ECG Rhythm recognition. Teaching objectives To enable staff nurses to recognise a normal heart rhythm. To teach a step by step approach to basic rhythm strip analysis. To give an introduction to common arrhythmis which they may come across on the wards. To aid recognition of life threatening heart rhythms. To discuss some causes and treatments of common ECG abnormailities. Lesson Plan to achieve learning outcomes. Establish previous knowledge of learners - Label diagram of conduction system and look at the Normal Sinus rhythm complex. Take learners through a step by step approach to analysing a heart rhythm - discuss each question and normal values. 5 minutes in pairs to go through the questions with the rhythms on the work sheet. Go through answers. Look more closely at the features of common arrythmias. Discuss diagnosis through 12 Lead ECG. Relate Rhythms to patient symptoms and first line of action to be taken by the nurse. - Discussion point. Look at life threatening arrythmias. Test learning outcomes - Pop Quiz? Give handout to learners to take away. Point out references for further reading/learning. Utube video to demonstrate heart action an rhythms.

LEARNING OUTCOMES. To recognise and understand the ‘Normal’ heart rhythm and what it represents. To perform a step by step basic rhythm strip analysis. To recognise common cardiac arrhythmias.

Conduction system of the heart. Handout image of the heart and Normal Sinus Rhythm. Label them with a partner. 2 minutes. Normal Heart rate 60-100BPM. Important to look at previous HR to develop a trend picture relevant to your patient. Speed of SA Node - 60-100BPM Speed of AV Node - 40 - 50BPM

Normal sinus rhythm NSR - Rate 60-100BPM P-R = atrial depolarisation QRS = ventricular depolarisation T = Ventricular repolarisation PR interval - 0.12s - 0.2s (3-5 small squares on 12 lead ECG) QRS Complex - 0.12s (approx 2-3 small squares on 12 lead ECG)

7 Questions to ask. Is the rhythm fast or slow? Are all the P waves alike? Are all the QRS complexes alike? Is there a P wave in front of every QRS? Is the PR interval constant or does it vary? Is the PR interval too short or too long? Is the QRS complex widened? 5 blocks on ECG paper = 1 second. Count the R waves in 6 seconds and multiply by 10. - works with both regular and irregular rhythms.

Common Rhythms? Tachycardia Bradycardia AF Heart Blocks 12 lead ECG may be required to confirm a diagnosis. What is meant by Tachycardia and bradycardia? What does AF mean? Atrial Fibrillation/Atrial Flutter. What is happening in the heart? Why might the patient be compromised? - Understanding of the Cardiac Cycle. - reading point. - google,

Common Rhythms. Atrial Fibrillation Atrial Flutter

First degree heart block Second degree heart block

Complete heart Block/Third degree heart block. Look back at the conduction picture and consider where these blocks are!

Ectopic beats. Atrial Ectopic - Premature atrial conduction Ventricular Ectopic - Premature ventricular conduction.

Discuss possible causes of a cardiac arrhythmia. What symptoms may your patient present with if they experience a change is heart Rhythm?

POP QUIZ! Which stage of Normal sinus rhythm represent ATRIAL DEPOLARISATION? What does the T wave on ECG represent? Describe how to measure HR on 12 Lead ECG. Which Heart Block presents with a prolonged P-R interval? How can you tell the difference between an atrial or a ventricular premature conduction? What HR may be on the cardiac monitor if patient is in PEA? What is the normal length of time for the P-R interval? What does the term Paroxysmal mean? There is a prize for the winning team!!

Further reading and references. J. R. Levick (2003) 4th ed. An introduction to cardiovascular Physiology. ECG Interpretation made incredibly easy.(2011) 5th ed - Available as PDF online. http://www.youtube.com/cardiacconduction http://www.nhlbi.nih.gov/health/health-topics/topics/arr