ekg rhythm review - maine cardiovascular health councilmainecardiohealth.org/presentations/2018...
TRANSCRIPT
![Page 1: EKG Rhythm Review - Maine Cardiovascular Health Councilmainecardiohealth.org/presentations/2018 summit...EKG Rhythm Review Stephanie Cordwell, BS, NRP Paramedic Program Director Kennebec](https://reader034.vdocuments.net/reader034/viewer/2022051813/6033b8d6ca5cd4373b78757a/html5/thumbnails/1.jpg)
EKG Rhythm Review
Stephanie Cordwell, BS, NRP
Paramedic Program Director Kennebec Valley Community College
![Page 2: EKG Rhythm Review - Maine Cardiovascular Health Councilmainecardiohealth.org/presentations/2018 summit...EKG Rhythm Review Stephanie Cordwell, BS, NRP Paramedic Program Director Kennebec](https://reader034.vdocuments.net/reader034/viewer/2022051813/6033b8d6ca5cd4373b78757a/html5/thumbnails/2.jpg)
Disclaimer:
I do not have any conflicts of interest or disclaimers*.
*Except…I have about 50 minutes to review a topic that I teach over a semester…
2
![Page 3: EKG Rhythm Review - Maine Cardiovascular Health Councilmainecardiohealth.org/presentations/2018 summit...EKG Rhythm Review Stephanie Cordwell, BS, NRP Paramedic Program Director Kennebec](https://reader034.vdocuments.net/reader034/viewer/2022051813/6033b8d6ca5cd4373b78757a/html5/thumbnails/3.jpg)
3
Course Objectives
Understand the difference between electrical and mechanical cardiac function;
Identify the components of an EKG rhythm strip;
Understand how to interpret 4-lead EKG findings including atrial,
junctional, and ventricular rhythms.
![Page 4: EKG Rhythm Review - Maine Cardiovascular Health Councilmainecardiohealth.org/presentations/2018 summit...EKG Rhythm Review Stephanie Cordwell, BS, NRP Paramedic Program Director Kennebec](https://reader034.vdocuments.net/reader034/viewer/2022051813/6033b8d6ca5cd4373b78757a/html5/thumbnails/4.jpg)
Cardiac cells…
4
• Automaticity • Excitability • Conductivity • Contractility
Gail Walraven, Basic Arrhythmias, Seventh Edition ©2011 by Pearson Education, Inc., Upper Saddle River, NJ
![Page 5: EKG Rhythm Review - Maine Cardiovascular Health Councilmainecardiohealth.org/presentations/2018 summit...EKG Rhythm Review Stephanie Cordwell, BS, NRP Paramedic Program Director Kennebec](https://reader034.vdocuments.net/reader034/viewer/2022051813/6033b8d6ca5cd4373b78757a/html5/thumbnails/5.jpg)
Cardiac Function…
5
Mechanical Function
Electrical Function
https://theydiffer.com/difference-between-skeletal-and-cardiac-muscle/ Gail Walraven, Basic Arrhythmias, Seventh Edition
©2011 by Pearson Education, Inc., Upper Saddle River, NJ
![Page 6: EKG Rhythm Review - Maine Cardiovascular Health Councilmainecardiohealth.org/presentations/2018 summit...EKG Rhythm Review Stephanie Cordwell, BS, NRP Paramedic Program Director Kennebec](https://reader034.vdocuments.net/reader034/viewer/2022051813/6033b8d6ca5cd4373b78757a/html5/thumbnails/6.jpg)
Mechanical vs. Electrical Function?
6 Gail Walraven, Basic Arrhythmias, Seventh Edition
©2011 by Pearson Education, Inc., Upper Saddle River, NJ https://www.medicalnewstoday.com/articles/258118.php
![Page 7: EKG Rhythm Review - Maine Cardiovascular Health Councilmainecardiohealth.org/presentations/2018 summit...EKG Rhythm Review Stephanie Cordwell, BS, NRP Paramedic Program Director Kennebec](https://reader034.vdocuments.net/reader034/viewer/2022051813/6033b8d6ca5cd4373b78757a/html5/thumbnails/7.jpg)
So…what are we looking for?
