PET$4551:$EKG$Arrhythmias$Outline$$There%are%a%total%of%32%Arrhythmias%you%will%be%responsible%for%identifying!%As%well%as%being%able%to%identify%if%a%person%is%having%a%heart%attack—Acute%MI,%or%has%had%a%heart%attack—Old%MI.%Below%is%an%outline%of%each%including:%type,%what%is%happening%in%the%heart,%characteristics%and%pictures%of%each.%This%guide%includes%all%information%from%class,%extra%information%that%Panton%said%in%class%including%which%ones%most%people%confuse%and%how%to%not%confuse%them,%information%and%pictures%from%the%EKG%book,%information%and%pictures%from%my%EKG%technician%certification%class%and%more!%Enjoy!%%$$Sinus$Arrhythmias:$1. Normal$Sinus$Rhythm$2. Sinus$Bradycardia$3. Sinus$Tachycardia$4. Sinus$Arrhythmia$5. Sinus$Arrest$6. Escape$beat$a. Atrial$b. Junctional$$c. Ventricular$7. Asystole$$Ectopic$Supraventricular$Arrhythmias:$• NonGsustained:$1. Premature$Atrial$Contractions$2. Junctional$Premature$Beat$• Sustained:$1. PSVT$or$PAT$2. Atrial$Flutter$3. Atrial$Fibrillation$4. Multifocal$Atrial$Tachycardia$5. Wandering$Pacemaker$$Ectopic$Ventricular$Arrhythmias:$1. Premature$Ventricular$Contractions$2. Ventricular$Tachycardia$3. Ventricular$Gibrillation$4. Accelerated$Idioventricular$Rhythm$5. Torsade$De$Pointes$$Conduction$Blocks$1. AV$Blocks$a. First$Degree$AV$Block$b. Second$Degree$AV$Block$i. Mobitz$Type$I$ii. Mobitz$Type$II$c. Third$Degree$AV$Block$2. Bundle$Branch$Blocks$a. Right$Bundle$Branch$Block$b. Left$Bundle$Branch$Block$$Pacemakers$1. Atrial$Pacemaker$2. Ventricular$Pacemaker$3. Sequential$Pacemaker$$Preexcitation$Syndromes$1. WolffGParkinsonGWhite$Syndrome$2. LownGGanongGLevine$Syndrome$$Heart$Attack$(MI)$1. Acute$MI$2. Old$MI$$$$$Conduction$Blocks$$Conduction$blocks$are$obstructions$of$electrical$conduction,$meaning$the$electrical$impulse$is$slowed$down$by$a$block.$There$are$3$types$of$conduction$blocks:$$1. Sinus$Node$Block:$looks$the$same$as$sinus$arrest$(flatline)—most$likely$won’t$be$asked$to$identify$this$on$Exam$2. AV$Blocks:$these$are$due$to$a$block$around$the$AV%node.$There$are$4$total.$As$degree$of$AV$block$progresses,$condition$worsens.$a. First$Degree$AV$Block$b. Second$Degree$AV$Blocks:$i. Mobitz$Type$I$ii. Mobitz$Type$II$c. Third$Degree$AV$Block$3. Bundle$Branch$Blocks:$these$are$due$to$a$block$in$the$ventricular%bundle%branches.$There$are$2$total.$a. Right$Bundle$Branch$Block$b. Left$Bundle$Branch$Block$$There$are$4$AV$Blocks:$$FIRST$DEGREE$AV$BLOCK$This$block$causes$a$prolonged$delay$of$conduction$through$the$AV$node.$PR$interval$>$0.2$sec.$Every$atrial$impulse$gets$through$to$the$ventricles,$so$for$every$P$wave,$there$will$be$a$QRS$complex.$The$PR$interval$will$be$the$same$length$for$each$consecutive$beat.$• This$is$how$I$think$of$these:$Where$is$the$AV$node?$Between$the$right$atria$and$right$ventricle.$The$P$wave$signifies$atrial$depolarization,$the$R$wave$signifies$ventricular$depolarization$and$the$PR$interval$is$the$time$inbetween$them$in$which$blood$passes$through$the$AV$node.$Since$here$there$is$a$prolonged$production$through$the$AV$node,$the$PR$interval$is$longer.$$$!$SECOND$DEGREE$AV$BLOCKS:$$There$are$2$Second$degree$AV$Blocks$in$which$not$every$atrial$impulse$is$getting$through$to$the$ventricles.