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Prepared by : ANWAR ISSA RN-BSN-CCRT-ICU

Prepared by : ANWAR ISSA RN-BSN-CCRT-ICU. How to analyze a rhythm strip ?. P wave : is P wave normal ? PR interval : is PR interval normal ? QRS complex : is QRS normal ? P-QRS relation : what is the relation between P wave and QRS ? Rate : what is the rate ?. P WAVE.

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Prepared by : ANWAR ISSA RN-BSN-CCRT-ICU

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  1. Prepared by : ANWAR ISSARN-BSN-CCRT-ICU

  2. How to analyze a rhythm strip ? • P wave : is P wave normal ? • PR interval : is PR interval normal ? • QRS complex : is QRS normal ? • P-QRS relation : what is the relation between P wave and QRS ? • Rate : what is the rate ?

  3. P WAVE • Are the P waves regular ? • Is the P wave normal and upright in lead II ? • Do all P waves look alike ?

  4. PR INTERVAL • Are all the PRI ‘s constant? • Is the PRI measurement within normal range? • If the PRI varies, is there a pattern to the changing measurements?

  5. QRS COMPLEX • Are all the QRS complexes of equal duration? • What is the measurement of the QRS complex? • Is the QRS measurement within normal limits? • Do all the QRS complexes look alike? • Are the unusual QRS complexes associated with ectopic beats?

  6. P-QRS RELATION • Is there a P for every QRS and vice versa? • Are they related to each other? • More P’s? More QRS’s ?

  7. HEART RATE • What is the exact rate? • Is the atrial rate the same as the ventricular rate? - If the rhythm is regular--- 300/# of big squares between RR. - -If the rhythm is irregular --- count the R waves on a 6 second strip and multiply by 10.

  8. Normal sinus rhythm

  9. * Condition where SA node stops firing, causing pause in electrical activity. * During the pause, atrial and ventricularcontraction do not occur.

  10. MATMultifocal Atrial Tachycardia Multifocal atrial tachycardia: narrow-complex tachycardia at 140 to 160 bpm with multiple P-wave morphologies (arrows)

  11. Atrial fibrillation / flutter Atrial fibrillation Atrial flutter

  12. JunctionalTachycardia Rate >100/min

  13. SVT (SupraVentricular Tachycardia)

  14. PSVT(Paroxysmal Supraventricular Tachycardia) Sinus rhythm with paroxysmal onset (arrow) of supraventricular tachycardia (PSVT)

  15. Wolff-Parkinson-White Wolff-Parkinson-White syndrome: normal sinus rhythm with delta wave notching of positive upstroke of QRS complex

  16. Premature Ventricular Contractions (PVC’s)

  17. Ventricular Tachycardia Monomorphic ventricular tachycardia

  18. Polymorphic Ventricular Tachycardia: Torsades de pointes Polymorphic ventricular tachycardia: QRS complexes display multiple morphologies (“polymorphic”)

  19. Ventricular fibrillation Coarse VF Fine VF

  20. Pacing Rhythms Pacing attempted: note pacing stimulus indicator (arrow) which is below threshold; no capture Pacing above threshold (60 mA): with capture (QRS complex broad and ventricular; T wave opposite QRS)

  21. 1 2 Idio-Ventricular Rhythm

  22. Asystole / Stand still

  23. THANK YOU

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