ekg pa class 2017
TRANSCRIPT
![Page 1: EKG PA Class 2017](https://reader035.vdocuments.net/reader035/viewer/2022062523/5883b9b91a28ab5c378b53c1/html5/thumbnails/1.jpg)
EKG
![Page 2: EKG PA Class 2017](https://reader035.vdocuments.net/reader035/viewer/2022062523/5883b9b91a28ab5c378b53c1/html5/thumbnails/2.jpg)
Write This DownSVT – supraventricular tachycardiaSR ST SB SA / PAC WAP AT AF AF / JR PJC AJR JT JB / PVC IR AIR AR A VT
VF TDP
![Page 3: EKG PA Class 2017](https://reader035.vdocuments.net/reader035/viewer/2022062523/5883b9b91a28ab5c378b53c1/html5/thumbnails/3.jpg)
Sinus Rhythm• Rate: 60–100.• Regularity: Regular.• P waves: Normal, Upright, Uniform, 1 P-wave:1 QRS.• PRI: 0.12–0.20, constant.• QRS: <0.12, narrow• Cause: Normal.• Adverse effects: None.• Treatment: None.
![Page 4: EKG PA Class 2017](https://reader035.vdocuments.net/reader035/viewer/2022062523/5883b9b91a28ab5c378b53c1/html5/thumbnails/4.jpg)
Normal Sinus Rhythm
![Page 5: EKG PA Class 2017](https://reader035.vdocuments.net/reader035/viewer/2022062523/5883b9b91a28ab5c378b53c1/html5/thumbnails/5.jpg)
Sinus Bradycardia
![Page 6: EKG PA Class 2017](https://reader035.vdocuments.net/reader035/viewer/2022062523/5883b9b91a28ab5c378b53c1/html5/thumbnails/6.jpg)
Sinus Tachycardia
![Page 7: EKG PA Class 2017](https://reader035.vdocuments.net/reader035/viewer/2022062523/5883b9b91a28ab5c378b53c1/html5/thumbnails/7.jpg)
Sinus Arrhythmia
![Page 8: EKG PA Class 2017](https://reader035.vdocuments.net/reader035/viewer/2022062523/5883b9b91a28ab5c378b53c1/html5/thumbnails/8.jpg)
Atrial Rhythms• Wandering Atrial Pacemaker• Premature Atrial Contraction• Atrial Tachycardia• Atrial Flutter• Atrial Fibrillation
![Page 9: EKG PA Class 2017](https://reader035.vdocuments.net/reader035/viewer/2022062523/5883b9b91a28ab5c378b53c1/html5/thumbnails/9.jpg)
Wandering Atrial Pacemaker• Rate: <100.• Regularity: Irregular.• P waves: Morphology of P wave changes from focus site.• PR: Varies, but usually less than .20.• QRS: <0.12, narrow
![Page 10: EKG PA Class 2017](https://reader035.vdocuments.net/reader035/viewer/2022062523/5883b9b91a28ab5c378b53c1/html5/thumbnails/10.jpg)
Wandering Atrial Pacemaker
![Page 11: EKG PA Class 2017](https://reader035.vdocuments.net/reader035/viewer/2022062523/5883b9b91a28ab5c378b53c1/html5/thumbnails/11.jpg)
Premature Atrial Contraction• Regularity: Depends on underlying rhythm; usually regular except for
PAC• Rate: Usually normal; depends on underlying rhythm• P Wave: P wave of early beat differs from sinus P Waves; can be
flattened or notched; may be lost in preceding T wave• PRI: .12–.20 seconds; can be greater than .20 seconds• QRS: Less than .12 seconds
![Page 12: EKG PA Class 2017](https://reader035.vdocuments.net/reader035/viewer/2022062523/5883b9b91a28ab5c378b53c1/html5/thumbnails/12.jpg)
PAC
![Page 13: EKG PA Class 2017](https://reader035.vdocuments.net/reader035/viewer/2022062523/5883b9b91a28ab5c378b53c1/html5/thumbnails/13.jpg)
Atrial Tachycardia• Regularity: Regular• Rate: 150–250 beats per minute• P Wave: Atrial P wave; differs from sinus P wave; can be lost in
