Basic Dysrhythmia &Recording ECG

1. Basic Dysrhythmia &Recording ECG Kamlya balgoon 2009

2. ECG - Analysis • Use a consistent method to analyze an ECG • Rate • Rhythm • Assess P wave • Assess P wave to QRS ratio 1=1 • Interval duration • Identify abnormalities kemo 2009

3. Lets Have A Deal …!!!! • Normal P, normal P-R, normal QRS, normal P:QRS ratio = Sinus …… • Problem in the P wave = Atrial ……… • Problem in the QRS = Ventricular ……… • More P waves than QRS = 2nd or 3rd Degree AV Block. • Fibrillation = always irregular kemo 2009

4. Arrhythmias • Originates from the SA node = Sinus • Originates from the atria = atrial • Originates from the AV node = nodal or Junctional • Originates from the ventricles ( high ) = Idioventricular • Originates from the ventricles (myocardial tissue ) = Ventricular • Impulse delay in the AV node = Block • No impulse = Asystole kemo 2009

5. Sinus Arrhythmias Normal QRS 1- Sinus Rhythm ( the only normal one ) • Regular • P-R interval Normal • Normal identical P waves • Each P followed by a QRS • Normal QRS • Rate 60-100 bpm PR interval kemo 2009

6. 2-Sinus Tachycardia • Ventricle & a trial rate ; greater than 100 • Ventricle & a trial rhythm : Regular • QRS shape & duration : normal • P wave shape normal • P-R interval normal between 0,12 & o,20 second • Normal identical P waves • Each P followed by a QRS • P: QRS ratio : 1:1 kemo 2009

7. 2-Sinus Tachycardia kemo 2009

8. 2-Sinus Tachycardia • Causes • Normal physiologic with increase cardiac out put • Shock • exercise • anxiety • fever • Anemia • Medication sympathomimetic & parasympatholytic (atropine ,epinephrine ) • Treatment • Treat cause • Medication ( antipyretics , beta blockers ) kemo 2009

9. 3- Sinus Bradycardia • Ventricle & a trial rate : less than 60 • Ventricle & a trial rhythm : Regular • QRS shape & duration : Normal • P wave shape Normal • P-R interval Normal between 0,12 & o,20 second • Normal identical P waves • Each P followed by a QRS • P: QRS ratio : 1:1 kemo 2009

10. 3- Sinus Bradycardia kemo 2009

11. 3- Sinus Bradycardia Causes • Slower metabolic need ( Sleep , Hypothermia , hypothyroidism ) • Vagal stimulation ( vomiting , suction , sever pain ) • Medication ( beta blockers , calcium channel blockers ) • Eye surgery • Increase intracranial pressure Treatment • Treat causes • Medication ( atropine ,epinephrine ) kemo 2009

12. 4- Sinus arrhythmia or sinus block • Same as sinus but with a missed beat. • After missing a beat, the rhythm will continue in regularity. A total beat missed kemo 2009

13. Sinus arrhythmia • It occurs impulse irregular rhythm • Rate increase with inspiration & decrease with expiration • It include heart disease ( valvular disease ) • P-R interval Normal • Normal identical P waves • Each P followed by a QRS • Normal QRS • Rate 60-100 bpm kemo 2009

14. Atrial Arrhythmias • General Characteristics P wave • Abnormal • Multiple Foci • Regular or Irregular • Fast most of the time • Normal QRS always kemo 2009

15. A trial dysrhythmias • Premature a trial complex • A trial Fibrillation • A trial Flutter • Atrial Tachycardia kemo 2009

16. A trial dysrhythmias 1- Premature a trial complex • An electrical impulse starts in atrium before next normal impulse of SA node Causes • Caffeine , alcohol , nicotine Treatment • Treat causes kemo 2009

17. Premature A trial Complex ( PAC) • Ventricle & a trial rate depend on underlying rhythm • Ventricle & a trial rhythm : irregular ( due to early p wave creating a PP interval is shorter • QRS shape & duration : normal • P wave shape an early & different p wave , hidden in T wave • P-R interval Normal between 0,12 & o,20 second • Each P followed by a QRS • P: QRS ratio : 1:1 kemo 2009

18. Premature A trial Complex ( PAC) kemo 2009

19. 2- A trial Fibrillation • Atrial fibrillation causes rapid ,disorganized & of artial muscle Unequal R-R = irregular kemo 2009

20. 1- Atrial Fibrillation Causes • Heart failure , A rtial enlargement, hypertension , Treatment • Digoxin , Beta blockers ( Diogxin ) • Anticoagulant if rhythm present for greater 48 hours • Synchronized cardio version if rhythm present less for 48 hours kemo 2009

21. Atrial Fibrillation • Ventricle & a trial rate : a trial rate 300 – 600 • Ventricle rate 120 to 200 in untreated a trial fibrillation • Ventricle & a trial rhythm : highly irregular • QRS shape & duration : normal • P wave shape : no discernible p wave , irregular undulating wave are seen are termed fibrillatory or f waves • P-R interval not can measure • Each P followed by a QRS • P: QRS ratio : many :1 kemo 2009

22. Atrial Fibrillation Unequal R-R = irregular kemo 2009

23. 3- A trial Flutter ٍ Normal QRS F wave kemo 2009

24. 2- Atrial Flutter Causes • Heart disease ( valvular disorder , Rheumatic & ischemic heart disease ) Treatment • Adenocard • Diltazem kemo 2009

25. Atrial Flutter • It occur in atrium & creates impulses at an artial rate 250 to 400 times per minute • It cause serious signs ( chest pain .shortness breathing ,low blood pressure ) Treatment • Electrical Cardiovesion kemo 2009

26. Atrial Flutter • Ventricle & a trial rate : a trial rate 250 – 400 • Ventricle rate 75to 150 in untreated a trial fibrillation • Ventricle & a trial rhythm : Mostly regular, but it can be irregular • QRS shape & duration : normal • P wave shape : saw –toothed shape this waves are referred to as F wave • P-R interval : multiple F wave • Each P followed by a QRS • P: QRS ratio : 2 :1 , 3 :1, 4 :1 kemo 2009

27. 4- Atrial Tachycardia • Some times it is called Supraventricular Tachycardia ( SVT ). • Very fast rate > 150 bpm. • Normal QRS. • No P wave .or very difficult discern No P wave Normal QRS Very fast kemo 2009

28. 4- Atrial Tachycardia • Some times it is called Supraventricular Tachycardia ( SVT ). • Very fast rate > 150 bpm. • Normal QRS. • No P wave. No P wave Normal QRS Very fast kemo 2009

29. 4- Atrial Tachycardia Cases • Ischemia • Hypoxia • Heart failure Treatment • Adenocard • Diltazem • Synchronized cardioversion kemo 2009

30. Thank you kamlya kemo 2009