Quick Ekg Reference
Quick Ekg Reference
Quick Ekg Reference
EKG Criteria
Rate: 60-100 bpm.
Rhythm: Regular.
P wave: look the same
PRI: .12-.20 seconds
QRS: .08-.12 seconds
narrow unless effected by underlying anomoly
SINUS BRADYCARDIA
EKG Criteria
Rate: <60 bpm.
Rhythm: Regular generally.
Pacemaker: SA node
P wave: Present, all originating from SA node, all look the same.
PRI: <.20 seconds and constant.
QRS: Normal, .08-.12 seconds
SINUS TACHYCARDIA
EKG Criteria
Rate: >100 bpm.
Rhythm: Regular, generally.
Pacemaker: SA node.
P wave: Present and normal,
may be buried in T waves in rapid tracings.
PRI: .12-.20 seconds, generally closer to .12
QRS: Normal.
SINUS ARRHYTHMIA
SINUS EXIT BLOCK
R-R irregular
P-P irregular
P before & for every QRS
PRI: .12-.20 seconds
QRS: .04-.12 seconds
SINUS ARREST
R-R irregular
P-P irregular
P before & for every QRS
PRI: .12-.20 seconds
QRS: .04-.20 seconds
Missing PQRS complex
ATRIAL RHYTHMS
PREMATURE ATRIAL CONTRACTION
EKG Criteria
Rate: Underlying rhythm.
Rhythm: Irregular with PACs.
Pacemaker: Ectopic atrial pacemaker outside SA node.
P wave: Ectopic P wave present,
generally different than normal SA P wave.
PRI: Generall normal range 120-200 msec,
but differ from underlying rhythm.
QRS: Same as underlying rhythm
ATRIAL FIBRILLATION
EKG Criteria
Undulating baseline replaces P waves
Rhythm: Irregularly irregular
ATRIAL FLUTTER
CARDIOVERSION
ATRIAL TACHYCARDIA
P before & every QRS
PRI: .12-.20 seconds
QRS: .08-.12
Can come in runs or bursts
JUNCTIONAL RHYTHMS
JUNCTIONAL RHYTHM
EKG Criteria
Rate: 40 - 60 bpm
Rhythm: Regular
Pacemaker: Atrioventricular junction
P wave: If present, negative in lead 2
PRI: .12 seconds or less
QRS: .08-.12 seconds, unless prolonged by aberrant conduction
JUNCTIONAL TACHYCARDIA
R-R regular; rate >100
P-P regular; rate >100 (may or may not have visable P at fast rate
P wave inverted, my come before, during or after QRS
If P is with T, it will NOT peak the T
EKG Criteria
Rate: Underlying rhythm
Rhythm: Irregular with PJC's
Pacemaker: Ectopic junctional pacemaker
P wave: If present, negative in Lead 2
PRI: .12 seconds or less
QRS: .08-.12 seconds, unless prolonged by aberrant conduction
HEART BLOCKS
FIRST DEGREE AVB
EKG Criteria
Rhythm: Regular
PRI: >.20 seconds
SECOND DEGREE-MOBITZ II
EKG Criteria
PRI: Constant on conducted complexes until a sudden block of AV conduction.
That is, a P wave is abruptly not followed by a QRS
SECOND DEGREE-WENCHEBACH-MOBITZ I
EKG Criteria
Rhythm: Irregular
PRI: Progressive lengthening of PRI until dropped beat.
A clue to Wenckebach is that the QRS's appear to occur in groups
AV DISSOCIATION
There is no fixed temporal relationship between P waves and QRS complexes
due to the existence of two independent pacemakers,
one in the SA node (or in the atria) which controls the beating of atria
and other in the AV junction (or in the ventricles) which controls the beating of ventricles.
When the atria are beating faster than the ventricles,
AV dissociation is due to complete AV block;
when the ventricles are beating faster than the atria,
AV dissociation is due to ectopic tachycardia (junctional or ventricular).
In complete AV dissociation no atrial impulse is conducted to the ventricles;
in incomplete AV dissociation some atrial impulses may be conducted to the ventricles
resulting in ventricular captures.
SUPRAVENTRICULAR TACHYCARDIA(SVT)
EKG Criteria
Rate: 140 - 220 bpm
Rhythm: Regular
Pacemaker: Reentry circuit
Accessory pathway: Normal or short (if down accessory pathway)
A-V nodal reentry: Hidden in or at end of QRS
PRI: Depends on location of circuit
QRS: Normal if accessory pathway used - prolonged (>120 msec) with delta wave
EKG Criteria
Rhythm: Irregular
QRS: Is not normal looking. Broadened, greater than 0.12 seconds.
P waves are usually obscured by the QRS, ST segment, or T wave of the OVC.
The P wave may sometimes be seen as notching during the ST segment or T wave.
BIGEMINY
EKG Criteria
No normal looking QRS complexes, often bizzare with notching.
Width of QRS>0.12 sec. ST segment and T wave are opposite polarity to the
QRS.
Sinus node may be depolarizing normally.
There is usually complete AV dissociation.
P waves are sometimes seen between QRS complexes.
They have no impact on the QRS complexes.
Rate: Generally 100 to 220 bpm
Rhythm: Generally regular, on occassion can be modestly irregular.
TORSADES
P wave obscured if present
QRS wide and bizarre morphology
Conduction as with PVCs
Rhythm Irregular
Paroxysmal–starting and stopping suddenly
The upward and downward deflection of the QRS complexes around the
baseline.
The term Torsade de Pointes means "twisting about the points."
ASYSTOLE
EKG Criteria
Complete absence of ventricular electrical activity.
Occasional P waves or erratic ventricular beats may be seen.
These patients will be pulseless.
Treatment must be immediate if the patient is to have any chance at
resusctiation.
Rate: None
Rhythm: None
Sometimes there is a few or more seconds of Asystole
as in the above strip of over 5 seconds.
IDIOVENTRICULAR
EKG Criteria
Rate: 40 bpm
Rhythm: Regular
P wave: Regular if present
PRI: If present, varies (no relationship to QRS complex [AV dissociation])
QRS: QRS interval >.12 seconds wide and bizarre
VENTRICULAR FIBRILLATION
EKG Criteria
Rate: Very rapid, too disorganized to count.
Rhythm: Irregular, waveform varies in size and shape
No normal QRS complexes.
Absent ST segments, P waves, T waves.
ATRIAL PACED
MVP OPERATION
NON-CAPTURED PACED
PACER FAILURE
ATRIAL-VENTRICULAR PACED
ICD
Below are 2 ways for Ventricular Tachycardia
to be terminated having a ICD.
Ventricular Tachycardia with ICD pacer
overriding the VT rate to convert back to sinus rhythm
Ventricular Tachycardia with ICD firing
(without the pacer override) conversion.
AGONAL RHYTHM