EKG Pictures Flashcards
Normal Sinus Rhythm
- Rate: 60 – 99
- Rhythm: Regular
- P Waves: Present
- P-R Interval: 0.12 – 0.20 seconds
- QRS Complex: < 0.12 seconds
Sinus Tachycardia
- Rate: >100
- Rhythm: Regular
- P Waves: Present
- P-R Interval: 0.12 – 0.20 seconds
- QRS Complex: < 0.12 second
Sinus Bradycardia
- Rate: <60
- Rhythm: Regular
- P Waves: Present
- P-R Interval: 0.12 – 0.20 seconds
- QRS Complex: < 0.12 seconds
Sinus Arrhythmia
- Rate: 60 – 100
- Rhythm: Regularly Irregular
- P Waves: Present
- P-R Interval: 0.12 – 0.20 seconds
- QRS Complex: < 0.12 seconds
Junctional Escape Rhythm
Rate: 40 – 60
May be accelerated (60-100) or junctional tachycardia (rate >100)
Rhythm: Regular
P Waves: None
P-R Interval: NA
QRS Complex: < 0.12 seconds
Ventricular Escape Rhythm
or Idioventricular Rhythm
Rate: 20 – 40 bpm
Rhythm: Regular
P Waves: None
P-R Interval: None
QRS Complex: > 0.12 seconds
Premature Atrial Contractions (PACs)
- Rate: 60 – 100 (Normal, right?)
- Rhythm: Looks irregularly irregular if there are multiple PACs. If there is just one PAB, then, the regular rhythm is reset
- P Waves: Present, but can’t always be seen
- P-R Interval: 0.12 – 0.20 seconds
- QRS Complex: < 0.12 seconds
Why? When the SA node or the AV node become irritated by…
Increased epinephrine in the body
Caffeine, cocaine, albuterol, β agonist medications, methamphetamines or digitalis…
Hyperthyroidism
…it can fire spontaneously, ahead of when it should. This firing produces an unusually shaped and unusually placed p wave.
Premature Atrial Contractions (PACs)
- Rate: 60 – 100 (Normal, right?)
- Rhythm: Looks irregularly irregular if there are multiple PACs. If there is just one PAB, then, the regular rhythm is reset
- P Waves: Present, but can’t always be seen
- P-R Interval: 0.12 – 0.20 seconds
- QRS Complex: < 0.12 seconds
Why? When the SA node or the AV node become irritated by…
Increased epinephrine in the body
Caffeine, cocaine, albuterol, β agonist medications, methamphetamines or digitalis…
Hyperthyroidism
…it can fire spontaneously, ahead of when it should. This firing produces an unusually shaped and unusually placed p wave.
Bigeminy-Premature Ventricular Contraction (PVC)
- Rate - any
- Rhythm – Irregular
- P Waves – None
- P-R - NA
- QRS – < 0.12 in the normal QRS complexes, however, PVCs are wider
- Comp. Pause – Yes
- Why? – A ventricular automaticity focus can be made irritable by low oxygen levels, hypokalemia, and injury to the heart muscle from infection, inflammation or infarction
Premature Ventricular Contraction (PVC)
3 or more PVCs in a row or 6 or more PVCs in a minute is Ventricular Tachycardia!
- Rate - any
- Rhythm – Irregular
- P Waves – None
- P-R - NA
- QRS – < 0.12 in the normal QRS complexes, however, PVCs are wider
- Comp. Pause – Yes
- Why? – A ventricular automaticity focus can be made irritable by low oxygen levels, hypokalemia, and injury to the heart muscle from infection, inflammation or infarction
Premature Ventricular Contraction (PVC)
multifocal PVCs-PVCs have different morphology which indicates multiple foci
- Rate - any
- Rhythm – Irregular
- P Waves – None
- P-R - NA
- QRS – < 0.12 in the normal QRS complexes, however, PVCs are wider
- Comp. Pause – Yes
- Why? – A ventricular automaticity focus can be made irritable by low oxygen levels, hypokalemia, and injury to the heart muscle from infection, inflammation or infarction
Premature Ventricular Contraction (PVC)
multifocal PVCs-PVCs have different morphology which indicates multiple foci
- Rate - any
- Rhythm – Irregular
- P Waves – None
- P-R - NA
- QRS – < 0.12 in the normal QRS complexes, however, PVCs are wider
- Comp. Pause – Yes
- Why? – A ventricular automaticity focus can be made irritable by low oxygen levels, hypokalemia, and injury to the heart muscle from infection, inflammation or infarction
Supraventricular Tachycardia (SVT)
Rate: >150-180
Rhythm: Regular
P Waves: Present or not discernable due to increased rate
P-R Interval: normal if it can be seen (which it usually can’t)
QRS Complex: < 0.12 seconds
Note: P waves may be hidden in preceding T
Supraventricular Tachycardia (SVT)
Onset 1/2 way through strip
Rate: >150-180
Rhythm: Regular
P Waves: Present or not discernable due to increased rate
P-R Interval: normal if it can be seen (which it usually can’t)
QRS Complex: < 0.12 seconds
Note: P waves may be hidden in preceding T
Ventricular Tachycardia
Rate: > 100
Rhythm: Regular
P Waves: None visible (SA nodes are still pacing, but p-waves buried in QRS)
P-R Interval: NA
QRS Complex: > 0.12 seconds
Note: 3 or more PVCs at a regular, rapid rate or 6 or more PVCs in a minute is V Tach
•Why?