7
Bledsoe/Porter/Cherry, Essentials of Paramedic
Care, Second Edition Update
© 2011 by Pearson Education, Inc. Upper
Saddle River, New Jersey
![Page 8: EKG Rhythm Review - Maine Cardiovascular Health Councilmainecardiohealth.org/presentations/2018 summit...EKG Rhythm Review Stephanie Cordwell, BS, NRP Paramedic Program Director Kennebec](https://reader034.vdocuments.net/reader034/viewer/2022051813/6033b8d6ca5cd4373b78757a/html5/thumbnails/8.jpg)
The EKG Paper
8
EKG Paper – measures time & voltage
Horizontally - time
One small box - 0.04 sec
One large box - 0.20 sec
Vertically - voltage
One large box - 0.5 mV
![Page 9: EKG Rhythm Review - Maine Cardiovascular Health Councilmainecardiohealth.org/presentations/2018 summit...EKG Rhythm Review Stephanie Cordwell, BS, NRP Paramedic Program Director Kennebec](https://reader034.vdocuments.net/reader034/viewer/2022051813/6033b8d6ca5cd4373b78757a/html5/thumbnails/9.jpg)
9
The EKG Paper (cont)
Every 3 seconds (15 large boxes) is marked by a vertical line.
This helps when calculating the heart rate.
3 sec 3 sec
![Page 10: EKG Rhythm Review - Maine Cardiovascular Health Councilmainecardiohealth.org/presentations/2018 summit...EKG Rhythm Review Stephanie Cordwell, BS, NRP Paramedic Program Director Kennebec](https://reader034.vdocuments.net/reader034/viewer/2022051813/6033b8d6ca5cd4373b78757a/html5/thumbnails/10.jpg)
Rhythm Interpretation
10
Ga
il W
alra
ve
n, B
asic
Arr
hyth
mia
s, S
eve
nth
Ed
itio
n
©2
01
1 b
y P
ea
rso
n E
du
ca
tio
n, In
c.,
Upp
er
Sa
dd
le R
ive
r, N
J
![Page 11: EKG Rhythm Review - Maine Cardiovascular Health Councilmainecardiohealth.org/presentations/2018 summit...EKG Rhythm Review Stephanie Cordwell, BS, NRP Paramedic Program Director Kennebec](https://reader034.vdocuments.net/reader034/viewer/2022051813/6033b8d6ca5cd4373b78757a/html5/thumbnails/11.jpg)
Calculating Heart Rates
11 Gail Walraven, Basic Arrhythmias, Seventh Edition
©2011 by Pearson Education, Inc., Upper Saddle River, NJ
![Page 12: EKG Rhythm Review - Maine Cardiovascular Health Councilmainecardiohealth.org/presentations/2018 summit...EKG Rhythm Review Stephanie Cordwell, BS, NRP Paramedic Program Director Kennebec](https://reader034.vdocuments.net/reader034/viewer/2022051813/6033b8d6ca5cd4373b78757a/html5/thumbnails/12.jpg)
12
“Normal” Sinus Rhythm Parameters
Rate 60 - 100 bpm
Regularity regular
P waves normal
PR interval 0.12 - 0.20 s
QRS duration 0.04 - 0.12 s
Any deviation from above is sinus tachycardia, sinus bradycardia or a dysrhythmia
![Page 13: EKG Rhythm Review - Maine Cardiovascular Health Councilmainecardiohealth.org/presentations/2018 summit...EKG Rhythm Review Stephanie Cordwell, BS, NRP Paramedic Program Director Kennebec](https://reader034.vdocuments.net/reader034/viewer/2022051813/6033b8d6ca5cd4373b78757a/html5/thumbnails/13.jpg)
13
Dysrhythmia Formation
Dysrhythmias can arise from problems in the:
• Sinus node
• Atrial cells
• AV junction/node
• Ventricular cells
![Page 14: EKG Rhythm Review - Maine Cardiovascular Health Councilmainecardiohealth.org/presentations/2018 summit...EKG Rhythm Review Stephanie Cordwell, BS, NRP Paramedic Program Director Kennebec](https://reader034.vdocuments.net/reader034/viewer/2022051813/6033b8d6ca5cd4373b78757a/html5/thumbnails/14.jpg)
14
SA Node Problems
SA node depolarizing too slow
Sinus Bradycardia
SA node depolarizing too fast
Sinus Tachycardia
*Sinus Tachycardia may be an appropriate response to stress.
