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# EKG Interpretation: Rhythm Strip

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#### Transcript of EKG Interpretation: Rhythm Strip

When QRS interval is too wide
The Basics
RATE
RHYTHM
INTERVALS
AXIS
EKG Interpretation: The Rhythm Strip
Yone Amuka, M.D.
UIC Emergency Medicine
Understanding The EKG
Understanding The EKG
Focus on ONE Camera first: The Rhythm Strip
The Rhythm Strip:
Can be ANY of the leads (cameras)

Usually an "upright" lead (NOT AvR or AvL)

Usually a 6 or 10 second segment of time
12 Lead Info Still To Come!
But For Now, Focus On The Rhythm Strip
Baby Steps...
The Rhythm Strip:
Can be ANY of the leads (cameras)

Usually an "upright" lead (NOT AvR or AvL)

Usually a 6 or 10 second segment of time
Must Have A System
RATE
RHYTHM
(AXIS)
INTERVAL
What is Normal Heart Rate?
60-100
What Is Expected Of You Next Week
How To Actually Calculate...
300,150,100,75,60...
Rhythm Strips come in two standard forms: 6 or 10 seconds
so just COUNT THE QRS COMPLEXES AND MULTIPLY BY 10 or 6
This will equal Rate/Min
Practice Time: What is this Rate?
Who Is Telling The Heart To Beat?
Ask yourself: Is there ONE P wave for every QRS?
If there is, we call it a SINUS rhythm
Is It Regular?
Even if originates at SA node, sometimes the rhythm off
Why is a regular rhythm important?
Atrial Depolarization = P wave on the EKG
When there is normal conduction
There is a normal window of time that the beat should move through each checkpoint
The PR Interval

The time between atrial contraction and ventricular priming

From start of Pwave to Start of QRS complex

Can be thought of as AV Node "Gate Check"

Normal Time Frame: .12-.20 Seconds
When PR interval is too long
Why is this important?
When PR interval is too long
Why is this important?
The QRS Interval

The time it takes the ventricles to contract

Normal Time Frame: <120 milliSeconds
Normal Conduction
Why is this important?
2nd Degree AV Block: Type I
PR Interval Gets Progressively "Longer" Until A Beat Is Dropped ("Wenkebach")
Usually benign: Common in athletes. No intervention necessary
2nd Degree AV Block: Type II
PR Interval Stays The Same And Then A Beat Is Suddenly Dropped
LIFE THREATENING!: Pacemaker is usually necessary
We've seen this before...
When QRS interval is too wide
Why is this important?
V-tach is a LIFE THREATENING rhythm!
As A Matter Of Fact...
The PR Interval

This is called 3rd degree AV (or complete heart) block
Sometimes the P wave isn't even associated with the QRS complex

Life Threatening Emergency!!!
168/Min
40/MIN
Full transcript