ECG review ACLS Program Ohio State University Medical Center Example Rhythm Normal Sinus Rhythm NSR Sinus Tachycardia Causes cid 137 Exercise cid 137 Hypovolemia cid 137 Medications cid 137 Fever cid 137 Hypoxia cid 137 Substances cid 137 Anxiety Fear cid 137 Acute MI cid 137 Fight or Flight cid 137 Congestive Heart Failure Sinus Bradycardia Causes cid 137 intrinsic sinus node disease cid 137 increased cid 137 drug effect parasympathetic tone ECG Characteristics Rate 60 100 per minute Rhythm R R P waves Upright similar P R 0 12 0 20 second consistent qRs 0 04 0 10 second P qRs 1P 1qRs Rate 100 Rhythm R R P waves Upright similar P R 0 12 0 20 second consistent qRs 0 04 0 10 second P qRs 1P 1qRs Rate 60 Rhythm R R P waves Upright similar P R 0 12 0 20 second consistent qRs 0 04 0 10 second P qRs 1P 1qRs Published by Department of Educational Development and Resources OSU Medical Center cid 148 December 2001 by The Ohio State Univeristy Medical Center All Rights Reserved 1 ECG review ACLS Program Ohio State University Medical Center Example PAC Rhythm Premature Atrial Contractions PAC Causes cid 137 normal cid 137 excessive use of caffeine tobacco or alcohol cid 137 CHF cid 137 Myocardial ischemia or injury cid 137 Hypokalemia Dig toxicity cid 137 COPD Atrial Flutter Causes cid 137 ischemic heart disease cid 137 Hypoxia cid 137 Acute MI cid 137 Dig Toxicity cid 137 Mitral or Tricuspid valve disease cid 137 Pulmonary embolism Atrial Fibrillation cid 137 Ischemic heart disease cid 137 Hypoxia cid 137 Acute MI cid 137 Digitalis toxicity cid 137 Mitral or tricuspid disease ECG Characteristics Rate usually 100 dependant On underlying rhythm Rhythm irregular P waves Early upright different from Sinus PR 0 12 0 20 second different from Sinus qRs 0 04 0 10 second P qRs 1 1 Rate Atrial rate 250 350 Vent 150 common Rhythm Atrial Regular Vent Reg or irreg P waves Not identifiable F waves Uniform sawtooth or picket fence PRI not measurable qRs 0 04 0 10 second Rate Atrial 400 700 Vent 160 180 minute Rhythm Atrial irregular Vent irregular P waves No identifiable Ps f waves may be seen PRI unable to measure No identifiable P qRs usually normal Published by Department of Educational Development and Resources OSU Medical Center cid 148 December 2001 by The Ohio State Univeristy Medical Center All Rights Reserved 2 ECG review ACLS Program Ohio State University Medical Center Example Rhythm Paroxysmal Atrial Tachycardia Causes cid 137 Same as PACs Premature Junctional Contraction PJC Causes cid 137 Same as PACs ECG Characteristics Rate usually 160 220 Rhythm Regular P waves differ in shape from Sinus Ps usually difficult to identify rate related PR Interval Normal when the Ps can be identified short if WPW present qRs usually normal Other Onset sudden often initiated by a PAC Rate usually 100 dependant on the underlying rhythm Rhythm irregular P waves Inverted before or after qRs or not visible PR interval 0 12 second when inverted P is before qRs qRs 0 04 0 10 second P qRs 1 1 if Ps are visible Published by Department of Educational Development and Resources OSU Medical Center cid 148 December 2001 by The Ohio State Univeristy Medical Center All Rights Reserved 3 ECG review ACLS Program Ohio State University Medical Center Example ECG Characteristics Rate 40 60 61 100 accelerated Rhythm Regular P waves Inverted before or after qRs or not visible PR interval 0 12 second when inverted P is before qRs qRs 0 04 0 10 second P qRs 1 1 if Ps are visible Rate 101 200 Same as Junctional Escape Rhythms Rhythm Absolutely regular Rate 150 per minute P Waves Not visible PRI not measurable qRs normal 0 04 0 10 sec Rhythm Junctional escape Rhythm Causes cid 137 healthy athlete at rest cid 137 related to medications Beta Blockers Calcium Channel Blockers Dig Toxicity cid 137 or increased parasympathetic tone cid 137 Acute Inferior Wall MI cid 137 Rheumatic Heart Disease cid 137 Post Cardiac Surgery cid 137 Valvular Disease cid 137 SA Node Disease cid 137 Hypoxia Junctional Tachycardia Causes cid 137 Same as Paroxysmal Atrial Tachycardia PAT Supraventricular Tachycardia SVT An umrella term used when unable to distinguish which rhythm is present Causes Same as Sinus Atrial and Junctional Tachycardia and Atrial Flutter Published by Department of Educational Development and Resources OSU Medical Center cid 148 December 2001 by The Ohio State Univeristy Medical Center All Rights Reserved 4 ECG review ACLS Program Ohio State University Medical Center Example PVC PVC Rhythm Premature Ventricular Complex PVC Causes cid 137 Gastric overload cid 137 Stress cid 137 Caffeine Alcohol Nicotine cid 137 Heart Disease cid 137 Acid Base Imbalance cid 137 Electrolyte Imbalance cid 137 Cyclic Antidepressants cid 137 Hypoxia cid 137 Acidosis cid 137 Acute MI ECG Characteristics Rate Dependent upon underlying rhythm Rhythm R R P waves Usually absent if present not associated with PVC qRs 0 12 second or greater bizarre and notched ST T Often opposite in direction to the qRs Timing One on a strip Rare One in a row Isolated Two in a row Pair couplet Three in a row V Tachycardia Pattern Every other Bigeminy Every third Trigeminy Morphology Similar shape Uniformed Different shape Multiformed Location R on T PVC falls on the T wave of the complex before the PVC Published by Department of Educational Development and Resources OSU Medical Center cid 148 December 2001 by The Ohio State Univeristy Medical Center All Rights Reserved 5 ECG review ACLS Program Ohio State University Medical Center Example Rhythm Ventricular Tachycardia Causes cid 137 Same as PVCs cid 137 R on T Phenomenon Ventricular Fibrillation Causes cid 137 Acute Myocardial Infarction cid 137 Untreated Ventricular Tachycardia cid 137 Hypothermia cid 137 R on T PVCs cid 137 Electrolyte imbalance cid 137 Electrical shock ECG Characteristics Rate 100 per minute and usually not 220 Rhythm Usually regular P Waves P waves or if present not associated with qRs qRs Wide 0 12 sec bizarre ST T wave Opposite direction of qRs A group of three PVCs in a row or more at a rate greater than 100 minute or more constitutes Ventricular Tachycardia Rate Rhythm chaotic undulating waves P Waves qRs ST T Wave Organized activity No Cardiac Output or Pulse regularity Published by Department of Educational Development and Resources OSU Medical Center cid 148 December 2001 by The Ohio State Univeristy Medical Center All Rights Reserved 6 ECG review ACLS Program Ohio State University Medical Center