![Page 15: EKG Rhythm Review - Maine Cardiovascular Health Councilmainecardiohealth.org/presentations/2018 summit...EKG Rhythm Review Stephanie Cordwell, BS, NRP Paramedic Program Director Kennebec](https://reader034.vdocuments.net/reader034/viewer/2022051813/6033b8d6ca5cd4373b78757a/html5/thumbnails/15.jpg)
Rate
Regularity
P waves
PR Interval
QRS Duration
30 bpm
Regular
Present & upright
0.12 seconds
0.10 seconds
15
Interpretation: Sinus Bradycardia Deviation from NSR? Rate <60 bpm
![Page 16: EKG Rhythm Review - Maine Cardiovascular Health Councilmainecardiohealth.org/presentations/2018 summit...EKG Rhythm Review Stephanie Cordwell, BS, NRP Paramedic Program Director Kennebec](https://reader034.vdocuments.net/reader034/viewer/2022051813/6033b8d6ca5cd4373b78757a/html5/thumbnails/16.jpg)
Rate
Regularity
P waves
PR Interval
QRS Duration
130 bpm
Regular
Present & upright
0.16 seconds
0.08 seconds
16
Interpretation: Sinus Tachycardia Deviation from NSR? Rate >100 bpm
![Page 17: EKG Rhythm Review - Maine Cardiovascular Health Councilmainecardiohealth.org/presentations/2018 summit...EKG Rhythm Review Stephanie Cordwell, BS, NRP Paramedic Program Director Kennebec](https://reader034.vdocuments.net/reader034/viewer/2022051813/6033b8d6ca5cd4373b78757a/html5/thumbnails/17.jpg)
17
Atrial Cell Problems
A single irritable focus within the atria conducted in a rapid and repetitive fashion
Atrial Flutter
Continuous, disorganized firing from multiple foci in the atria
Atrial Fibrillation
![Page 18: EKG Rhythm Review - Maine Cardiovascular Health Councilmainecardiohealth.org/presentations/2018 summit...EKG Rhythm Review Stephanie Cordwell, BS, NRP Paramedic Program Director Kennebec](https://reader034.vdocuments.net/reader034/viewer/2022051813/6033b8d6ca5cd4373b78757a/html5/thumbnails/18.jpg)
Rate
Regularity
P waves
PR Interval
QRS Duration
Averages 100 bpm
Irregularly irregular
none
none
0.06 seconds
18
Interpretation: Atrial Fibrillation Deviation from NSR? Disorganized atrial depolarization; atrial activity is chaotic
![Page 19: EKG Rhythm Review - Maine Cardiovascular Health Councilmainecardiohealth.org/presentations/2018 summit...EKG Rhythm Review Stephanie Cordwell, BS, NRP Paramedic Program Director Kennebec](https://reader034.vdocuments.net/reader034/viewer/2022051813/6033b8d6ca5cd4373b78757a/html5/thumbnails/19.jpg)
Rate
Regularity
P waves
PR Interval
QRS Duration
70 bpm
regular
Flutter waves
none
0.06 seconds
19
Interpretation: Atrial Flutter Deviation from NSR? No P waves; re-entry issue, only some impulses are conducted through
![Page 20: EKG Rhythm Review - Maine Cardiovascular Health Councilmainecardiohealth.org/presentations/2018 summit...EKG Rhythm Review Stephanie Cordwell, BS, NRP Paramedic Program Director Kennebec](https://reader034.vdocuments.net/reader034/viewer/2022051813/6033b8d6ca5cd4373b78757a/html5/thumbnails/20.jpg)
20
AV Junctional Problems
Continuous, rapid, organized firing due to re-entry circus loop at AV junction
Supraventricular Tachycardia
Impulses originating from the SA node are delayed or blocked at the AV junction/node, disrupting ventricular depolarization
AV Blocks
![Page 21: EKG Rhythm Review - Maine Cardiovascular Health Councilmainecardiohealth.org/presentations/2018 summit...EKG Rhythm Review Stephanie Cordwell, BS, NRP Paramedic Program Director Kennebec](https://reader034.vdocuments.net/reader034/viewer/2022051813/6033b8d6ca5cd4373b78757a/html5/thumbnails/21.jpg)
Rate
Regularity
P waves
PR Interval
QRS Duration
160 bpm
regular
Cannot determine
Cannot determine
0.08 seconds
21