preceding T wave• PRI: .12–.20 seconds• QRS: Less than .12 seconds
![Page 14: EKG PA Class 2017](https://reader035.vdocuments.net/reader035/viewer/2022062523/5883b9b91a28ab5c378b53c1/html5/thumbnails/14.jpg)
Atrial Tachycardia
Paroxysmal Atrial
Tachycardia
![Page 15: EKG PA Class 2017](https://reader035.vdocuments.net/reader035/viewer/2022062523/5883b9b91a28ab5c378b53c1/html5/thumbnails/15.jpg)
Atrial Flutter• Regularity:
• Atrial Rhythm regular• Ventricular rhythm usually regular
• Can be irregular if there is variable block• Controlled vs Uncontrolled (over 100 in uncontrolled)
• Rate: • Atrial rate 250–350 beats per minute; ventricular rate varies
• P Wave: • Characteristic saw tooth pattern (F waves)
• PRI:• Unable to determine
• QRS: • Less than .12 seconds
![Page 16: EKG PA Class 2017](https://reader035.vdocuments.net/reader035/viewer/2022062523/5883b9b91a28ab5c378b53c1/html5/thumbnails/16.jpg)
Atrial Flutter
![Page 17: EKG PA Class 2017](https://reader035.vdocuments.net/reader035/viewer/2022062523/5883b9b91a28ab5c378b53c1/html5/thumbnails/17.jpg)
Atrial Fibrillation• Regularity:
• Grossly irregular• Rate:
• Atrial greater than 350 beats per minute• Ventricular rate varies greatly
• Controlled vs Uncontrolled (same as for A flutter)• P Wave:
• No discernible P waves (DO NOT mistake S for P); atrial activity is referred to as fibrillatory waves (f waves)
• PRI: • Unable to measure
• QRS: • Less than .12 seconds
![Page 18: EKG PA Class 2017](https://reader035.vdocuments.net/reader035/viewer/2022062523/5883b9b91a28ab5c378b53c1/html5/thumbnails/18.jpg)
Junctional Rhythms• Premature Junctional Contraction (PJC)• Junctional Bradycardia• Junctional Rhythm (Junctional Escape)• Accelerated Junctional Rhythm• Junctional Tachycardia• Supraventricular Tachycardia
![Page 19: EKG PA Class 2017](https://reader035.vdocuments.net/reader035/viewer/2022062523/5883b9b91a28ab5c378b53c1/html5/thumbnails/19.jpg)
Premature Junctional Contraction (PJC)• Rate: Can occur at any rate.• Regularity: Regular but interrupted by premature beat.• P waves: Inverted or absent.• PR: 0.12 secs if P wave precedes QRS.• QRS: <0.12 secs
![Page 20: EKG PA Class 2017](https://reader035.vdocuments.net/reader035/viewer/2022062523/5883b9b91a28ab5c378b53c1/html5/thumbnails/20.jpg)
PJC
![Page 21: EKG PA Class 2017](https://reader035.vdocuments.net/reader035/viewer/2022062523/5883b9b91a28ab5c378b53c1/html5/thumbnails/21.jpg)
Junctional Bradycardia• Rate: <40.• Regularity: Regular.• P waves: Inverted or absent.• PR: <0.12 secs if P wave precedes QRS.• QRS: <0.12 secs
![Page 22: EKG PA Class 2017](https://reader035.vdocuments.net/reader035/viewer/2022062523/5883b9b91a28ab5c378b53c1/html5/thumbnails/22.jpg)
Junctional Bradycardia
![Page 23: EKG PA Class 2017](https://reader035.vdocuments.net/reader035/viewer/2022062523/5883b9b91a28ab5c378b53c1/html5/thumbnails/23.jpg)
Junctional Rhythm (Junctional Escape Rhythm)• Rate: 40–60.• Regularity: Regular.• P waves: Inverted or absent.• PR: <0.12 secs if P wave precedes QRS.• QRS: <0.12 secs.
