ECG
CONDUCTION
OF CARDIAC
ELECTRICAL
IMPULSES
• SA NODE
• AV NODE
• BUNDLE of HIS
• LEFT and RIGHT
BUNDLE
BRANCH
• PURKINJE
FIBERS
Electrical Conduction System of the HEART
Schematic Representation of Normal ECG
CONDUCTION
OF CARDIAC
ELECTRICAL
IMPULSES
• SA NODE
• AV NODE
• BUNDLE of HIS
• LEFT and RIGHT
BUNDLE
BRANCH
• PURKINJE
FIBERS
How to interpret?
RATE ? / min 60 / min
RHYTHM Regular or Irregular Regular
P WAVE Present or Absent Present
PR Normal?
INTERVAL
(0.12 – 0.20 sec) Normal
QRS Normal?
(0.08 – 0.12 sec) Normal
CARDIAC
ARRHYTHMIAS
AN D
ALGORITHMS
BRADYCARDI A
Heart rate of less than 60 bpm
► SINUS BRADYCARDIA
► 1ST DEGREE AV BLOCK
► 2ND DEGREE AV BLOCK
TYPE I ( MOBITZ 1 )
TYPE II ( MOBITZ 2 )
► 3RD DEGREE AV BLOCK
BRADYCARDIA …
SINUS
BRADYCARDIA
RATE : < 60 /min
RHYTHM : REGULAR
P WAVE : PRESENT
PR INTERVAL : NORMAL
QRS : NORMAL
BRADYCARDIA …
Prolonged PR interval
RATE : < 60 /min / Normal
RHYTHM : REGULAR
P WAVE : PRESENT
PR INTERVAL : PROLONGED
QRS : NORMAL
BRADYCARDIA …
MOBITZ 1
RATE : NORMAL / < 60 /min
RHYTHM : irREGULAR
P WAVE : PRESENT
PR INTERVAL : progressively PROLONGED
PR INTERVAL
QRS : one (1) drop
BRADYCARDIA …
MOBITZ 2
RATE : NORMAL / < 60 /min
RHYTHM : irREGULAR
P WAVE : PRESENT
PR INTERVAL fixed
:
PR INTERVAL
QRS : two (2) drops
BRADYCARDIA …
COMPLETE HEART BLOCK
RATE : < 60 /min
RHYTHM : REGULAR
P WAVE : no relationship b/w the qrs
PR INTERVAL unidentified
:
QRS : present
ALGORITH
M
BRADYCARDIA WITH PULSE ASSESSMENT
Oxygen, Cardiac Monitor, IV access, ECG
ST BL ● Hypotension ? UNSTBL
● Altered mental status?
AObserve
E ● Signs of shock? A AA E
ALWAYS TROPINE
and Monitor ● Chest discomfort?
● Heart Failure ? TAKE T TRANSCUTANEOUS
PACING
● EXPERT DOWN D DOPAMINE
CONSULTATION
● TRANSVENOUS EVERYTHING E EPINEPHRINE
PACING
TACHYC AR DI A
Heart rate of more than 100 bpm
► SINUS TACHYCARDIA
► SUPRAVENTRICULAR
TACHYCARDIA (SVT)
► ATRIAL FLUTTER
► ATRIAL FIBRILLATION
► VENTRICULAR TACHYCARDIA
● MONOMORPHIC
● POLYMORPHIC
TACHYCARDIA …
SINUS TACHYCA R DIA
RATE : >100 /min
RHYTHM : REGULAR
P WAVE : PRESENT
PR INTERVAL : noRMAL
QRS : NARROW
TACHYCARDIA …
ATRIAL FLUTTE R
MANAGEMENT
RATE : >100 /min
STABLE: B-D-D-A
RHYTHM : REGULAR
P WAVE : NONE ► BETA-BLOCKER,DILTIAZEM,DIGOXIN,
AMIODARONE
PR INTERVAL : NONE
UNSTABLE
QRS : NARROW
► SYNCHRONIZED CARDIOVERSION 50J
TACHYCARDIA …
ATRIAL FI BRILLATION
RATE : >100 /min MANAGEMENT
RHYTHM : IRREGULAR STABLE: B-D-D-A
P WAVE : NONE ► BETA-BLOCKER,DILTIAZEM,DIGOXIN,
PR INTERVAL : NONE AMIODARONE
QRS : NARROW UNSTABLE
► SYNCHRONIZED CARDIOVERSION 100-120j
ASYSTOLE
How to confirm?
1. Check the pulse
2. Check the leads
3. Increase the amplitude
IDENTIFY
THE
RHYTHM
SINUS
TACHYCARDIA
SINUS
BRADYCARDIA
COARSE
VENTRICULAR
FIBRILLATION
2ND DEGREE AV
BLOCK TYPE 2
ATRIAL
FIBRILLATION
2ND DEGREE AV
BLOCK TYPE 1
3RD DEGREE AV
BLOCK
ATRIAL FLUTTER
PULSELESS
ELECTRICAL
ACTIVITY
MONOMORPHIC
VENTRICULAR
TACHYCARDIA
ASYSTOLE
FINE
VENTRICULAR
FIBRILLATION
3RD DEGREE AV
BLOCK
SUPRAVENTRICULAR
TACHYCARDIA
COARSE
VENTRICULAR
FIBRILLATION
