EKG COPY Flashcards
Atrial fibrillation
- Rate: Variable (∼150–200 beats/min)
- Rhythm: Irregular
- PR interval: No P wave; PR interval not discernible
- QT interval: QRS normal
Note: Must be differentiated from atrial flutter: (1) absence of flutter waves and presence of fibrillatory line; (2) flutter usually associated with higher ventricular rates (>150 beats/min). Loss of atrial contraction reduces cardiac output (10–20%). Mural atrial thrombi may develop. Considered controlled if ventricular rate is <100 beats/min.
Atrial flutter
- Rate: Rapid, atrial usually regular (250–350 beats/min); ventricular usually regular (<100 beats/min)
- Rhythm: Atrial and ventricular regular
- PR interval: Flutter (F) waves are saw-toothed. PR interval cannot be measured.
- QT interval: QRS usually normal; ST segment and T waves are not identifiable.
Note: Vagal maneuvers will slow ventricular response, simplifying recognition of the F waves.
AV block (1st degree)
- Rate: 60–100 beats/min
- Rhythm: Regular
- PR interval: Prolonged (>0.20 sec) and constant
- QT interval: Normal
Note: Usually clinically insignificant; may be early harbinger of drug toxicity.
AV Block (2nd degree)
Mobitz Type I / Wenckebach
- Rate: 60–100 beats/min
- Rhythm: Atrial regular; ventricular irregular
- PR interval: P wave normal; PR interval progressively lengthens with each cycle until QRS complex is dropped (dropped beat). PR interval following dropped beat is shorter than normal.
- QT interval: QRS complex normal but dropped periodically.
Note: Commonly seen in trained athletes and with drug toxicity.
AV Block (2nd degree)
Mobitz Type II
- Rate: <100 beats/min
- Rhythm: Atrial regular; ventricular regular or irregular
- PR interval: P waves normal, but some are not followed by QRS complex.
- QT interval: Normal but may have widened QRS complex if block is at level of bundle branch. ST segment and T wave may be abnormal, depending on location of block.
Note: In contrast to Mobitz type I block, the PR and RR intervals are constant and the dropped QRS occurs without warning. The wider the QRS complex (block lower in the conduction system), the greater the amount of myocardial damage.
AV Block (3rd degree)
Complete Heart Block
- Rate: <45 beats/min
- Rhythm: Atrial regular; ventricular regular; no relationship between P wave and QRS complex
- PR interval: Variable because atria and ventricles beat independently
- QT interval: QRS morphology variable, depending on the origin of the ventricular beat in the intrinsic pacemaker system (atrioventricular junctional vs. ventricular pacemaker). ST segment and T wave normal.
Note: AV block represents complete failure of conduction from atria to ventricles (no P wave is conducted to the ventricle). The atrial rate is faster than ventricular rate. P waves have no relationship to QRS complexes (e.g., they are electrically disconnected). In contrast, with AV dissociation, the P wave is conducted through the AV node and the atrial and ventricular rate are similar. Immediate treatment with atropine or isoproterenol is required if cardiac output is reduced. Consideration should be given to insertion of a pacemaker. Seen as a complication of mitral valve replacement.
Bundle Branch Block - Left
- Rate: <100 beats/min
- Rhythm: Regular
- PR interval: Normal
- QT interval: Complete LBBB (QRS >0.12 sec); incomplete LBBB (QRS = 0.10–0.12 sec); lead V1 negative RS complex; I, aVL, V6 wide R wave without Q or S component. ST segment and T-wave direction opposite direction of the R wave.
Note: LBBB does not occur in healthy patients and usually indicates serious heart disease with a poor prognosis. In patients with LBBB, insertion of a pulmonary artery catheter may lead to complete heart block.
Bundle Branch Block - Right
- Rate: <100 beats/min
- Rhythm: Regular
- PR interval: Normal
- QT interval: Complete RBBB (QRS >0.12 sec); incomplete RBBB (QRS = 0.10–0.12 sec). Varying patterns of QRS complex; rSR (V1); RS, wide R with M pattern. ST segment and T wave opposite direction of the R wave.
Note: In the presence of RBBB, Q waves may be seen with a myocardial infarction.
Digitalis effect
- Rate: <100 beats/min
- Rhythm: Regular
- PR interval: Normal or prolonged
- QT interval: ST-segment sloping (“digitalis effect”)
Note: Digitalis toxicity can be the cause of many common arrhythmias (e.g., premature ventricular contractions, second-degree heart block). Verapamil, quinidine, and amiodarone cause an increase in serum digitalis concentration.
Hypercalcemia
- Rate: <100 beats/min
- Rhythm: Regular
- PR interval: Normal - increased
- QT interval: Decreased
Hyperkalemia
- Rate: <100 beats/min
- Rhythm: Regular
- PR interval: Normal
- QT interval: Increased
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Other:
- T wave peaked
Hypocalcemia
- Rate: <100 beats/min
- Rhythm: Regular
- PR interval: Normal
- QT interval: Increased
Hypokalemia
- Rate: <100 beats/min
- Rhythm: Regular
- PR interval: Normal
- QT interval: Normal
-
Other:
- T wave flat
- U wave
Hypothermia
- Rate: <60 beats/min
- Rhythm: Sinus
- PR interval: Prolonged
- QT interval: Prolonged
Note: Seen at temperatures below 33°C with ST-segment elevation (J point or Osborn wave). Tremor due to shivering or Parkinson’s disease may interfere with ECG interpretation and may be confused with atrial flutter. May represent normal variant of early ventricular repolarization. (Arrow indicates J point or Osborn waves.)
Multifocal Atrial Tachycardia
- Rate: 100–200 beats/min
- Rhythm: Irregular
- PR interval: Consecutive P waves are of varying shape.
- QT interval: Normal
Note: Seen in patients with severe lung disease. Vagal maneuvers have no effect. At heart rates <100 beats/min, it may appear as wandering atrial pacemaker. May be mistaken for atrial fibrillation. Treatment is of the causative disease process.