Ekg Course Notes & Outlines

Topics: Cardiac electrophysiology, Cardiology, Heart Pages: 7 (2435 words) Published: June 22, 2013
Chapter #5 Rhythm Interpretation
* ECG Wave form Components- Waves, Segments, Intervals
** Evaluated and classified based on Size, Length of time, & Location on the Trace. All of these components determining the types of CARDIAC RHYTHM’s. 1. First- gather all the data regarding the different waveforms and their patterns 2. Second- match all information to the specific ECG rhythm criteria so to classify the various cardiac dysrhythmias. * Cardiac Dysrhythmia Interpretation = is an ART!!!

* Often practitioners discuss how to classify a dysrhythmia because patients may experience a variety of different cardiac dysrhythmias at the same time. * GOOD TO KNOW!!! - Short or Longer than normal QT intervals may indicate that the patient is at an increased risk for certain dysrhythmias and sudden death!!! * ECG analysis consists of 5-steps for gathering data about each rhythm strip: I.

II. Rhythm/Regularity
III. Rate
IV. P wave configuration
V. PR Interval
VI. QRS complex- Duration & Configuration

Step #1: Determining the ECG Rhythm or Regularity
The rhythm can be regular or irregular in intervals…
a> P wave represents = Atrial Depolarization, rhythm of atrial contractions are evaluated by assessing the regularity or irregularity of the P wave’s and their occurrences. b> QRS complex represents = Ventricular Depolarization, assessed to evaluate ventricular contractions. c> P-P wave intervals should be evaluated first:

1. Point of the caliper should go from start of 1st P wave to the start of the 2nd (Measure several intervals to determine if regular or irregular). 10 sec of ECG tracing should be used to determine Reg. or Irreg. rhythm throughout the strip. d> Determine the rhythm of the QRS complex:

2. Analyze interval form the same waveform in each QRS complexes. ( IMPORTANT: measure the same part of each complex to determine ventricular depolarization regularity.) Point of caliper should go on the start of the 1st complex and of the start of the 2nd complex. 3. Intervals should be evaluated throughout at least a 6-sec strip to determine QRS complex rhythm. Step #2: Determining the Atrial & Ventricular Rate

a> Atrial rate is determined by the P-P cave interval measurement. b> Ventricular rate is determined by the R-R wave measurement. c> Atrial & Ventricular rates will most frequently be the same, but can differ due to conditions occurring in the myocardium. Knowing this will help to find the right dysrhythmia. d> REGULAR RHYTHM: for P-P or R-R use caliper to determine the number of small boxes between the two points or the duration of time {1 sm. Box = 0.04 sec}. Move calipers to the bottom or top of page so not to distort the trace printout. Once you have the count use the 1500 method. (1500/ # of sm. Box). Over 100 TACHYCARDIA and under 60 BRADYCARDIA. e> IRREGULAR RHYTHM: use 6-sec method, just take # of P waves and QRS complexes in a 6-sec strip and multiply by 10. ( waves/complexes # x 10) Step #3: Identifying P Wave Configurations (Shape)

a> Analyzing P waves in relation to the QRS complex is necessary in determining the type of dysrhythmia. b> P wave is the atrial contraction and how the electrical current is moving through the Atria. The relationship between P waves and QRS complexes provide insight into how the coordination between Atrial & Ventricular Contractions. c> Questions to ask when analyzing P wave:

Are the shapes and waveforms all the same? (Appearing different my mean that the route the current is moving at through the Atria is not on the same path/ Sometimes no P wave exists.) Does each P wave have a QRS complex following it? (Normal path, P wave is followed by QRS complex. If additional waves or complexes present w/o a front P wave, normal conduction pathways may not have been used and Atria & Ventricles are not contracting together.) Step # 4: Measuring the PR Interval...

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