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2 For more presentations ECG Rhythm Interpretation Module IV a Sinus Rhythms and Premature Beats

3 For more presentations Course Objectives To recognize the normal rhythm of the heart - Normal Sinus Rhythm. To recognize the 13 most common rhythm disturbances. To recognize an acute myocardial infarction on a 12-lead ECG.

4 For more presentations Learning Modules ECG Basics How to Analyze a Rhythm Normal Sinus Rhythm Heart Arrhythmias Diagnosing a Myocardial Infarction

5 For more presentations Arrhythmias Sinus Rhythms Premature Beats Supraventricular Arrhythmias Ventricular Arrhythmias AV Junctional Blocks

6 For more presentations Sinus Rhythms Sinus Bradycardia Sinus Tachycardia

7 For more presentations Rhythm #1 30 bpm Rate? Regularity? regular normal 0.10 s P waves? PR interval? 0.12 s QRS duration? Interpretation? Sinus Bradycardia

8 For more presentations Sinus Bradycardia Deviation from NSR - Rate< 60 bpm

9 For more presentations Sinus Bradycardia Etiology: SA node is depolarizing slower than normal, impulse is conducted normally (i.e. normal PR and QRS interval).

10 For more presentations Rhythm #2 130 bpm Rate? Regularity? regular normal 0.08 s P waves? PR interval? 0.16 s QRS duration? Interpretation? Sinus Tachycardia

11 For more presentations Sinus Tachycardia Deviation from NSR - Rate> 100 bpm

12 For more presentations Sinus Tachycardia Etiology: SA node is depolarizing faster than normal, impulse is conducted normally. Remember: sinus tachycardia is a response to physical or psychological stress, not a primary arrhythmia.

13 For more presentations Premature Beats Premature Atrial Contractions (PACs) Premature Ventricular Contractions (PVCs)

14 For more presentations Rhythm #3 70 bpm Rate? Regularity? occasionally irreg. 2/7 different contour 0.08 s P waves? PR interval? 0.14 s (except 2/7) QRS duration? Interpretation?NSR with Premature Atrial Contractions

15 For more presentations Premature Atrial Contractions Deviation from NSR –These ectopic beats originate in the atria (but not in the SA node), therefore the contour of the P wave, the PR interval, and the timing are different than a normally generated pulse from the SA node.

16 For more presentations Premature Atrial Contractions Etiology: Excitation of an atrial cell forms an impulse that is then conducted normally through the AV node and ventricles.

17 For more presentations Teaching Moment When an impulse originates anywhere in the atria (SA node, atrial cells, AV node, Bundle of His) and then is conducted normally through the ventricles, the QRS will be narrow ( s).

18 For more presentations Rhythm #4 60 bpm Rate? Regularity? occasionally irreg. none for 7 th QRS 0.08 s (7th wide) P waves? PR interval? 0.14 s QRS duration? Interpretation? Sinus Rhythm with 1 PVC

19 For more presentations PVCs Deviation from NSR –Ectopic beats originate in the ventricles resulting in wide and bizarre QRS complexes. –When there are more than 1 premature beats and look alike, they are called uniform. When they look different, they are called multiform.

20 For more presentations PVCs Etiology: One or more ventricular cells are depolarizing and the impulses are abnormally conducting through the ventricles.

21 For more presentations Teaching Moment When an impulse originates in a ventricle, conduction through the ventricles will be inefficient and the QRS will be wide and bizarre.

22 For more presentations Ventricular Conduction Normal Signal moves rapidly through the ventricles Abnormal Signal moves slowly through the ventricles

23 For more presentations End of Module IV a Sinus Rhythms and Premature Beats Proceed to Module IV a Practice Quiz on WebCT

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