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Chapter 2 for 12 Lead Training -RHYTHM PRACTICE-

Chapter 2 for 12 Lead Training -RHYTHM PRACTICE-. Ontario Base Hospital Group Education Subcommittee 2008. TIME IS MUSCLE. RHYTHM PRACTICE. AUTHOR Tim Dodd, AEMCA, ACP Hamilton Base Hospital. REVIEWERS/CONTRIBUTORS Al Santos A-EMCA, ACP Donna L. Smith AEMCA, ACP Hamilton Base Hospital.

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Chapter 2 for 12 Lead Training -RHYTHM PRACTICE-

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  1. Chapter 2 for 12 Lead Training-RHYTHM PRACTICE- Ontario Base Hospital Group Education Subcommittee 2008 TIME IS MUSCLE

  2. RHYTHM PRACTICE AUTHOR Tim Dodd, AEMCA, ACP Hamilton Base Hospital REVIEWERS/CONTRIBUTORS Al Santos A-EMCA, ACP Donna L. Smith AEMCA, ACP Hamilton Base Hospital 2008 Ontario Base Hospital Group

  3. Let’s Have Some Fun!

  4. Sinus Mechanisms

  5. Sinus Node • Normal Sinus Rhythm (NSR) • Sinus Bradycardia • Sinus Tachycardia • Sinus Arrhythmia • Sinus Arrest/Pause • Sinoatrial Exit Block

  6. Normal Sinus Rhythm (NSR) • Rate: 60-100 beats/min • Rhythm: regular • P waves: uniform, + (upright) in lead II, one precedes each QRS complex • PR interval: 0.12 - 0.20 seconds and constant • QRS duration: < 0.12 sec

  7. Normal Sinus Rhythm (NSR)

  8. Sinus Bradycardia • Rate: less than 60 beats/min • Rhythm: regular • P waves: uniform in appearance, upright and one precedes each QRS complex • PR interval: 0.12 - 0.20 sec and constant • QRS duration: < 0.12 sec

  9. Sinus Bradycardia

  10. Sinus Tachycardia • Rate:greater than 100-150 beats/min • Rhythm: regular • P waves: uniform, upright, one precedes each QRS • PR interval: 0.12 - 0.20 sec and constant • QRS duration: < 0.12 sec

  11. Sinus Tachycardia

  12. ENOUGH OF SINUS

  13. Sinus Arrhythmia • Rate: 60-100 beats/min • Rhythm:irregular • P waves: uniform in appearance, upright, one precedes each QRS • PR interval: 0.12 - 0.20 sec and constant • QRS duration: < 0.12 sec

  14. Sinus Arrhythmia

  15. Sinus Arrest/Pause • Rate:usually normal but varies due to the arrest • Rhythm:irregular; the arrest is of undetermined length • P waves: uniform in appearance, upright, one precedes each QRS • PR interval: 0.12 - 0.20 sec and constant • QRS duration: < 0.12 sec

  16. Sinus Arrest/Pause

  17. Sinoatrial Exit Block • Rate:varies due to the pause • Rhythm:irregular; each pause is the same as the distance between two other P-P intervals • P waves: uniform in appearance, upright, one precedes each QRS • PR interval: 0.12 - 0.20 sec and constant • QRS duration: < 0.12 sec

  18. Sinoatrial Exit Block

  19. Atrial Dysrhythmias

  20. Atrial Dysrhythmias • Premature Atrial Complexes (PACs) • Wandering Atrial Pacemaker (WAP) • Supraventricular Tachycardia (SVT) • Wolff-Parkinson-White Syndrome (WPW) • Atrial Flutter • Atrial Fibrillation (A-Fib)

  21. Premature Atrial Complexes (PACs) • Rate:depends on underlying rhythm • Rhythm:regular with premature beats • P waves:premature (earlier than expected) and may differ in shape from sinus P waves • PR interval: 0.12 - 0.20 sec and constant • QRS duration: < 0.12 sec Note: Ectopic complex