![Page 24: EKG PA Class 2017](https://reader035.vdocuments.net/reader035/viewer/2022062523/5883b9b91a28ab5c378b53c1/html5/thumbnails/24.jpg)
Junctional Rhythm
![Page 25: EKG PA Class 2017](https://reader035.vdocuments.net/reader035/viewer/2022062523/5883b9b91a28ab5c378b53c1/html5/thumbnails/25.jpg)
Accelerated Junctional Rhythm• Rate: 60–100. • Regularity: Regular.• P waves: Inverted or absent.• PR: <0.12 secs if P wave precedes QRS.• QRS: <0.12 secs
![Page 26: EKG PA Class 2017](https://reader035.vdocuments.net/reader035/viewer/2022062523/5883b9b91a28ab5c378b53c1/html5/thumbnails/26.jpg)
Accelerated Junctional Rhythm
![Page 27: EKG PA Class 2017](https://reader035.vdocuments.net/reader035/viewer/2022062523/5883b9b91a28ab5c378b53c1/html5/thumbnails/27.jpg)
Junctional Tachycardia• Rate: >100.• Regularity: Regular.• P waves: Inverted or absent.• PR: <0.12 secs if P wave precedes QRS.• QRS: <0.12 secs.
![Page 28: EKG PA Class 2017](https://reader035.vdocuments.net/reader035/viewer/2022062523/5883b9b91a28ab5c378b53c1/html5/thumbnails/28.jpg)
Junctional Tachycardia
![Page 29: EKG PA Class 2017](https://reader035.vdocuments.net/reader035/viewer/2022062523/5883b9b91a28ab5c378b53c1/html5/thumbnails/29.jpg)
Supraventricular TachycardiaPhrase used to describe a rapid, regular supraventricular arrhythmia when more accurate identification is impossible because P waves aren’t visible and rate is common to other arrhythmias. SVTs with Overlapping Rate Ranges:Sinus Tachycardia 100-160 beats/minAtrial Tachycardia 150-250 beats/minAtrial Flutter 150-250 beats/minJunctional Tachycardia 100-180 beats/min
![Page 30: EKG PA Class 2017](https://reader035.vdocuments.net/reader035/viewer/2022062523/5883b9b91a28ab5c378b53c1/html5/thumbnails/30.jpg)
Ventricular Rhythms• Premature Ventricular Contraction (PVC)• Idioventricular Rhythm• Accelerated Idioventricular Rhythm• Agonal Rhythm• Ventricular Tachycardia• Torsades De Pointes• Ventricular Fibrillation• Asystole, P-Wave Asystole• Ventricular Pacemaker• Dual Chamber Pacemaker (AV Sequential)
![Page 31: EKG PA Class 2017](https://reader035.vdocuments.net/reader035/viewer/2022062523/5883b9b91a28ab5c378b53c1/html5/thumbnails/31.jpg)
Premature Ventricular Contraction• Rate: Can occur at any rate.• Regularity: Regular but interrupted by premature beat.• P waves: Usually not seen.• PR: Not applicable.• QRS: Wide and bizarre in shape; >0.12 secs wide.
![Page 32: EKG PA Class 2017](https://reader035.vdocuments.net/reader035/viewer/2022062523/5883b9b91a28ab5c378b53c1/html5/thumbnails/32.jpg)
Premature Ventricular Contractions
Unifocal PVC’s (Come from same source)
Multifocal PVC’s
![Page 33: EKG PA Class 2017](https://reader035.vdocuments.net/reader035/viewer/2022062523/5883b9b91a28ab5c378b53c1/html5/thumbnails/33.jpg)
PVC
Can have couplets as well in which case two PVC’s would be “stacked” together, or you can have a “run”.
![Page 34: EKG PA Class 2017](https://reader035.vdocuments.net/reader035/viewer/2022062523/5883b9b91a28ab5c378b53c1/html5/thumbnails/34.jpg)
PVC
![Page 35: EKG PA Class 2017](https://reader035.vdocuments.net/reader035/viewer/2022062523/5883b9b91a28ab5c378b53c1/html5/thumbnails/35.jpg)
Idioventricular Rhythm• Rate: 20–40.• Regularity: Regular.• P waves: None.• PR: Not applicable.• QRS: Wide and bizarre; >0.12 secs wide.
![Page 36: EKG PA Class 2017](https://reader035.vdocuments.net/reader035/viewer/2022062523/5883b9b91a28ab5c378b53c1/html5/thumbnails/36.jpg)
Idioventricular Rhythm
![Page 37: EKG PA Class 2017](https://reader035.vdocuments.net/reader035/viewer/2022062523/5883b9b91a28ab5c378b53c1/html5/thumbnails/37.jpg)
Accelerated Idioventricular Rhythm• Rate: 40–100.• Regularity: Usually regular, but can be a bit irregular.• P waves: Usually not seen.• PR: Not applicable.• QRS: Wide and bizarre; >0.12 secs.
