Basicekgft chapter5-6 ppt
- 1. Basic EKG Interpretation CHAPTER 5 / 6: ATRIAL AND JUNCTIONAL ARRHYTHMIAS Accompanying Textbook: ECG Interpretation Made Incredibly Easy, 5th Ed. © 2011 by Lippincott Williams & Wilkins. All rights reserved Instructed by: Douglas J Michel, PMD
- 2. 2 2018 © MediPro Presentation Template www.website.com PRIMARY ATRIAL RHYTHMS A T R I A L A R R H Y T H M I A S Atrial Fibrillation is one of the most common arrhythmias, in which the atrium “quivers” or shakes rather than contracting, resulting in a very erratic narrow complex rhythm with no P waves. ATRIAL FIBRILLATION Atrial Tachycardia originates from a cluster of active cardiac cells within the atrium, outside of the AV node. Varieties include Atrial Tachycardia with block, Multifocal Atrial Tachycardia, and Paroxysmal Atrial Tachycardia ATRIAL TACHYCARDIA Atrial Flutter, also very common, occurs when a pacemaker site within the atrium contracts rapidly, however only a select few impulses are transmitted through the AV node, resulting in ventricular contraction. ATRIAL FLUTTER ATRIAL TACHYCARDIA ATRIAL FIBRILLATION ATRIAL FLUTTER
- 3. 3 2018 © MediPro Presentation Template www.website.com 3 2018 © MediPro Presentation Template Atrial Tachycardia is characterized by P waves of a differing morphology from Sinus P waves and a rapid heart rate usually greater than 150 bpm. PR INTERVAL: 0.12-0.20 QRS INTERVAL: 0.06-0.12 QT INTERVAL: 0.36-0.44 T WAVES – Normal in appearance RHYTHM - Regular P WAVE MORPHOLOGY: Different shape HEART RATE: Usually over 150 bpm ATRIAL TACHYCARDIA CHARACTERISTICS ATRIAL TACHYCARDIA
- 4. 4 2018 © MediPro Presentation Template www.website.com Atrial Tachycardia has three primary types: (NOTED BY EXCEPTIONS) ATRIAL TACHYCARDIA WITH BLOCK Multiple P waves for each QRS complex, differing morphology from SA P waves MULTIFOCAL ATRIAL TACHYCARDIA Three or more P wave morphologies, heart rates in excess of 100 bpm. Rapid version of Wandering Atrial Pacemaker PAROXYSMAL ATRIAL TACHYCARDIA Brief period of Atrial Tachycardia with observable start and end. Unless otherwise stated, assume all other characteristics to be within normal limits. ATRIAL TACHYCARDIA TYPES A T R I A L A R R H Y T H M I A S
- 5. 5 2018 © MediPro Presentation Template www.website.com ATRIAL FIBRILLATION Defined by: Highly Irregular rhythm with no discernable R-R pattern No conducted P waves associated with ventricular contraction Fibrillating baseline ATRIAL FLUTTER Defined by: Very rapid Atrial depolarization exceeding the R-R rate. Presence of F waves Multiple P waves for each QRS Sawtooth like appearance COMMON AF FINDINGS Atrial Fibrillation averaging over 100 bpm is called Atrial Fibrillation with RVR Very common to find rates well in excess of 100 bpm. COMMON FINDINGS Atrial Flutter often has a regular R- R interval and an identifiable pattern expressed as a ration of conducted to non conducted P waves. Irregular Atrial Flutter is called Atrial Flutter with variable block. MOST COMMON ATRIAL ARRHYTHMIAS A T R I A L A R R H Y T H M I A S
- 6. 6 2018 © MediPro Presentation Template www.website.com Wandering Atrial Pacemaker occurs when multiple pacemaker sites exist in the atriums and alternate between one another. Characterized by 3 or more P wave morphologies, a pattern of P wave changes, and heart rates within normal limits. Multifocal Atrial Rhythm occurs when multiple pacemaker sites exist within the atriums and they fire randomly. Characterized by 3 or more P wave morphologies, NO pattern to the changing P wave morphologies, and heart rates within normal limits. The Slower Atrial Arrhythmias WAP and MAR A T R I A L A R R H Y T H M I A S
- 7. 7 2018 © MediPro Presentation Template www.website.com Premature atrial contractions fall earlier than the normal, out of sequence with the normal rhythm. PAC’s will be usually have a narrow QRS complex and will be very similar in appearance to the normal QRS complexes. In addition, P waves may be visible or they may be buried in the preceding T wave. Ectopy is nearly always followed by a compensation pause, which is normal and is not reported or counted as a pause unless it is excessively long in duration. Premature Atrial Contractions A T R I A L A R R H Y T H M I A S Compare Morphologies Observe your patient! The easiest way to identify what form of ectopy you have found is to compare the QRS morphology to that of the patients normal heart beats. If the QRS looks just like all the others, yet comes early, it is a PAC. If the QRS of the early beat appears significantly different than those of the sinus beats, consider an alternate origin.
