Ecg Module 2
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ECG Rhythm Interpretation Module II How to Analyze a Rhythm
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.
Learning Modules • • • • • •
ECG Basics How to Analyze a Rhythm Normal Sinus Rhythm Heart Arrhythmias Diagnosing a Myocardial Infarction Advanced 12-Lead Interpretation
Rhythm Analysis
• • • • •
Step 1: Step 2: Step 3: Step 4: Step 5:
Calculate rate. Determine regularity. Assess the P waves. Determine PR interval. Determine QRS duration.
Step 1: Calculate Rate 3 sec
3 sec
• Option 1 – Count the # of R waves in a 6 second rhythm strip, then multiply by 10. – Reminder: all rhythm strips in the Modules are 6 seconds in length.
Interpretation? 9 x 10 = 90 bpm
Step 1: Calculate Rate R wave
• Option 2 – Find a R wave that lands on a bold line. – Count the # of large boxes to the next R wave. If the second R wave is 1 large box away the rate is 300, 2 boxes - 150, 3 boxes - 100, 4 boxes - 75, etc. (cont)
Step 1: Calculate Rate 3 1 1 0 5 0 7 6 5 0 0 0 5 0 0
• Option 2 (cont) – Memorize the sequence: 300 - 150 - 100 - 75 - 60 - 50
Interpretation? Approx. 1 box less than 100 = 95 bpm
Step 2: Determine regularity R
R
• Look at the R-R distances (using a caliper or markings on a pen or paper). • Regular (are they equidistant apart)? Occasionally irregular? Regularly irregular? Irregularly irregular? Interpretation?
Regular
Step 3: Assess the P waves
• • • •
Are there P waves? Do the P waves all look alike? Do the P waves occur at a regular rate? Is there one P wave before each QRS? Interpretation? Normal P waves with 1 P wave for every QRS
Step 4: Determine PR interval
• Normal: 0.12 - 0.20 seconds. (3 - 5 boxes)
Interpretation? 0.12 seconds
Step 5: QRS duration
• Normal: 0.04 - 0.12 seconds. (1 - 3 boxes)
Interpretation? 0.08 seconds
Rhythm Summary
• • • • •
Rate Regularity P waves PR interval QRS duration Interpretation?
90-95 bpm regular normal 0.12 s 0.08 s
Normal Sinus Rhythm
End of Module II How to Analyze a Rhythm Proceed to Module II Practice Quiz on WebCT Then proceed to module III
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.
Learning Modules • • • • • •
ECG Basics How to Analyze a Rhythm Normal Sinus Rhythm Heart Arrhythmias Diagnosing a Myocardial Infarction Advanced 12-Lead Interpretation
Rhythm Analysis
• • • • •
Step 1: Step 2: Step 3: Step 4: Step 5:
Calculate rate. Determine regularity. Assess the P waves. Determine PR interval. Determine QRS duration.
Step 1: Calculate Rate 3 sec
3 sec
• Option 1 – Count the # of R waves in a 6 second rhythm strip, then multiply by 10. – Reminder: all rhythm strips in the Modules are 6 seconds in length.
Interpretation? 9 x 10 = 90 bpm
Step 1: Calculate Rate R wave
• Option 2 – Find a R wave that lands on a bold line. – Count the # of large boxes to the next R wave. If the second R wave is 1 large box away the rate is 300, 2 boxes - 150, 3 boxes - 100, 4 boxes - 75, etc. (cont)
Step 1: Calculate Rate 3 1 1 0 5 0 7 6 5 0 0 0 5 0 0
• Option 2 (cont) – Memorize the sequence: 300 - 150 - 100 - 75 - 60 - 50
Interpretation? Approx. 1 box less than 100 = 95 bpm
Step 2: Determine regularity R
R
• Look at the R-R distances (using a caliper or markings on a pen or paper). • Regular (are they equidistant apart)? Occasionally irregular? Regularly irregular? Irregularly irregular? Interpretation?
Regular
Step 3: Assess the P waves
• • • •
Are there P waves? Do the P waves all look alike? Do the P waves occur at a regular rate? Is there one P wave before each QRS? Interpretation? Normal P waves with 1 P wave for every QRS
Step 4: Determine PR interval
• Normal: 0.12 - 0.20 seconds. (3 - 5 boxes)
Interpretation? 0.12 seconds
Step 5: QRS duration
• Normal: 0.04 - 0.12 seconds. (1 - 3 boxes)
Interpretation? 0.08 seconds
Rhythm Summary
• • • • •
Rate Regularity P waves PR interval QRS duration Interpretation?
90-95 bpm regular normal 0.12 s 0.08 s
Normal Sinus Rhythm
End of Module II How to Analyze a Rhythm Proceed to Module II Practice Quiz on WebCT Then proceed to module III
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