![Page 38: EKG PA Class 2017](https://reader035.vdocuments.net/reader035/viewer/2022062523/5883b9b91a28ab5c378b53c1/html5/thumbnails/38.jpg)
AIR
![Page 39: EKG PA Class 2017](https://reader035.vdocuments.net/reader035/viewer/2022062523/5883b9b91a28ab5c378b53c1/html5/thumbnails/39.jpg)
Agonal Rhythm• Rate: <20.• Regularity: Irregular.• P waves: None.• PR: Not applicable.• QRS: Wide and bizarre; >0.12 secs wide
![Page 40: EKG PA Class 2017](https://reader035.vdocuments.net/reader035/viewer/2022062523/5883b9b91a28ab5c378b53c1/html5/thumbnails/40.jpg)
AR
![Page 41: EKG PA Class 2017](https://reader035.vdocuments.net/reader035/viewer/2022062523/5883b9b91a28ab5c378b53c1/html5/thumbnails/41.jpg)
Ventricular Tachycardia• Rate: >100.• Regularity: Usually regular but can be a bit irregular.• P waves: Usually none; dissociated if present.• PR: Variable if Ps present.• QRS: Wide and bizarre; >0,12 secs wide
![Page 42: EKG PA Class 2017](https://reader035.vdocuments.net/reader035/viewer/2022062523/5883b9b91a28ab5c378b53c1/html5/thumbnails/42.jpg)
VT
![Page 43: EKG PA Class 2017](https://reader035.vdocuments.net/reader035/viewer/2022062523/5883b9b91a28ab5c378b53c1/html5/thumbnails/43.jpg)
Torsades de Pointes• Rate: >200.• Regularity: Regular or irregular.• P waves: None.• PR: Not applicable.• QRS: Wide and bizarre; >0,12 secs wide
![Page 44: EKG PA Class 2017](https://reader035.vdocuments.net/reader035/viewer/2022062523/5883b9b91a28ab5c378b53c1/html5/thumbnails/44.jpg)
TDP
![Page 45: EKG PA Class 2017](https://reader035.vdocuments.net/reader035/viewer/2022062523/5883b9b91a28ab5c378b53c1/html5/thumbnails/45.jpg)
Ventricular Fibrillation• Rate: Cannot be counted.• Regularity: Not applicable.• P waves: None• PR: Not applicable.• QRS: None; wavy or spiked baseline
![Page 46: EKG PA Class 2017](https://reader035.vdocuments.net/reader035/viewer/2022062523/5883b9b91a28ab5c378b53c1/html5/thumbnails/46.jpg)
VF
![Page 47: EKG PA Class 2017](https://reader035.vdocuments.net/reader035/viewer/2022062523/5883b9b91a28ab5c378b53c1/html5/thumbnails/47.jpg)
Asystole• Rate: Zero.• Regularity: Not applicable.• P waves: None (unless it’s P wave asystole).• PR: Not applicable.• QRS: None.
![Page 48: EKG PA Class 2017](https://reader035.vdocuments.net/reader035/viewer/2022062523/5883b9b91a28ab5c378b53c1/html5/thumbnails/48.jpg)
A
P wave Asystole
![Page 49: EKG PA Class 2017](https://reader035.vdocuments.net/reader035/viewer/2022062523/5883b9b91a28ab5c378b53c1/html5/thumbnails/49.jpg)
Heart Blocks (AV Node Blocks)NAMES
• First Degree Heart Block• Second Degree Heart Block Type I• Mobitz I, Wenkebach
• Second Degree Heart Block Type II• Mobitz II
• Third Degree Heart Block
![Page 50: EKG PA Class 2017](https://reader035.vdocuments.net/reader035/viewer/2022062523/5883b9b91a28ab5c378b53c1/html5/thumbnails/50.jpg)
Heart BlocksWHAT THEY ARE
• Three Degrees of AV block:• First degree:
• There is a delay in transmission of sinus impulses to the ventricle. Prolonged PR interval.
• Second degree: AV selectively blocks impulses• Some sinus impulses get through to ventricles, some don’t. Dropped beats.