- 8. 8 2018 © MediPro Presentation Template www.website.com Characterized by a different P wave morphology suggesting an atrial origin other than the SA node. With 3 or more different P wave morphologies, consider possible MAT. ATRIAL TACHYCARDIA ATRIAL FIBRILLATION Atrial Fibrillation with RVR can often be difficult to analyze at very high rates. Look for gaps in the rhythm suggesting an irregular underlying rhythm. Characterized by no discernable P waves, irregularly irregular rhythm, and fibrillations in the baseline. Characterized by a very rapid heart rate, narrow complex, and inverted or retrograde P waves. This is often confused with Junctional Tachycardia. AVRT / AVNRT SUPRAVENTRICULAR TACHYCARDIA A T R I A L A R R H Y T H M I A S Supraventricular Tachycardia is a “catch all” term, translated as “above the ventricles” tachycardia. The use of this term is typically when a precise determination as to the rhythm cannot be observed without further information or medical intervention to first slow the rhythm. SVT includes all rapid tachycardias originating above the ventricles. The primary characteristics of SVT include a heart rate at or above 150 bpm, a narrow QRS complex, regular rhythm, and the absence of discernable P waves. SVT includes Sinus Tachycardia, Atrial Tachycardia, Atrial Fibrillation with RVR, rapid Atrial Flutter, AVNRT, AVRT, and MAT.
- 9. 9 2018 © MediPro Presentation Template www.website.com RATE: 40-60 BPM Inverted or Retrograde P waves JUNCTIONAL RHYTHM RATE: 60-100 Inverted or Retrograde P waves ACCELERATED JUNCTIONAL RHYTHM RATE: Over 100 bpm Inverted or Retrograde P waves JUNCTIONAL TACHYCARDIA Junctional Rhythms A V N O D E A R R H Y T H M I A S
- 10. 10 2018 © MediPro Presentation Template www.website.com Identified by “Delta” Waves Slurring upturn into the QRS WOLFF PARKINSON WHITE Retrograde / Inverted P wave Minor QRS morphology change PREMATURE JUNCTIONAL CONTRACTION Other Junctional Variations A V N O D E A R R H Y T H M I A S
- 11. 11 2018 © MediPro Presentation Template www.website.com EXTENTED PR INTERVAL Greater than 0.201ST Degree STEADILY CHANGING PR INTERVAL Followed by a dropped heartbeat.2nd Degree Type I CONSTANT PR INTERVAL Followed by a dropped heartbeat2nd Degree Type II COMPLETE AV DISSOCIATION Constant P-P Interval, Constant R-R Interval, Variable PR3rd Degree AV NODAL BLOCKS A V N O D E A R R H Y T H M I A S *NOTE* AV Blocks and SA Blocks are similar: The difference is whether or not the SA node signal is stopped at the Sinoatrial region or if it is stopped at the Atrioventricular region. This is evidenced by NO P wave at drops in SA Block, while a nonconducted P wave will be present at drops in AV Blocks.