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. 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

5. 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

6. 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 bpm
Normal QRS
PR interval
kemo 2009

7. 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

8. 2-Sinus Tachycardia
kemo 2009

9. 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

10. 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

11. 3- Sinus Bradycardia
kemo 2009

12. 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

13. 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

14. 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 bpm
kemo 2009

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

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

17. 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

18. 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

19. Premature A trial Complex ( PAC)
kemo 2009

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

21. 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

22. 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

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

24. 3- A trial Flutter ٍ
Normal QRS
F wave
kemo 2009

25. 2- Atrial Flutter Causes Treatment
Heart disease ( valvular disorder , Rheumatic & ischemic heart disease )
Treatment
Adenocard
Diltazem
kemo 2009

26. 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

27. 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

28. 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

29. 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

30. 4- Atrial Tachycardia Cases Treatment Ischemia Hypoxia Heart failure
Adenocard
Diltazem
Synchronized cardioversion
kemo 2009

31. Thank you
kamlya
kemo 2009