• Third degree: junction will escape or ventricles• None of the sinus impulses gets through to ventricles. Dropped beats, AV
dissociation.* ALWAYS an underlying SINUS RHYTHM, P waves are therefore Sinus P waves
![Page 51: EKG PA Class 2017](https://reader035.vdocuments.net/reader035/viewer/2022062523/5883b9b91a28ab5c378b53c1/html5/thumbnails/51.jpg)
First Degree• Rate: Can occur at any rate.• Regularity: Depends on underlying rhythm.• P waves: Upright, matching, one per QRS.• PR: Prolonged (>0.20).• QRS: <0.12.
![Page 52: EKG PA Class 2017](https://reader035.vdocuments.net/reader035/viewer/2022062523/5883b9b91a28ab5c378b53c1/html5/thumbnails/52.jpg)
First Degree
![Page 53: EKG PA Class 2017](https://reader035.vdocuments.net/reader035/viewer/2022062523/5883b9b91a28ab5c378b53c1/html5/thumbnails/53.jpg)
Wenkebach (Second Degree Type 1)• Regularity: Irregular; R-R interval changes
as PR interval gets longer; characteristic grouped beating• Rate: Usually slightly slower than normal• P Wave: Upright and uniform; some P waves not followed by QRS
complexes• PRI: Progressively lengthens until one P wave is not conducted• QRS: Less than .12 seconds• “Wencke Walks Away”
![Page 54: EKG PA Class 2017](https://reader035.vdocuments.net/reader035/viewer/2022062523/5883b9b91a28ab5c378b53c1/html5/thumbnails/54.jpg)
Wenkebach
![Page 55: EKG PA Class 2017](https://reader035.vdocuments.net/reader035/viewer/2022062523/5883b9b91a28ab5c378b53c1/html5/thumbnails/55.jpg)
Second Degree HB Type 2
![Page 56: EKG PA Class 2017](https://reader035.vdocuments.net/reader035/viewer/2022062523/5883b9b91a28ab5c378b53c1/html5/thumbnails/56.jpg)
Third Degree Heart Block (Complete HB)• Regularity: Regular• Rate: 40–60 beats per minute if focus is junctional 20–40 beats per minute if focus is ventricular• P Wave: Upright and uniform; more P waves than QRS complexes• PRI: No relationship between P waves and QRS complexes; P waves
occasionally superimposed on QRS complexes• QRS: Less than <.12 seconds if focus is Junctional; >.12 seconds or
more if focus is ventricular
![Page 57: EKG PA Class 2017](https://reader035.vdocuments.net/reader035/viewer/2022062523/5883b9b91a28ab5c378b53c1/html5/thumbnails/57.jpg)
Complete HB
![Page 58: EKG PA Class 2017](https://reader035.vdocuments.net/reader035/viewer/2022062523/5883b9b91a28ab5c378b53c1/html5/thumbnails/58.jpg)
12 LeadsLateral Leads – I, aVL, V5, V6
Inferior Leads – II, III, aVF
Anterior Leads – V3, V4
Septal Leads – V1, V2
![Page 59: EKG PA Class 2017](https://reader035.vdocuments.net/reader035/viewer/2022062523/5883b9b91a28ab5c378b53c1/html5/thumbnails/59.jpg)
![Page 60: EKG PA Class 2017](https://reader035.vdocuments.net/reader035/viewer/2022062523/5883b9b91a28ab5c378b53c1/html5/thumbnails/60.jpg)
ST segment and T waveST depression with T wave inversion = Ischemia
ST elevation with or without T wave changes = Myocardial Injury
![Page 61: EKG PA Class 2017](https://reader035.vdocuments.net/reader035/viewer/2022062523/5883b9b91a28ab5c378b53c1/html5/thumbnails/61.jpg)
ST segment shapes
![Page 62: EKG PA Class 2017](https://reader035.vdocuments.net/reader035/viewer/2022062523/5883b9b91a28ab5c378b53c1/html5/thumbnails/62.jpg)
ST Depression/Elevation Significance• Considered significant if the ST segment is at least 2 boxes below
baseline• Texts vary, some may say 1 box
• Changes must be seen in 2 contiguous leads
![Page 63: EKG PA Class 2017](https://reader035.vdocuments.net/reader035/viewer/2022062523/5883b9b91a28ab5c378b53c1/html5/thumbnails/63.jpg)
