Rhythm lecture 2 -ECG
what does a reentrant rhythm usually produce?
what is an example of a supra ventricular rhythm with abnormal conduction (wide QRS)?
wolfe parkinson white
what is an example of a supra ventricular rhythm (narrow QRS) that is regular?
PSVT, and atrial flutter
what is an example of a supra ventricular rhythm (narrow QRS) that is irregular?
what is an example of a ventricular rhythm (wide QRS)? (2)
ventricular tachycardia and ventricular fibrillation
what is the rate for PSVT (paroxysmal supra ventricular tachycardia)
what does the ECG look like for a PSVT?
regular, no p wave, narrow QRS
what is the hallmark for PSVT?
begins and ends abruptly
what is the most common paroxysmal tachycardia?
PSVT is generally due to a reentrant mechanism. Where is the reentrant mechanism from?
impulse circulates in the AV node until terminated
no P wave seen-retrograde atrial depolarization
what is supraventricular tachycardia?
general term for narrow complex tachycardia
where does atrial flutter originate?
describe the rates in atrial flutter
regular, fast atrial activity (250-350bpm)
ventricular rate depends on conduction through AV node (often 150bpm)
rate for atrial flutter
250-350 (often over 300)
in atrial flutter the ventricular rate depends on AV node conduction. What is the most common ratio?
2:1 --> 150bpm ventricular rate
what is the rhythm for atrial flutter look like?
-P wave present and at times buried-SAW TOOTH PATTERN!!!!
when the rate is close to 150 bpm in atrial flutter what should look for?
buried P waves with 2:1 conduction ratio
when I say "SAW TOOTH PATTERN", you say??????
where does atrial fibrillation most commonly originate?
around the pulmonary veins
what is atrial fibrillation?
chaotic atrial activity-no atrial contraction
irregular ventricular contraction
what does the ECG look like for atrial fibrillation?
-no P wave
rate for A-fib?
rate varies-usually fast
how is A-fib classified?
by the ventricular rate
-Afib w/ rapid ventricular response-->RVR
-Afib w/ controlled ventricular response
-Afib w/ slow ventricular response-->generally due to meds or sick sinus syndrome
what is WPW (Wolfe Parkinson White) syndrome?
reentrant rhythm due to an accessory pathway b/w atrium and ventricle- Bundle of Kent
what is WPW syndrome also called?
what is WPW syndrome associated with?
what does the ECG look like for WPW syndrome?
-normal P wave
-PR interval is short (<0.12 seconds)
-ST-T wave changes
rate for ventricular tachycardia
>120 bpm (usually 150-300)
what does the ECG look like for ventricular tachycardia?
-no marriage of P and QRS= AV dissociation
-P wave (representing sinus beats) hidden in QRS
what is a fusion beat?
complex caused by combo of both SA and ventricular pacemaker
what is a capture beat?
normally conducted sinus beat
what is wide complex tachycardia until proven otherwise?
**get a cardiologist involved!!**
what is the rate for Torsades de Pointes?
what does the ECG look like for Torsades de Pointes?
-QRS morphology twists around like streamer
-PROLONGED QT INTERVAL!!!!
how do you treat Torsades de Pointes?
(ACLS)= IV Mag
what does Torsades de Pointes often degenerate to?
Vfib (VERY SERIOUS DYSRHYTHMIA!!)
what 3 things may cause Torsades de Pointes?
what does the ECG look like in V-fib?
-No P wave or QRS
rate for V-fib
no discernable rate
what is asystole?
-no heart beat
-make sure the lead is not off
what is PEA (pulseless electrical activity)?
any rhythm w/o a pulse