$$1. MOBITZ$TYPE$I$“WENKEBACH ”$This$is$a$block$within$the$AV$node$which$is$characterized$by$a$longer$and$longer$delay$(progressive$lengthening$of$PR$interval)$which$goes$on$until$the$conduction$does$not$go$through$anymore$(usually$after$beat$3$or$4).$What$does$this$look$like?$o PR$interval$starts$off$normal.$Then,$with$each$consecutive$heart$beat,$the$PR$interval$gets$longer$and$longer$until$there$is$a$lost$beat$which$usually$occurs$at$every$third$or$fourth$beat.$$$$$2. MOBITZ$TYPE$II$This$is$a$block$below$the$AV$node—so$further$down$than$Type$I.$Progressive$lengthening$of$the$PR$interval$does$NOT$occur.$The%EKG%shows%two%or%more%normal%beats%with%normal%PR%intervals%and%then%a%P%wave%that%is%NOT%followed%by%a%QRS%complex%(a%dropped%beat).$The$cycle$is$then$repeated.$The$ratio$of$conducted$beats$to$nonconducted$beats$is$rarely$constant.$$$$THIRD$DEGREE$AV$BLOCK$This$block$allows$NO$atrial$impulses$to$make$it$through$to$the$ventricles.$Therefore,$the$ventricles$will$generate$an$escape$beat.$In$third$degree$AV$Block$the$EKG$shows$P%waves%marching%across%the%rhythm%strip%at%their%usual%rate%(60%to%100%bpm)%but%bearing%no%relationship%to%the%QRS%complexes%that%appear%at%a%much%slower%escape%rate.%The%QRS%complexes%appear%wide%and%bizarre,%just%like%PVC’s%(don’t%get%confused!),%because%they%arise%from%a%ventricular%source.%• Remember:$ventricles$generate$escape$beats$at$30G45$bpm$• Wide$QRS$complexes$=$ventricular$origin$$!First,$notice$that$the$P$waves$are$occuring$at$even$intervals$and$much$faster$than$the$QRS$complexes,$therefore$there$is$no$correlation$between$the$two.$$Then,$notice$the$QRS$complexes$are$wide$and$don’t$look$the$same$for$each$beat.$Finally,$notice$that$each$QRS$complex$occurs$after$a$long$pause$=$ventricular$escape,$which$is$occuring$at$45$bpm.$$The$above$picture$resembles$a$slow$run$of$PVCs$(slow$Vtach)$but$there$is$one$important$difference:$PVCs$are$premature,$occuring$before$the$next$expected$beat!$And$a$ventricular$escape$beat$occurs$after$a$long$pause.$$$$$$$$$$$$$$$$$$$$There$are$2$Bundle$Branch$Blocks:$$RIGHT$BUNDLE$BRANCH$BLOCK$This$block$causes$conduction$through$the$right$side$of$the$heart$to$occur$after$the$left$side$has$already$depolarized—right$side$has$slowed$down$• QRS$complexes$>$0.12$sec.$(a$delay$in$right$ventricular$depolarization$prolongs$the$total$time$for$ventricular$repolarization)$• V1$and$V2$will$have$RSR’$(“rabbit$ears”)$Remember:$what$is$normal$in$these$leads?$“rS”.$So,$RSR’$results$as$left$ventricle$depolarization$swings$back$toward$right$due$to$delay$in$right$ventricle$depolariation.$• Lateral$leads$I,$aVL,$V5$and$V6$will$have$deep$S$waves$$ $!$LEFT$BUNDLE$BRANCH$BLOCK$This$block$is$opposite$of$the$right$bundle$branch$block$except$the$left$side$has$slow ed$dow n$• QRS$complexes$>$0.12$sec$• Lateral$leads$I,$aVL,$V5$and$V6$will$have$marked$prolongation$of$the$already$tall$R$waves,$which$will$have$a$broad$or$notched$tip$• Leads$over$the$right$ventricle$(V2,$V3)$will$have$deep$S$waves$• Left$axis$deviation$may$also$occur$$!!***Do%not%confuse%Left%Ventricular%Hypertrophy%and%Left%Bundle%Branch%Block!%%•
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