Basic Dysrhythmia &Recording ECG Kamlya balgoon 2009

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

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

Dysrhythmia !!! Abnormal conduction of electrical through the heart. It causes disturbance heart rate , heart rhythm It named according to site of origin of impulse & conduction kemo 2009

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

Sinus Arrhythmias 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 Normal QRS PR interval kemo 2009

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

2-Sinus Tachycardia kemo 2009

2-Sinus Tachycardia Causes Treatment 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

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

3- Sinus Bradycardia kemo 2009

3- Sinus Bradycardia Causes Treatment 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

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

Sinus arrhythmia P-R interval Normal Normal identical P waves 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

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

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

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

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

Premature A trial Complex ( PAC) kemo 2009

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

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

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

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

3- A trial Flutter ٍ Normal QRS F wave kemo 2009

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

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

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

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

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

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

Thank you kamlya kemo 2009