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Analyzing EKG Rhythm Strips

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by

Jamie Hartman

on 6 September 2016

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Transcript of Analyzing EKG Rhythm Strips

Regular or Irregular??
Measure R to R interval
If irregular, any patterns to irregularity?
Is it regular except for a few beats?
P Waves
Are P waves regular?
One P wave for every QRS?
Is P wave before QRS?
Is P wave normal and upright?
Do all the P waves look alike?
QRS Complex
Are all QRS complexes equal duration?
What is the measurement of QRS complex?
Is measurement WNL?
0.06-0.12 seconds
Do all QRS complexes look alike?
Cardiac Rhythms Day 1
Analyzing EKG rhythms

Analyzing Rhythm Strips

Regular or irregular?
Calculate heart rate
P waves
PR interval
QRS complex
QT interval
Calculating Rate
Count number of R waves in 6 second strip and multiply by 10
PR Interval
Are all PRI constant?
Is PRI within normal range
(0.12-0.20 seconds)
QT interval
What is the measurement of QT interval?
Is it WNL? (Dependent on heart rate)
Increased HR = shortened QT interval
Normal = approx. 1/2 R-R interval
3.1

Gail Walraven, Basic Arrhythmias, Sixth Edition
©2006 by Pearson Education, Inc., Upper Saddle River, NJ

3.14

Gail Walraven, Basic Arrhythmias, Sixth Edition
©2006 by Pearson Education, Inc., Upper Saddle River, NJ

3.3

Gail Walraven, Basic Arrhythmias, Sixth Edition
©2006 by Pearson Education, Inc., Upper Saddle River, NJ

3.15

Gail Walraven, Basic Arrhythmias, Sixth Edition
©2006 by Pearson Education, Inc., Upper Saddle River, NJ

3.14

Gail Walraven, Basic Arrhythmias, Sixth Edition
©2006 by Pearson Education, Inc., Upper Saddle River, NJ

3.3

Gail Walraven, Basic Arrhythmias, Sixth Edition
©2006 by Pearson Education, Inc., Upper Saddle River, NJ

3.15

Gail Walraven, Basic Arrhythmias, Sixth Edition
©2006 by Pearson Education, Inc., Upper Saddle River, NJ

Review of Anatomy

4 chambers
2 atria
2 ventricles
Cardiac Action Potential
Polarization- Ready state
Depolarization- Discharge state, cell "fires"
Repolarization- recover and restore
EKG
Represents electrical activity of the heart
Does NOT reflect mechanical activity
How would we assess mechanical activity?
Can we have electrical activity without mechanical response?
Inherent Rates
Sinus Node 60-100 beats/min
AV node 40-60 beats/min
Ventricles 20-40 beats/min
Fastest rate wins
Irritable
Escape
SA node is normal pacemaker
SA node --> AV node --> Bundle of His --> R/L Bundle Branches --> Purkinje Fibers
Conduction System
Waves and Measurements
Electricity flowing toward positive electrode = upright pattern


P WAVE
Atrial Depolarization

PR interval
Onset of atrial depolarization to onset of ventricular depolarization
Beginning of P wave to 1st deflection of next wave
0.12-0.20 seconds
QRS Complex
Ventricular Depolarization
Electricity flowing toward a negative electrode = inverted pattern.
0.06-0.12 seconds
Q: first negative deflection
R: first positive deflection
S: second negative deflection
ST Segment
T Wave

Ventricular repolarization
QT Interval
Total ventricular activity
Varies with age, gender, HR
Increased HR = decreased QT interval
Long QT interval = Increased relative refractory period
First find J Point
Elevation
MI, pericarditis, ventricular aneurysm,
Depression
Myocardial ischemia
Cardiac cells have automaticity
Sinus Rhythm
Regular
Rate: 60-100
P Wave: Normal and upright
PRI: 0.12-0.20
QRS: Less than 0.12 seconds
Sinus Arrhythmia
Irregular
Rate: usually 60-100
P Wave: Normal and upright
PRI: 0.12-0.20
QRS: Less than 0.12 seconds
Sinus Tachycardia
Regular
Rate: Greater than 100 (usually 100-160)
P Wave: Normal and upright
PRI: 0.12-0.20
QRS: Less than 0.12 seconds
Sinus Bradycardia
Regular
Rate: Less than 60 bpm
P Wave: Normal and upright
PRI: 0.12-0.20
QRS: Less than 0.12 seconds
Sinus node fires faster during inspiration and slower during expiration

Right Atrium
Blood low in oxygen
SVC, IVC, coronary sinus
Pumps to R) Ventricle (hopefully)
Tricuspid Valve
3 cusps
Separates RA from RV
Right Ventricle
Pumps blood to pulmonary artery
Thicker walls than atria
Left Atrium
Blood from pulmonary veins
Pumps to Left Ventricle
Left Ventricle
Pumps blood to aorta and rest of the body
Thick wall
J Point
ST
Segment
Full transcript