ECG made easy...My version-02(for emergency setting)

First degree heart block
In this situation, there will be prolong PR interval(more than 3 small squares in a 25mm/sec setting). The rhythm is regular. This is caused by a block in the conduction at the AV node.

Second degree heart block-Mobitz type I
This occurs when there is progressive slowing at the AV node. The PR interval will be progressively lengthening followed by a disappearing QRS complex, meaning a P wave without a QRS complex.


Second degree heart block- Mobitz type II
One or more QRS complex are dropped with the PR intervals remaining equal.

Third degree heart block
Occurs when there is complete blockage of impulse at the AV junction or at the common bundle branch.(sometimes at bilateral bundle branch as well). The RR intervals and the P wave intervals are regular. However, the PR interval are chaotic and irregular. Basically, the P wave and R wave are like from 2 different strips.

Premature ventricular contraction
This occurs due to increase automaticity of the ventricular walls or sometimes due to reentry phenomena. The QRS complex comes earlier than expected and is often a wide complex due to its ventricular origin. A PVC that comes in every second complex is a ventricular bigemini while ventricular trigemini is when it comes in every third complex.

Idioventricular
The heart rate is around 20-40bpm. There is absence of P wave and QRS complex is widened. Idioventricular rhythm occurs when SA and AV node are not firing properly or firing slower than the ventricular pace maker.


Torsade de Pointes
It is paroxysmal(starting and stopping suddenly). The QRS complex will be wide and bizzare. Hallmark of this rhythm is the upward and downward deflection of the QRS complexes around the baseline. The term Torsade de Pointes means "twisting about the points".


Ventricular tachycardia
The rate is extremely high ranging from 100 to 250 bpm. QRS complex is wide and bizzare. Can intervene by giving amiodarone or lidocaine or cardioversion. Must be manage properly as it can soon deteriorates to ventricular fibrillation. Pulseless ventricular tachycardia requires defibrillation.


Ventricular fibrillation
VF is a chaotic rhythm originating from the ventricles resulting in no cardiac output. Requires immediate defibrillation and ACLS protocols.

Asystole/Ventricular standstill
Occurs when there is no more electrical activity in the heart. When this occurs, remember to increase the magnification of the cardiac monitoring to exclude fine ventricular fibrillation.



Premature junctional contraction
PJC arises from irritable focus at the AV junction. Characteristic includes absent or inverted P wave and also a shortened PR interval.

Junctional rhythm/junctional escape rhythm
The junctional rhythm occurs when the impulse originates from the AV junction-AV node and the bundle of His. The rate of the junctional rhythm is about 40-60 bpm. There will b absence of P wave or an inverted P wave. Normally has narrow QRS complex.

Accelerated junctional rhythm
Junctional rhythm with a rate of more than 60 bpm but less than 100 bpm.

Junctional tachycardia
Junctional rhythm with a rate of more than 100bpm.

Any mistakes please inform me.^^

ECG made easy...My version-01(for emergency setting)

Here's some short notes on some common ECG patterns...

Normal sinus rhythm
Rate of between 60-100 bpm(beats per minute)
Every QRS complex is preceded by a P wave and every P wave must be followed by a QRS.

Sinus tachycardia
Rate of more than 100 bpm in a normal adult but often it is limited below 150bpm. Results from sympathetic activation(ie due to pain, fever, hypovolemia)

Sinus bradycardia
Rate of less than 60 bpm in a normal adult. Athletes may constantly be in sinus bradycardia as they have better stroke volume.

Sinus arrhythmia
The rhythm is regularly irregular, with the rate increasing on inspiration and decreasing on expiration. This is commonly seen in children and less common in adults. Often, it is benign.

Sinus exit block/sinoatrial block
This results when the impulse from the sinoatrial(SA) node is block and does not depolarizes the atrium. Although there SA node is firing at the usual rate, the impulses are not passed on. There will be pauses equivalent to multiple P-P intervals.

Sinus pause/sinus arrest
This is resulted when the SA node fails to fire. The difference from sinus exit block is that the pause is normally not equivalent to multiple P-P intervals.
Premature atrial contraction(PAC)
PAC occurs when there is a premature firing from the SA node. This is due to increase irritability of the atria resulting in increased automaticity. Since the SA node firing is earlier, the complex comes earlier. Observe that in the strip, the P wave comes before the dissolution of the T wave. This causes the P wave to become abnormal(biphasic, raised, flattened...). A normal QRS complex(narrow QRS as it originates from the atria) follows the P wave.


Atrial Tachycardia
Often have a rate of between 170 to 230 bpm. The narrow QRS complex shows that it is supraventricular in origin and the rate differentiates it from sinus tachycardia.


Atrial fibrillation
Is a irregularly irregular rhythm. The chaotic rhythm and the absence of P wave is the hallmark of this dysrhythmia.

Atrial flutter
This results from an reentry circuit within the atria at a rate of 250-350. This dysrhythmia is recognized by the sawtooth appearance of the baseline.


Wolf-Parkinson-White(WPW) syndrome
In this condition, there will be presence of delta wave at the foot of the QRS complex. The delta wave is the hallmark of WPW.