Quick Clinical Analysisasda.net.au/.../2020/01/ECG-INTERPRETATION-HANDS-ON...Quick Clinical Analysis ECG INTERPRETATION . We will learn to quickly identify 18 rhythms. We will focus

Quick Clinical Analysis ECG INTERPRETATION

We will learn to quickly identify 18 rhythms.

We will focus only on identification not causes ,

pathophysiology or treatment. See examples in your handout

OVERVIEW

1)  P-waves and T-waves are upright

2)  P-waves precede all QRS complexes

3)  QRS complexes are narrow less than 0.12 milliseconds

4)  P-R intervals are less than 0.20 milliseconds

5)  The J-Point is isoelectric

6)  The heart rate is between 60-100 beats per minute

1-NORMAL SINUS RHYTHM

1) All the features of NSR except rate is less than 60 beats per minute

2-SINUS BRADYCARDIA

1) Same as NSR except rate over 100 beats per minute

3) SINUS TACHYCARDIA/SUPERVENTRICULAR TACHCARDIA

1)  No P-waves

2)  Irregularly irregular pattern of QRS complexes

3)  multiple undulations between normal width QRS complexes ( less than 0.12 ms)

4-ATRIAL FIBRILLATION

1) Identifiable saw-tooth pattern between regular QRS complexes( less than 0.12 ms)

5-ATRIAL FLUTTER

1-fixed prolonged P-R interval( over 0.20 ms /5 small boxes)

6-1ST DEGREE AV BLOCK

1) Progressive prolongation of the P-R interval until a beat/QRS is dropped/missed and the the cycle repeats.

7-2ND DEGREE AV BLOCK TYPE 1

Fixed prolonged P-R interval with dropped beats/QRS complexes

8-2ND DEGREE AV BLOCK TYPE 2

1)  p-waves are regularly spaced but have no relationship to the QRS complexes

2)  QRS Complexes are wide ( over 0.12 ms)

3)  The P-waves seem to be marching through the QRS complexes

9-THIRD DEGREE AV BLOCK

1)-there are no P-waves

2)-can look like sinus rhythm but P-wave is absent

3) Can be wide QRS complexes without P-waves

10-JUNCTIONAL RHYTHMS

1)-regular wide QRS complexes with a rate over 100 beats per minute

2) No P-waves are seen

11-VENTRICULAR TACHYCARDIA

1) No P-waves or QRS complexes seen but there is electrical activity

12-VENTRICULAR FIBRILLATION

1) No electrical activity is seen even though baseline often wanders

13-ASYSTOLE

1)  No P-waves or QRS complexes are seen but electrical activity is present and so is a form of ventricular fibrillation.

2)  There is a characteristic sine wave pattern

14-TORSADES DE POINTS( TWISTING POINTS)

The J-point is elevated

15-ST ELEVATION

1) The J-point is depressed

16-ST DEPRESSION

1) Wide QRS complexes that occur before the next QRS complex is due

17-PVC’S ( PREMATURE VENTRICULAR CONTRACTIONS)

1)  You see a new P, QRS and T-wave prior to when the next is expected

2)  often get a compensatory pause in the cycle after the PAC and the regular rhythm resumes.

3)  However there may be no pause.

18- PAC ( PREMATURE ATRIAL CONTRACTIONS)