Documenti di Didattica
Documenti di Professioni
Documenti di Cultura
-criteriae for normal sinus rhythm (benda nie beza2, so myb different
bw different sources)
1. heart rate of 60-100 bpm
2. regular rhythm
3. P wave must present for every QRS complex in ratio of 1:1
4. PR interval is bw 0.12 sec to 0.2 sec (3-5 small sq)
5. QRS should be less than 0.12 sec (3 small sq)
-lead v1/v2 look at RV, lead v3/v4 look at IV septum, lead v5/v6 look at
LV
-description of ECG step by step
1. rhythm & rate
4. cardiac axis
2. PR interval
5. T waves, ST segments, etc
3. QRS complex duration
origin of
-P waves - atrial contraction
-QRS - ventricular depolarization
-T - ventricular repolarization
-U - repolarization of papillary ms
2. mobitz type 2
-one P wave not followed by QRS complex
-PR interval of conducted beats is constant
right axis deviation
-the cause of 1st degree heart block is delay somewhere along the
conduction pathway
-for 2nd degree heart block the excitation completely fails to pass
through AV node or bundle of His. the underlying causes are still the
same as 1st degree heart block
-wenckebach is usually benign but mobitz type 2, 2:1, 3:1, and 4:1 may
precedes complete or 3rd degree heart block
third degree heart block / complete heart block
-occur when atrial contraction normal but no beats conducted to the
ventricles
-may occur as acute phenomenon in pt with MI (usually transient), or it
myb chronic, usually dt fibrosis around bundle of His. may also be
caused by block of both bundle branches
-possible patterns
1. PR interval at all leads no consistency
3. abN shaped QRS
2. no relationship bw P & QRS
pathways of depolarization
-conduction problems in :1. AV/BoH 2. LBB/RBB - results in bundle branch block
---here begins the little bit more complex part of ECG--1)atrial escape
-atrium takes over as focus of depolarization
-abN P with normal QRS
-if widespread called as ectopic atrial rhythm
junctional extrasystole
2) junctional escape
-AV node takes over as focus of depolarization
-no P, normal QRS
3) ventricular escape
-no P, abN QRS (& wide), abN T
6) ventricular extrasystole
-common, but usually of no importance. but when they occur early in T
wave of preceding beat they may induce VF
-early beat, wide QRS, abN T
torsades de pointes VT
-broad complex tachycardia in which QRS initially upright but then
changed to become downward pointing
-its either self-limiting or progress to VF
7) atrial flutter
-atrial rate of >250/min & no flat baseline bw P waves (sawtooth
appearance)
-atrial flutter usually with AV block eg atrial flutter with 2:1 block, atrial
flutter with 3:1 block
8) supraventricular tachycardia
a- atrial tachycardia -P waves superimposed on T waves of preceding
beats. normal QRS
b- junctional tachycardia - no P waves, QRS complexes completely
regular, narrow QRS, normal T waves
atrial tachycardia
WPW syndrome
LGL syndrome
digoxin
subendocardial ischemia (exercise induced or during angina atk)
RA hypertrophy
LA hypertrophy
abN of T wave
-T wave inversion is seen in the following :
1. normal - leads aVR, V1, sometimes leads III & V2
2. MI/ischemia
4. BBB
3. ventricular hypertrophy 5. digoxin
-biphasic T waves seen in leads adjacent to those
showing inverted T waves
electrolyte abN
-hypoK - T wave flattening + appearance of a hump on end of T wave
called as U wave
-hyperK -peaked T waves with disappearance of ST segment
-QRS complex mb widened
2+
-effects of abN Mg lvl are similar
-hypoCa - prolongation of QT interval
-hyperCa - shortens QT interval
-hypo/hyperNa - no effect on ECG
prolonged QT (>450 ms or 11 small sq)
-causes - Romano-Ward syndrome
-antiarrhythmic drugs (mc) eg amiodarone, procainamide,
disopyramide, sotalol
-other drugs - TCA, erythromycin
-low K, low Mg, low Ca
-sick sinus syndrome - sinus bradycardia + junctional escape (or could
be others eg atrial extrasystole etc)
-pt often asx, but may complain dizziness,
syncope, or sx suggesting paroxysmal tachycardia