Interpretation: Supraventricular Tachycardia
Deviation from NSR? Regular, tachycardic rate, cannot discern P waves
![Page 22: EKG Rhythm Review - Maine Cardiovascular Health Councilmainecardiohealth.org/presentations/2018 summit...EKG Rhythm Review Stephanie Cordwell, BS, NRP Paramedic Program Director Kennebec](https://reader034.vdocuments.net/reader034/viewer/2022051813/6033b8d6ca5cd4373b78757a/html5/thumbnails/22.jpg)
Rate
Regularity
P waves
PR Interval
QRS Duration
60 bpm
regular
normal
0.36 seconds
0.08 seconds
22
Interpretation: 1st Degree AV Block
Deviation from NSR? PR Interval > 0.20 seconds
![Page 23: EKG Rhythm Review - Maine Cardiovascular Health Councilmainecardiohealth.org/presentations/2018 summit...EKG Rhythm Review Stephanie Cordwell, BS, NRP Paramedic Program Director Kennebec](https://reader034.vdocuments.net/reader034/viewer/2022051813/6033b8d6ca5cd4373b78757a/html5/thumbnails/23.jpg)
Rate
Regularity
P waves
PR Interval
QRS Duration
50 bpm
Regularly irregular
normal
lengthens
0.08 seconds
23
Interpretation: 2nd Degree Type I AV Block
Deviation from NSR? PR Interval progressively lengthens until dropped beat, pattern resets
![Page 24: EKG Rhythm Review - Maine Cardiovascular Health Councilmainecardiohealth.org/presentations/2018 summit...EKG Rhythm Review Stephanie Cordwell, BS, NRP Paramedic Program Director Kennebec](https://reader034.vdocuments.net/reader034/viewer/2022051813/6033b8d6ca5cd4373b78757a/html5/thumbnails/24.jpg)
Rate
Regularity
P waves
PR Interval
QRS Duration
40 bpm
Regular
Normal
0.14 seconds
0.08 seconds
24
Interpretation: 2nd Degree Type II AV Block
Deviation from NSR? PR Interval normal when present; occasionally atrial impulse blocked
![Page 25: EKG Rhythm Review - Maine Cardiovascular Health Councilmainecardiohealth.org/presentations/2018 summit...EKG Rhythm Review Stephanie Cordwell, BS, NRP Paramedic Program Director Kennebec](https://reader034.vdocuments.net/reader034/viewer/2022051813/6033b8d6ca5cd4373b78757a/html5/thumbnails/25.jpg)
Rate
Regularity
P waves
PR Interval
QRS Duration
40 bpm
Regular
No relation to QRS
none
Wide (>0.12 sec )
25
Interpretation: 3rd Degree AV Block
Deviation from NSR? Atrial impulses are completely blocked; ventricles working independently.
![Page 26: EKG Rhythm Review - Maine Cardiovascular Health Councilmainecardiohealth.org/presentations/2018 summit...EKG Rhythm Review Stephanie Cordwell, BS, NRP Paramedic Program Director Kennebec](https://reader034.vdocuments.net/reader034/viewer/2022051813/6033b8d6ca5cd4373b78757a/html5/thumbnails/26.jpg)
26
Ventricular Cell Problems
Occasional depolarization from 1 or more foci within the ventricles
Premature Ventricular Complex (PVC)
Rapid, regular depolarization from irritable foci within the ventricles
Ventricular Tachycardia
Disorganized quivering of the heart muscle, ineffective cardiac output
Ventricular Fibrillation
![Page 27: EKG Rhythm Review - Maine Cardiovascular Health Councilmainecardiohealth.org/presentations/2018 summit...EKG Rhythm Review Stephanie Cordwell, BS, NRP Paramedic Program Director Kennebec](https://reader034.vdocuments.net/reader034/viewer/2022051813/6033b8d6ca5cd4373b78757a/html5/thumbnails/27.jpg)
Rate
Regularity
P waves
PR Interval
QRS Duration
40 bpm
varies
Upright when present
0.14 seconds
variable
27
Interpretation: Sinus with Premature Ventricular Contractions (PVC)
Deviation from NSR? Ectopic beat originating in the ventricles resulting in wide, bizarre QRS
