1. The Cardiac Cycle and The ECG
Carson Vandiver
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2. Einthovens Triangle

3. The Normal ECG

4. Sinus Rhythms The Impulse is Originating in the SA node (Sinus Node)
Characterized by:
One P wave for Every QRS Complex
Rhythm is Normally Spaced out Regularly
PR interval is between Seconds
QRS is less than .12 Seconds
Classified by Rate

5. Normal Sinus Rhythm Rate is Between 60-100

6. Sinus Bradycardia Rate is less than 60 beats per minute

7. Sinus Tachycardia Rate is between 100 and 150

8. Sinus Arrhythmia Impulse is still originating in SA node but QRS complexes are spaced out unevenly (Usually related to breathing pattern)

9. Wandering Atrial Pacemaker Has all the characteristics of sinus Arrhythmia but P waves have different Morphology

10. AV Blocks
AV blocks means that there is an issue with the conduction of the Impulse through the AV node
Characterized by:
By an Abnormal PR interval
Or More than 1 P wave associated with Every QRS

11. First Degree AV Block Impulse is being held for too long at AV Node Usually Benign (Very Common in Elderly)

12. Second Degree Type 1 AV Block PR Interval gets longer until QRS is Dropped Commonly associated with Myocardial infarctions (Heart Attack) or infections of the heart such as myocarditis

13. Second Degree Type 2 AV Block Impulse is blocked at AV Node Commonly associated with extensive damage to the bundle branches usually caused by an anteroseptal Myocardial infarction (heart attack)

14. Third Degree AV Block Total disassociation between the electrical activity in the Atria and Ventricles Very critical requires immediate intervention because they are normally hypotensive and Bradycardic

15. Junctional Rhythms
Av Junction is the secondary pacemaker site for the heart if the impulse fails to start in the SA node the AV junction will start firing
Junctional Rhythms are Characterized by:
The Absence of a P wave
Regularly spaced out QRS Complexes
QRS that is less than .12 seconds in length
The are classified by Rate
Can be caused by drug toxicity from Digoxin, Myocardial infarctions and a number of other physiological issues

16. Junctional Escape Rhythm Rate is 40-60 Beats per Minute

17. Accelerated Junctional Rhythm Rate 60-100 Beats per Minute

18. Junctional Tachycardia Rate is between 100-150 beats per minute

19. Atrial Arrhythmias Impulse is originating in the SA node
Characterized by
QRS that is less than .12 seconds
Can be benign or life threatening

20. Atrial Fibrillation (A-Fib) No organized atrial contraction Atria is Fibrillating (Pulsating)

21. Atrial Flutter Well defined pacemaker within atria firing at a rate of 250-350 times

22. Suparventricular Tachycardia (SVT) Occurs when a Pacemaker site develops within the Atria and fires very quickly (Greater than 150 beats per minute) Life Threatening

23. Ventricular Dysthymias
Caused by a pacemaker site developing somewhere in the Ventricles
Characterized by:
QRS complex that is greater than .12
Can Be life threatening

24. Ventricular Tachycardia (V-tach) Caused by a pacemaker site originating in the ventricles and beating very fast ( beats per minute) Life Threatening requires intervention

25. Cardiac Arrest Rhythms
With these rhythms the patient does not have a pulse
Very life threatening
If the person does not have a pulse you should be doing CPR
Depending on the rhythm these patients require drugs and defibrillation to correct

26. Ventricular Fibrillation (V-Fib) No organized electrical rhythm Ventricles are Fibrillating (Pulsating)

27. Pulseless electrical activity (PEA) The lights are on but no one is home The heart is still experiencing organized electrical activity but there is no mechanical activity ie. The person does not have a pulse

28. Asystole No electrical activity

29. Ectopic Beats An Ectopic beat is premature heart beat
They are broken down by the origin of the electrical impulse
Most of the time they are benign

30. Premature Atrial Contraction

31. Premature Junctional Contraction A beat originates in the AV Junction early

32. Premature Ventricular contraction

33. Bundle Branch Block There is a block in the transmission of the electrical impulse somewhere in the ventricles Can be found within any other rythm

34. 12-Lead ECG Much more complicated to read
Used in the pre-hospital setting to Identify ST elevation Myocardial Infarctions
Used in the hospital setting to aid in the diagnosis various cardiac related conditions
Uses the 4 limb leads plus 6 precordial leads to take pictures of the heart from different angles

35. 12-Lead ECG patches placement

36. 12-Lead ECG