Pathological Q WavesQ Wave Significance• Q > 1/3 QRS, or • Q > 1 box wide & NOT in lead III ALONE
![Page 64: EKG PA Class 2017](https://reader035.vdocuments.net/reader035/viewer/2022062523/5883b9b91a28ab5c378b53c1/html5/thumbnails/64.jpg)
Summary
![Page 65: EKG PA Class 2017](https://reader035.vdocuments.net/reader035/viewer/2022062523/5883b9b91a28ab5c378b53c1/html5/thumbnails/65.jpg)
Examples
![Page 66: EKG PA Class 2017](https://reader035.vdocuments.net/reader035/viewer/2022062523/5883b9b91a28ab5c378b53c1/html5/thumbnails/66.jpg)
![Page 67: EKG PA Class 2017](https://reader035.vdocuments.net/reader035/viewer/2022062523/5883b9b91a28ab5c378b53c1/html5/thumbnails/67.jpg)
Electrical Reciprocity• Only two main areas of the heart that do this: • Inferior and lateral leads• Septal and posterior (Not going to see posterior on 12 lead)
leads. • ST Elevation in II, III, AVF will cause ST Depression in I, AVL
(Maybe V5,V6)• Septal lead changes are one view to reflect posterior involvement
in a 12 lead
![Page 68: EKG PA Class 2017](https://reader035.vdocuments.net/reader035/viewer/2022062523/5883b9b91a28ab5c378b53c1/html5/thumbnails/68.jpg)
Electrical Reciprocity
![Page 69: EKG PA Class 2017](https://reader035.vdocuments.net/reader035/viewer/2022062523/5883b9b91a28ab5c378b53c1/html5/thumbnails/69.jpg)
Good R-wave Progression
![Page 70: EKG PA Class 2017](https://reader035.vdocuments.net/reader035/viewer/2022062523/5883b9b91a28ab5c378b53c1/html5/thumbnails/70.jpg)
Poor R-wave Progression
![Page 71: EKG PA Class 2017](https://reader035.vdocuments.net/reader035/viewer/2022062523/5883b9b91a28ab5c378b53c1/html5/thumbnails/71.jpg)
Example
![Page 72: EKG PA Class 2017](https://reader035.vdocuments.net/reader035/viewer/2022062523/5883b9b91a28ab5c378b53c1/html5/thumbnails/72.jpg)
Inferolateral STEMI with reciprocal changes
![Page 73: EKG PA Class 2017](https://reader035.vdocuments.net/reader035/viewer/2022062523/5883b9b91a28ab5c378b53c1/html5/thumbnails/73.jpg)
![Page 74: EKG PA Class 2017](https://reader035.vdocuments.net/reader035/viewer/2022062523/5883b9b91a28ab5c378b53c1/html5/thumbnails/74.jpg)
Inferior STEMI with reciprocal changes
![Page 75: EKG PA Class 2017](https://reader035.vdocuments.net/reader035/viewer/2022062523/5883b9b91a28ab5c378b53c1/html5/thumbnails/75.jpg)
![Page 76: EKG PA Class 2017](https://reader035.vdocuments.net/reader035/viewer/2022062523/5883b9b91a28ab5c378b53c1/html5/thumbnails/76.jpg)
Lateral STEMI with reciprocal ST depression
![Page 77: EKG PA Class 2017](https://reader035.vdocuments.net/reader035/viewer/2022062523/5883b9b91a28ab5c378b53c1/html5/thumbnails/77.jpg)
![Page 78: EKG PA Class 2017](https://reader035.vdocuments.net/reader035/viewer/2022062523/5883b9b91a28ab5c378b53c1/html5/thumbnails/78.jpg)
Anteroseptal STEMI with lateral extension
![Page 79: EKG PA Class 2017](https://reader035.vdocuments.net/reader035/viewer/2022062523/5883b9b91a28ab5c378b53c1/html5/thumbnails/79.jpg)
QRS Axis• Main direction electrical impulse travels in the heart• Normal Axis (0 to 90, +++)• Physiological LAD (0 to -30, ++-)• Pathological LAD (-30 to -90, +--)• Right Axis Deviation (RAD) (90 to 180, - any +)• Extreme RAD (180 to -90, ---)
• Look at leads I, II, and III
![Page 80: EKG PA Class 2017](https://reader035.vdocuments.net/reader035/viewer/2022062523/5883b9b91a28ab5c378b53c1/html5/thumbnails/80.jpg)
Normal QRS deflections