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Prepared by : ANWAR ISSA RN-BSN-CCRT-ICU. How to analyze a rhythm strip ?. P wave : is P wave normal ? PR interval : is PR interval normal ? QRS complex : is QRS normal ? P-QRS relation : what is the relation between P wave and QRS ? Rate : what is the rate ?. P WAVE. - PowerPoint PPT Presentation
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Prepared by : ANWAR ISSARN-BSN-CCRT-ICU
• P wave : is P wave normal ?
• PR interval : is PR interval normal ?
• QRS complex : is QRS normal ?
• P-QRS relation : what is the relation between P wave and QRS ?
• Rate : what is the rate ?
How to analyze a rhythm strip ?
• Are the P waves regular ?
• Is the P wave normal and upright in lead II ?
• Do all P waves look alike ?
P WAVE
• Are all the PRI ‘s constant?
• Is the PRI measurement within normal range?
• If the PRI varies, is there a pattern to the changing measurements?
PR INTERVAL
• Are all the QRS complexes of equal duration?
• What is the measurement of the QRS complex?
• Is the QRS measurement within normal limits?
• Do all the QRS complexes look alike?
• Are the unusual QRS complexes associated with ectopic beats?
QRS COMPLEX
• Is there a P for every QRS and vice versa?
• Are they related to each other?
• More P’s? More QRS’s ?
P-QRS RELATION
• What is the exact rate?
• Is the atrial rate the same as the ventricular rate? - If the rhythm is regular--- 300/# of big squares between RR.
-
-If the rhythm is irregular --- count the R waves on a 6 second strip and multiply by 10.
HEART RATE
Normal sinus rhythm
* Condition where SA node stops firing, causing pause in electrical activity. * During the pause, atrial and ventricularcontraction do not occur.
MATMultifocal Atrial Tachycardia
Multifocal atrial tachycardia: narrow-complex tachycardia at 140 to 160 bpm with multiple P-wave morphologies (arrows)
Atrial fibrillation / flutter
Atrial fibrillation
Atrial flutter
Junctional TachycardiaRate > 100/min
SVT (SupraVentricular Tachycardia)
PSVT(Paroxysmal Supraventricular Tachycardia)
Sinus rhythm with paroxysmal onset (arrow) of supraventricular tachycardia (PSVT)
Wolff-Parkinson-White
Wolff-Parkinson-White syndrome: normal sinus rhythm with delta wave notching of positive upstroke of QRS complex
Premature Ventricular Contractions (PVC’s)
Ventricular Tachycardia
Monomorphic ventricular tachycardia
Polymorphic Ventricular Tachycardia:
Torsades de pointes
Polymorphic ventricular tachycardia: QRS complexes display multiple morphologies (“polymorphic”)
Ventricular fibrillation
Coarse VF
Fine VF
Pacing above threshold (60 mA): with capture (QRS complex broad and ventricular; T wave opposite QRS)
Pacing attempted: note pacing stimulus indicator (arrow) which is below threshold; no capture
Pacing Rhythms
2
1
Idio-Ventricular Rhythm
Asystole / Stand still
RATE SINUS AV NODE
VENTRICULAR
> 100 Sinus tachycardia
Junctionaltachycardia
Ventricular tachycardia
60-100 NormalSinus
AcceleratedJunctional
40-60 SinusBradycardia
Junctional rhythm
Accelerated ventricularRhythm
20-40 Idioventricular rhythm