be synchronous
may become weaker with very fast pulse rates
what can sinus tachycardia be caused by?
normal process (e.g. exercise)
pain
hypovolaemia
anaemia
what are the 2 categories of arrhythmia?
supraventricular
ventricular
where do supraventricular arrhythmias originate from?
atria
where within the atria do supraventricular arrhythmias come from?
point other than the SA node
how do supraventricular arrhythmias appear on ECG?
QRS relatively normal
may be taller and more narrow
where do ventricular arrhythmias originate from?
ventricles
do ventricular arrhythmias follow the normal conduction pathway?
no
how does the ECG of a patient with ventricular arrhythmias appear?
QRS complexes are wide and bizarre
what has happened if the P-QRS-T complex looks different to normal?
impulse has arisen from an ectopic location
what does ectopic mean?
out of place (i.e. not the SA node)
what is occurring during ectopic beats?
beats originate from cells other than those in the SA node
when do ectopic beats occur in the cardiac cycle?
prematurely - interrupt normal rhythm
where can ectopic beats originate from?
atria or ventricles
what are ectopic beats classified by?
point of origin
what are atrial ectopic beats known as?
atrial premature complex
what are junctional ectopic beats known as?
junctional premature complex
what are ventricular ectopic beats called?
ventricular premature complex
what are other forms of ectopic beats?
supraventricular tachycardia
escape beats seen with 3rd degree AV block
why are supraventricular ectopic beats called that?
originate above the SA node
what is caused by supraventricular ectopic beats?
heartbeat occurs earlier than expected after the last complex before the next SA node impulse
how would supraventricular arrhythmias appear on ECG?
abnormal P wave as not initiated by SA node
QRS complex after
what is the rhythm like in supraventricular arrhythmia?
irregularly irregular
what are supraventricular arrhythmias known as?
atrial premature complex
premature atrial contraction
atrial premature beat
what is indicated by 3 or more atrial premature complexes in a row?
supraventricular tachycardia
what HR may be seen with supraventricular tachycardia?
170-350 bpm
how may supraventricular tachycardia appear on ECG?
QRS complexes narrower and more upright than normal
may or may not see an associated P wave
what are the clinical signs of slow SVT?
often none
what are the clinical signs of fast SVT?
weakness
collapse
poor PQ
poor peripheral perfusion
pale MM
prolonged CRT
why do clinical signs of SVT occur?
inadequate diastolic filling due to sort period of diastole
what are the causes of SVT?
often associated with underlying cardiac disease (DCM)
can be associated with systemic disease such as hypovolaemia, toxicity, ischemia and electrolyte imbalances
how can SVT be treated?
decrease HR
treat underlying cause
what drugs may be used for SVT?
beta blockers (Solatol / Atenolol)
calcium channel blockers (Diltiazem)
what sort of arrhythmia is atrial fibrillation?
supraventricular tachycardia
what happens when the heart is in atrial fibrillation?
rapid and irregular contraction of the atria
in what animals is atrial fibrillation seen?
common in dogs
rare in cats
what is the pulse like in a patient with AF?
pulse deficits
irregular pulse
what is the HR like of a patient with AF?
rapid often >200
irregular beat with no pattern
what does AF appear like on ECG?
supraventricular QRS complex (taller and narrower)
no visible P waves as impulse not from SA node
what does a heart with atrial fibrillation sound like?
trainers in a tumble dryer!
how is AF treated?
decrease HR
increase CO
calcium channel blockers
beta blockers
digoxin
amiodarone
what are junctional premature complexes?
ectopic beats that arise from an area within the atrioventricular junction
what is the effect of junctional premature complexes arising from the region of the AV node?
ventricles usually activated normally
how common are JPCs?
less common than APCs or VPCs
how do JPCs appear on ECG?
QRS complex premature with morphology similar to sinus complexes but narrower
usually without preceding P wave but this can be hidden, abnormal or premature
what controls ventricular contractions when ventricular arrhythmia seen?
ectopic site below the AV node
an area of the ventricles becomes the pacemaker
why are ventricular complexes wide and bizarre on ECG?
normal electrical pathway not followed and conduction is slower
what are the causes of ventricular arrhythmias?
underlying primary cardiac disease (e.g. DCM)
complication due to another condition (e.g. GDV, pyo, pancreatitis)
when do VPCs occur in the cardiac cycle?
prior to normal SA node depolarisation
how do VPCs appear on ECG?
no preceding P wave except by coincidence
wide and bizarre QRS
describe pulse quality with VPCs
weak on certain beats
are pulse deficits seen with VPCs?
yes
what are VPCs also known as?
premature ventricular contractions (PVCs)
what is accelerated idioventricular rhythm?