![Page 28: EKG Rhythm Review - Maine Cardiovascular Health Councilmainecardiohealth.org/presentations/2018 summit...EKG Rhythm Review Stephanie Cordwell, BS, NRP Paramedic Program Director Kennebec](https://reader034.vdocuments.net/reader034/viewer/2022051813/6033b8d6ca5cd4373b78757a/html5/thumbnails/28.jpg)
Rate
Regularity
P waves
PR Interval
QRS Duration
160 bpm
regular
none
none
Wide (>0.12 seconds)
28
Interpretation: Ventricular Tachycardia
Deviation from NSR? Ventricular cells fire continuously – life threatening dysrhythmia
![Page 29: EKG Rhythm Review - Maine Cardiovascular Health Councilmainecardiohealth.org/presentations/2018 summit...EKG Rhythm Review Stephanie Cordwell, BS, NRP Paramedic Program Director Kennebec](https://reader034.vdocuments.net/reader034/viewer/2022051813/6033b8d6ca5cd4373b78757a/html5/thumbnails/29.jpg)
Rate
Regularity
P waves
PR Interval
QRS Duration
40 bpm
regular
none
none
Wide (>0.12 seconds)
29
Interpretation: Idioventricular
Deviation from NSR? Escape rhythm to prevent complete cardiac standstill
![Page 30: EKG Rhythm Review - Maine Cardiovascular Health Councilmainecardiohealth.org/presentations/2018 summit...EKG Rhythm Review Stephanie Cordwell, BS, NRP Paramedic Program Director Kennebec](https://reader034.vdocuments.net/reader034/viewer/2022051813/6033b8d6ca5cd4373b78757a/html5/thumbnails/30.jpg)
Rate
Regularity
P waves
PR Interval
QRS Duration
irregular
disorganized
none
none
none
30
Interpretation: Ventricular Fibrillation
Deviation from NSR? Multiple ventricular foci firing without effective contractions – life threatening dysrhythmia
![Page 31: EKG Rhythm Review - Maine Cardiovascular Health Councilmainecardiohealth.org/presentations/2018 summit...EKG Rhythm Review Stephanie Cordwell, BS, NRP Paramedic Program Director Kennebec](https://reader034.vdocuments.net/reader034/viewer/2022051813/6033b8d6ca5cd4373b78757a/html5/thumbnails/31.jpg)
Rate
Regularity
P waves
PR Interval
QRS Duration
none
none
none
none
none
31
Interpretation: Asystole
Deviation from NSR? No electrical activity in the heart
![Page 32: EKG Rhythm Review - Maine Cardiovascular Health Councilmainecardiohealth.org/presentations/2018 summit...EKG Rhythm Review Stephanie Cordwell, BS, NRP Paramedic Program Director Kennebec](https://reader034.vdocuments.net/reader034/viewer/2022051813/6033b8d6ca5cd4373b78757a/html5/thumbnails/32.jpg)
Let’s review…
The heart has two functioning systems
The mechanical system = pulse & BP
The electrical system = cardiac monitor
The EKG represents the electrical conduction system and how the various cells are depolarizing and repolarizing
32
![Page 33: EKG Rhythm Review - Maine Cardiovascular Health Councilmainecardiohealth.org/presentations/2018 summit...EKG Rhythm Review Stephanie Cordwell, BS, NRP Paramedic Program Director Kennebec](https://reader034.vdocuments.net/reader034/viewer/2022051813/6033b8d6ca5cd4373b78757a/html5/thumbnails/33.jpg)
Let’s review (continued)…
Upright P waves = atrial depolarization
QRS Complexes = ventricular depolarization
Any deviation from “Normal” Sinus Rhythm is a dysrhythmia, not all deviations are lethal.
33
![Page 34: EKG Rhythm Review - Maine Cardiovascular Health Councilmainecardiohealth.org/presentations/2018 summit...EKG Rhythm Review Stephanie Cordwell, BS, NRP Paramedic Program Director Kennebec](https://reader034.vdocuments.net/reader034/viewer/2022051813/6033b8d6ca5cd4373b78757a/html5/thumbnails/34.jpg)
Lastly…
Rhythm recognition takes lots of practice, think of it like learning another language.
Remember, what you see on the monitor is only telling a small part of the cardiac story for your patient, you must actually touch and assess them.
34