Prophecy ECG Complete Study Guide
steps for interpreting rhythms
1. Regular/Irregular
2. Rate?
3. P before every QRS and a QRS for every P wave?
4. P-R interval measurement and is it consistent?
5. QRS wide or narrow?
where to put limb leads on 12 lead EKG
on wrists and ankles
best lead for atrial rhythms
lead II
best lead for ventricular rhythms
V1
SA node intrinsic rate
60-100
AV node intrinsic rate
40-60
atrial depolarization
P wave
PR interval
measured BEFORE P WAVE and AT THE Q
norm: 0.12-.20s
***its too long if it is longer than 5 little boxes or one big box
normal PR Interval
0.12-0.20 seconds
ventricular depolarization
QRS complex
ventricular repolarization
T wave
absolute refractory period
The minimum length of time after an action potential during which another action potential cannot begin
-toilet theory
-problem when QT interval increases
5 large boxes
1 second
15 large boxes
3 seconds
30 large boxes
6 seconds
normal P wave
less than 0.12
normal QRS
0.04-0.12s
QT interval
BEGINNING OF Q TO END OF T
-normal 0.34-0.43
how to calc rate in regular rhythm
1500/number of small boxes between R's
-should have little to no variation (less than 0.12s variation)
how to calc rate in irregular rhythm
count R waves in 6 second strip and multiply by 10
normal sinus rhythm rate
60-100
sinus bradycardia rate
<60
sinus tachycardia rate
100-150
*if regular and >150 = SVT
*if irregular and >150 = A-fib with RVR
Sinus Arrest
*if there is no P wave before flat line then this is arrest
*if there is a P wave before flat line then it is a block
premature atrial contractions
a full PQRST that is early
-this rhythm will be irregular
-PAC is a beat, not a rhythm
-determine underlying rhythm and then say with PACs
bigeminy PACs
PACs that occur every second beat
trigeminy PACs
PACs that occur every 3rd beat
Atrial Fibrillation
NO DISTINGUISHED P
-electricity is going like a pinball then transmits to ventricle
-rhythm is irregular
-if >than 150bpm then a-fib RVR
if irregular and greater than 150bpm
a-fib with RVR
Atrial Flutter
USUALLY REGULAR
atrial rate i.e. 3:1
P wave is flutter/sawtooth
Atrial or Supraventricular Tachycardia
umbrella term
rate >150
SVT if >150 and regular
A-fib with RVR if >150 and irregular
Junctional Rhythm P waves
inverted P waves or P waves after the QRS or no P waves
Junctional Rhythm Rates
Junctional/Junctional Escape Rhythm: 40-60bpm
Accelerated Junctional Rhythm: 60-100bpm
Junctional Tachycardia: >100bpm
Junctional Rhythms Regular or Irregular
Regular
clue for ventricular rhythms
all QRS complexes will be wide
>3 boxes
Premature Ventricular Contraction
irregular rhythm
see underlying rate
QRS WIDE AND BIZARRE
Unifocal Premature Ventricular Contraction
wide and bizarre QRS come from the same origin
Multifocal Premature Ventricular Contraction
wide and bizarre QRS come from different origins
Couplet PVCs
2 PVCs in a row
Triplet PVCs
3 PVCs in a row
V-tach
Regular
>100
wide and bizarre QRS
HIGH AND WIDE
types of v-tach
monomorphic (lady fingers)
polymorphic (arthritic fingers)
torsades de pointes
V-fib
chaotic rhythm
unable to measure rate
can be course or fine
**course v-fib can look like v-tach but not high and wide enough
idioventricular rhythm
Regular Rhythm
BOTH ATRIAL AND VENTRICULAR RHYTHM
NO P WAVE + WIDE QRS
Rate is 20-50 min
Accelerated Idioventricular Rhythm
Regular Rhythm
Rate is 50-100
irregular P waves
Agonal
slow irregular rhythm with wide QRS that vary in morphology
-nearing death
First Degree Block
Regular Rhythm
Rate usually 60-100
PR INTERVAL 0.20s OR 5 BOXES
Second Degree Block Type 1
Irregular Rhythm
Rate 60-100
PR PROGRESSIVELY LONGER UNTIL QRS DROP
LONGER LONGER LONGER DROP
Second Degree Block Type II
Irregular Rhythm
Rate <60
PR INTERVAL CONSISTENT OR FIXED
-QRS drops but PR stays consistent
Third Degree Block
R-R regular
P-P regular
NO RELATIONSHIP BETWEEN P AND QRS
Asystole
patient is dead