  22. Premature Atrial Complexes (PACs)

  23. Wandering Atrial Pacemaker (WAP) • Rate: usually 60-100 beats/min;if greater than 100 beats/min, it’s termed multifocal atrial tachycardia • Rhythm:may be normal or irregular due to shift in ectopic atrial locations • P waves:size, shape and direction change (3 or more different P waves) • PR interval:may be normal or variable • QRS duration: < 0.12 sec

  24. Wandering Atrial Pacemaker (WAP)

  25. Supraventricular Tachycardia (SVT/PSVT) • Rate:120-250 beats/min • Rhythm: regular • P waves:not present • PR interval:not measurable • QRS duration: < 0.12 sec Note: PSVT is an SVT that starts/ends suddenly

  26. Supraventricular Tachycardia (SVT)

  27. Wolff-Parkinson-White Syndrome (WPW) • Rate: usually 60-100 beats/min (can be associated with runs/episodes of A-Fib) • Rhythm: regular • P waves: uniform in appearance, upright, one precedes each QRS • PR interval: 0.12 - 0.20 sec and constant • QRS duration:usually > 0.12 sec; slurred upstroke of the QRS complex (delta wave)

  28. Wolff-Parkinson-White Syndrome (WPW)

  29. Atrial Flutter • Rate:atrial rate 250-450 beats/min; ventricular rate will not usually exceed 180 beats/min • Rhythm:atrial regular; ventricular regular or irregular • P waves:saw-toothed “flutter” waves • PR interval:not measurable • QRS duration: < 0.12 sec

  30. Atrial Flutter

  31. Atrial Fibrillation (A-fib) • Rate:variable • Rhythm:irregularly irregular • P waves:no identifiable P waves • PR interval:not measurable • QRS duration: < 0.12 sec

  32. Atrial Fibrillation (A-fib)

  33. Junctional Rhythms

  34. Junctional Rhythms • Premature Junctional Complex (PJC) • Junctional Rhythm • Accelerated Junctional Rhythm • Junctional Tachycardia

  35. Premature Junctional Complexes (PJC) • Rate: usually normal but depends on the underlying rhythm • Rhythm:regular with premature beats • P waves:may occur before, during or after the QRS (inverted if visible) • PR interval:if P visible, < or = to 0.12 sec • QRS duration: < 0.12 sec Note: Ectopic complex

  36. Premature Junctional Complexes (PJC)

  37. Junctional Rhythm • Rate:40-60 beats/min • Rhythm: regular • P waves:not present or may occur before, during or after the QRS (inverted if present) • PR interval:not measurable, but if present usually < or = to 0.12 sec • QRS duration: < 0.12 sec

  38. Junctional Rhythm

  39. Junctional Rhythm

  40. Accelerated Junctional Rhythm • Rate:61-100 beats/min • Rhythm: regular • P waves:not present or may occur before, during or after the QRS (inverted if present; may be notched or S waved) • PR interval:not measurable, but if present usually < or = to 0.12 sec • QRS duration: < 0.12 sec

  41. Accelerated Junctional Rhythm

  42. Junctional Tachycardia • Rate:101-180 beats/min • Rhythm: regular • P waves:not present or may occur before, during or after the QRS (inverted if present) • PR interval:not measurable, but if present usually < or = to 0.12 sec • QRS duration: < 0.12 sec

  43. Junctional Tachycardia

  44. Ventricular Rhythms

  45. Ventricular Rhythms • Premature Ventricular Complexes (PVC's) • Idioventricular Rhythm • Ventricular Tachycardia (VT) • Torsades de Pointes (TdeP) • Ventricular Fibrillation (VF) • Asystole

  46. Premature Ventricular Complexes (PVC's) • Rate:depends on underlying rhythm • Rhythm:regular with premature beats • P waves:absent • PR interval:none • QRS duration:> 0.12 sec, wide and bizarre! Note: Ectopic complex

  47. Premature Ventricular Complexes (PVC's) Note – Complexes not Contractions

  48. PVC’s • Uniformed/Multiformed • Couplets/Salvos/Runs • Bigeminy/Trigeminy/Quadrageminy

  49. Uniformed PVC’s

  50. R on T Phenomena

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