3 or more VPCs together
what is the heart rate like with accelerated idioventricular rhythm?
not very elevated 140-180 bpm
how should accelerated idioventricular rhythm be managed?
generally considered benign at this rate
unlikely to affect CO
treatment not usually needed
monitor for V tach
when may accelerated idioventricular rhythm be seen?
patients recovering from extensive abdominal surgery
what may accelerated idioventricular rhythm progress to?
VT
what is ventricular tachycardia?
3 or more VPCs in a row
with HR of >180 bpm
how does VT appear on ECG?
QRS wide and bizarre
absent P waves
T waves large
what are the clinical findings in a patient with VT?
decreased CO
signs of haemodynamic compromise
what is the pulse of a patient with VT like?
weak
rapid and irregular
what indicates decreased CO?
hypotension
collapse
what are signs of haemodynamic compromise?
altered mentation
signs of hypoperfusion (pale MM, >CRT, hypothermia, poor PQ)
what are the causes of VT?
primary cardiac disease
significant abdominal pathology
inflammation
severe anaemia
abnormal autonomic activity (high sympathetic tone)
electrolyte disturbances
drug toxicities
neoplasia
what can cause abnormal autonomic activity (high sympathetic tone)?
pain
what are the consequences of sustained VT?
cardiogenic shock
decreased systemic tissue perfusion
decreased cardiac perfusion
myocardial failure
malignant arrhythmia (VF)
sudden death
what is the aim of treatment of VT?
convert to sinus rhythm and slow HR down to allow better CO and peripheral perfusion
what does treatment of VT depend on?
degree of haemodynamic compromise
underlying cause
what are patients with underlying heart disease more likely to need if in VT?
immediate drug intervention as risk of CPA
what is PVT?
ventricular tachycardia with no associated pulse
what should be done if PVT identified?
CPR commenced immediately
what drugs are used to treat VT?
lidocaine
beta blockers
amiodarone
procainamide
magnesium
what is the most common drug used for VT?
lidocaine
how does lidocaine work?
sodium channel blocker
what is R on T phenomenon?
VPC is so premature it is superimposed on the T wave of the preceding complex
can be sinus or ectopic beat
what happens in the ventricles during R on T phenomenon?
have not had time to completely repolarise from previous contraction before they are depolarised again
what makes R on T phenomenon so serious?
end of T wave is a vulnerable period
anything abnormal in this time can preclude VT or VF
what may R on T phenomenon preclude?
VT
VF
what is the aim of defibrillation?
high energy electric shock to the heart to reset the electrical state of the heart and convert from shockable rhythm to normal sinus
what is the effect of defibrillation of a non-shockable rhythm?
may be detrimental to survival
what are the shockable rhythms?
PVT
VF
what are the non-shockable rhythms?
PEA
asystole
what can VF result in?
patient death unless instantly recognised and treated
what occurs during VF?
no effective ventricular contraction
no cardiac output so no pulse
patient will be collapsed
how does VF appear on ECG?
rapid, irregular wavy baseline with no recognisiable normal complexes
what are the 2 types of VF?
course
fine
how is VF treated?
CPR
defibrillation
what is occurring during PEA?
electrical impulses within the heart but no corresponding contractions
how does PEA appear on ECG?
slow, normal or fast HR
normal P-QRS-T which may become increasingly wide and bizarre
what is found on exam of a patient in PEA?
no audible heart beats
no palpable pulses
no CO
how is PEA treated?
CPR
adrenaline and atropine
check pulse concurrently
only shock if converts to shockable rhythm
what is the most common arrest rhythm in dogs and cats?
asystole
how does asystole appear on ECG?
flat line
no complexes
how is asystole treated?
CPR
non-shockable rhythm
what disease processes is asystole associated with?
end stage disease
can be caused by very high vagal tone
identify this ECG trace
HR regularly irregular
normal range for species
sinus arrhythmia
identify this ECG trace
HR of 40
sinus bradycardia
identify this ECG trace
sick sinus syndrome
identify this ECG trace
first degree AV block
identify this ECG trace
second degree AV block - Mobitz type 1 / Wenckebach
identify this ECG trace
sinus rhythm
identify this ECG trace
second degree AV block (Mobitz (2))
identify this ECG trace
3rd degree AV block
P waves
Escape beats seen
identify this ECG trace (rhythm is faster than normal for age, breed, species)
sinus tachycardia
identify this ECG trace
supraventricular tachycardia
identify this ECG trace
Atrial fibrillation
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junctional premature complex
identify this ECG trace
ventricular premature complex
identify this ECG trace (rate is not very elevated - 140-180 bpm)
accelerated idioventricular rhythm
identify this ECG trace (HR >180 bpm)
VT
identify this ECG trace
R on T phenomenon
identify this ECG trace (no pulse palpable)
pulseless ventricular tachycardia
identify this ECG trace
fine VF
identify this ECG trace
course VF
identify this ECG trace (no pulse)
PEA
identify this ECG trace
asystole