–Ischemic heart disease
–Myocardial scar from previous MI can cause an ectopic electrical focus
–Hemodynamic compromise
Ventricular Tachycardia
Rate: > 100
Rhythm: Regular
P Waves: None visible (SA nodes are still pacing, but p-waves buried in QRS)
P-R Interval: NA
QRS Complex: > 0.12 seconds
Note: 3 or more PVCs at a regular, rapid rate or 6 or more PVCs in a minute is V Tach
•Why?
–Ischemic heart disease
–Myocardial scar from previous MI can cause an ectopic electrical focus
–Hemodynamic compromise
Torsades de Pointes
- Rate: > 100 (usually 250 – 350 bpm)
- Rhythm: roughly regular
- P Waves: None visible
- P-R Interval: None
- QRS Complex: > 0.12 seconds
- Why? ? Two competitive, irritable foci in the ventricular myocardium
- Causes
–Hypokalemia
–Hypomagnesemia
–Hypocalcemia
–Medications that block potassium channels including anti-hypertensives, antibiotics and anti-convulsants
–Congenital Long QT syndrome (especially in female patients)
Atrial Flutter
Rate: Atrial – 250 – 360
Ventricular – Can vary
Rhythm: Regular Atrial Contraction
P Waves: Flutter (F) waves (aka “sawtooth waves”)
P-R Interval: N/A
QRS Complex: < 0.12 seconds
Why? The long AV node refractory period keeps the atrial signal from conducting through to the ventricles – therefore, the ventricular rate is much slower than the atrial rate
Atrial Flutter
Rate: Atrial – 250 – 360
Ventricular – Can vary
Rhythm: Regular Atrial Contraction
P Waves: Flutter (F) waves (aka “sawtooth waves”)
P-R Interval: N/A
QRS Complex: < 0.12 seconds
Why? The long AV node refractory period keeps the atrial signal from conducting through to the ventricles – therefore, the ventricular rate is much slower than the atrial rate
Atrial Fibrillation
Rate: Atrial – Fibrillation
Ventricular – Varies
Rhythm: ”Irregularly Irregular”
P Waves: Absent!
+ Fibrillation waves
P-R Interval: N/A
QRS Complex: < 0.12 seconds
Why? Atria not conducting or contracting with any regularity
Atrial Fibrillation
Rate: Atrial – Fibrillation
Ventricular – Varies
Rhythm: ”Irregularly Irregular”
P Waves: Absent!
+ Fibrillation waves
P-R Interval: N/A
QRS Complex: < 0.12 seconds
Why? Atria not conducting or contracting with any regularity
Ventricular Fibrillation **CPR and Defribillator!!**
Rate: None
Rhythm: Chaotic
P Waves: None
P-R Interval: None
QRS Complex: None
Why? Cardiac arrest! There is no coordinated electrical activity in the heart, no squeezing of the ventricles and thus no blood is being circulated to the body!
Pulseless Electrical Activity (PEA)
Rate: Chaotic to Normal
Rhythm: Chaotic to Normal
P Waves: May be normal or absent
P-R Interval: May be normal or absent
QRS Complex: May be normal or absent
Why? A dying heart generates electrical impulses, but nothing that can cause atrial or ventricular contractions to generate a pulse
Aystole
- Rate: None
- Rhythm: None
- P Waves: None
- P-R Interval: None
- QRS Complex: None
1st Degree Heart Block
Rate: Typically benign
Rhythm: Regular
P Waves: Present
P-R Interval: >0.2
QRS Complex: <0.12
Why? Increased vagal tone (athletes), medications (antiarrhythmics), MI, electrolyte disturbance….and many others
2st Degree Heart Block type I
Long, longer, drop…Wenchebach
Rate: Typically benign
Rhythm: Irregularly regular
P Waves: Present
P-R Interval: >0.2
QRS Complex: <0.12
Why? Athletes, electrolyte disturbance….and many others
2st Degree Heart Block type II
Rate: Typically bradycardic
Rhythm: Regular with irregularity
P Waves: Present
P-R Interval: >0.2
QRS Complex: <0.12
PR interval remains unchanged with intermittent non-conducting P waves
Can lead to syncope or complete heart block, usually needs pacemaker, seen in chronic fibrotic disease of the conduction system, chronic inflammatory conditions (lymes)
3rd Degree /
Complete Heart Block
Rate: Typically bradycardic
Rhythm: Regular
P Waves: Present
P-R Interval:
QRS Complex: <0.12
Why? Complete dissociation between atria and ventricles, needs pacemaker!
Ventricular Fibrillation
Atrial flutter with 2:1 conduction
Mild ST depression V4-V6
Supraventricular tachycardia rate=190
ST depression at arrows
Sinus bradycardia rate=42
Sinus rhythm
Short PR interval and ventricular pre-excitation
Possible Wolff Parkinson White
DELTA WAVES
Hyperkalemia-PEAKED T WAVES
Sinus bradycardia with 1st degree AV heart block
3rd degree heart block
Second degree AV block type II
2:1 conduction
Right bundle branch block
Left bundle branch block
Hyperkalemia
Second degree AV block type I
Junctional escape rhythm
Ventricular tachycardia
Supraventricular Tachycardia
Sinus Bradycardia
Rate=48
Mutifocal atrial tachycardia
First degree AV block
ST-T waves consistent with lateral ischemia
Long QT interval
Sinus tachycardia
Rate=155
atrial fibrillation
inferior infarct
atrial flutter with 2:1 block
