EKG Rhythms

atrial depolarization

What does the PR interval represent?

ventricular depolarization

What does the QRS wave represent?

early ventricular repolarization/ atrial hidden in u wave

What does the ST segment represent?

ventricular repolarization

What the U wave represent?

cardiac cells generate cardiac muscle contraction; an increase in electrical charge

What is depolarization of the heart?

Ventricles are Resting and are filling up w bld

Repol = Resting "R = R"

What is repolarization of the heart?

should always occur prior to QRS complex.

Duration: 0.06-0.12 seconds.

rounded

P wave measurements

beginning of P wave to beginning of QRS complex.

Duration: 0.12-0.20 seconds

PR interval measurements

▪ Measured from the beginning to the end of the QRS

▪The interval normally measures between 0.04 and 0.12 seconds

▪> than 0.12 is considered to be abnormal

▪ Reflects the period of time required to depolarize the ventricles

▪ Can occur without Q or without S

QRS complex measurements

Normal interval 0.36-0.44

QT interval measurements

- Normal sinus rhythm

- Sinus bradycardia

- Sinus tachycardia

- Sinus arrhythmia

- Sinus arrest/pause

What are the main5 sinus rhythms?

Normal sinus rhythm

What rhythm is this?

Sinus bradycardia

rate: below 60 bpm

What rhythm is this?

sinus tachycardia

Rate: 100-160

What rhythm is this?

Causes

- Rest/sleep, good athletic conditioning, MI, Hypothermia, medications (digoxin, verapamil)

Symptoms

- Chest pain, SOB, CHF, HTN, altered LOC

Treatment

- O2, IV, Atropine IV, transcutaneous pacing

What are the causes and treatment for sinus bradycardia?

Causes

- Fever, Pain, Anxiety, Infection, Dehydration, Activity, Caffeine, Atropine, Epinephrine

Symptoms

- usually asymptomatic but can be angina

Treatments

- Correct underlying cause

What are the causes and treatment for sinus tachycardia?

sinus arrhythmia

What rhythm is this?

Causes

-Breathing

Symptoms

- None

Treatment

- None

- No emergency intervention needed

What are the causes and treatments for sinus arrhythmia?

Sinus arrest/pause

- PQRST is absent for 1 or more cycles

- No conduction from sinus node (fails to initiate impulse)

What rhythm is this?

- Premature atrial contractions PAC's

- Supraventricular tachycardia SVT

- Atrial fibrillation A-FIB

- Atrial flutter A-flutter

What are the 4 Atrial rhythms?

Premature atrial contractions PAC

What is this rhythm?

Supraventricular Tachycardia (SVT)

Rate: 150-250

What is this rhythm?

Causes

- Hypoxia, CAD after MI, Respiratory failure, Digitals toxicity,

Symptoms

- Sudden racing of heart, anxiety

Treatments

- (Stable): O2, IV, Vagal maneuver

- (Unstable): O2, IV, Meds " Adenosine, verapamil", synchronized countershock

What are the causes and treatment for Supraventricular tachycardia?

Atrial Fibrillation (A-Fib)

What rhythm is this?

Symptoms

- Palpations, weakness, dizziness, chest pain, and skipped beats

Treatment

- (stable): Calcium channel blockers, Beta-blockers

- (unstable): synchronized cardioversion

What are the causes and treatment for Atrial Fibrillation?

Atrial Flutter

- Sawtooth look

What is this rhythm?

Symptoms

- Palpation, weakness, dizziness

Treatment

- (stable): calcium channel blockers, beta-blockers

- (Unstable): Synchronized cardioversion

What are the causes and treatments for Atrial flutter?

third-degree heart block

- atria and ventriculus beat independently

What rhythm is this?

Causes

- (Above Bundle of HIS): Damage to AV node, Increased parasympathetic tone associated with inferior MI

- (Below Bundle of HIS): Anterior MI, extensive conduction system disease

Treatment

- (narrow QRS): O2, IV, Atropine, Pacing, Dopamine, Epinephrine

- (wide QRS): O2, IV, transcutaneous paving

What are the causes and treatments for third-degree heart block?

- Premature ventricular contraction PVC

- Ventricular Tachycardia

- Ventricular Fibrillation V-Fib

- Asystole

- Pulseless electrical activity

What are the 5 ventricular rhythms?

premature ventricular contraction (PVC)

What rhythm is this?

Cause

- Normal variant, Anxiety, exercise, MI, acid-base imbalance, Hypokalemia, caffeine, drugs

Symptoms

- Skipped beats, palpations, angina

Treatment

- (nonacute area): Oral antiarrhythmics, beta, and calcium channel blocker

- (in acute area): IV Amiodarone & procainamide

What are the causes and treatment for PVC's?

Bigeminy

- Every other one

What kind of PVC is this?

Trigeminy

- Every third one

What kind of PVC is this?

Quadrigeminy

- Every other 4

What kind of PVC is this?

Unifocal

- Same place in ventricle

What kind of PVC is this?

Multifocal PVC because the 2 PVC look different from each other. They are coming from 2 (multi) different irritated areas of the ventricle

What kind of PVC is this?

Unifocal couplet

- 2 in a row

What kind of PVC is this?

Ventricular tachycardia

- 3 or more PVC's in a row

- Rate: 110-250

- Grave stone look (will take u to the grave lol)

What is this rhythm?

Causes

- Hypoxia, exercise, acid-base imbalance, ventricular aneurysm

Symptoms

- Pulmonary congestion, Acute MI, CHF, Decrease LOC

- (pulseless): LOC change, no palpable pulses

Treatments

-( Stable): O2, IV Amiodarone

- (unstable w/pulse): O2, Synchronized cardioversion, Amiodarone

- (unstable/ Pulseless): CPR and defib

What are the causes and treatment for Ventricular tachycardia V-Tach

ventricular fibrillation V-Fib

What rhythm is this?

Causes

- Sudden cardiac death, untreated VT, Accidental electrocution, Lightening strike, Mitral valve prolapse

Symptoms

- No cardiac output, No pulse/Bp, Apnea. cyanosis

Treatment

- CPR, Defib, Intubation

What are the causes and treatments for ventricular fibrillation V-Fib

Torsade's de pointes

- may or may not have a pulse

- follow ventricular tachycardia protocalls

What is this rhythm?

Asystole

What is this rhythm?

causes

- Traumatic cardiac event, result of countershock

Symptoms

- No pulse/bp, unconsciousness, cyanosis, seizures

Treatment

- CPR, endotracheal intubation, IV access, medications, find cause of rhythm

What are the causes and treatments for asystole?

Pulseless electrical activity (PEA)

- Organized electrical activity observed without a palpable pulse

What rhythm is this?

Causes

- Obstructive shock (Tension pneumothorax, cardiac tamponade, massive pulmonary emboli, drug overdose

Symptoms

- No pulse/bp, unconsciousness, or electrical activity on a monitor

Treatment

- CPR, endotracheal intubation

What are the causes and treatments for PEA?

Atrial, ventricular and Dual chamber

What are the 3 types of pacemakers?

Atrial Pacemaker

What kind of pace maker is this?

Ventricular Pacemaker

What kind of pacemaker is this?

Atrial and ventricular (Dual)

Whay kind of pacemaker is this?

"Atropine to Speed, Adenosine to Slow, Amiodarone for Rhythm to Flow!"

Atropine: Deals mainly with SA (sinus rhythm issues)

Adenosine: Deals mainly in the middle between AV (atrial rhythm issues)

Amiodarone: Deals mainly with Ventricular issues

A fun rhythm to Remember the 3 A meds :)