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RECOGNITION
T
Q
T
Q
T
Q
T
Q
Sinus Rhythm
Sinus Rhythm
Sinus Rhythm
Sinus
Sinus Bradycardia
Bradycardia
Regularly occurring PQRST
Rate < 60 / min
Rate = 48/min
Rate = 48/min
56/min
Sinus
Sinus Bradycardia
Bradycardia
Sinus
Sinus Tachycardia
Tachycardia
Regularly occurring PQRST
Rate > 100 / min
Rate = 111/min
Rate = 111/min
Rate = 111/min
105/min
Sinus
Sinus Tachycardia
Tachycardia
Sinus
Sinus Arrhythmia
Arrhythmia
Identical but irregularly
occurring PQRST
longest PP or RR > the
shortest by 0.16 sec or more
Rate = 71/min
Rate = 94/min
Rate = 79/min
Rate = 94/min
Sinus
Sinus Arrhythmia
Arrhythmia
Coronary
Coronary Sinus
Sinus Rhythm
Rhythm
Regularly occurring PQRST
Inverted P waves at II, III, AVF
Coronary
Coronary Sinus
Sinus Rhythm
Rhythm
Sinus Rhythm
Premature
Premature Atrial
Atrial Contraction
Contraction
Prematurely occurring PQRTS complex
P wave different in configuration
from the sinus beat.
PR interval often long.
QRS narrow.
Wandering
Wandering Atrial
Atrial
Pacemaker
Pacemaker
Variable P wave morphology
Impulses originate from varying
points in the atrium
Wandering
Wandering Atrial
Atrial Pacemaker
Pacemaker
Multifocal
Multifocal Atrial
Atrial
Tachycardia
Tachycardia
Impulses originate irregularly
and rapidly at different points
in the atrium
Varying P wave, PR, PP and RR intervals
Ventricular rate > 100/min
Multifocal
Multifocal Atrial
Atrial Tachycardia
Tachycardia
Paroxysmal
Paroxysmal Supraventricular
Supraventricular Tachycardia
Tachycardia
AVN Conduction
with unilateral block
pathway
pathway
pathway
pathway
AV
AVNODE
NODE
Atrial
Atrial Flutter
Flutter
Atrial rate = 220-300/min
( P as flutter waves )
Variable degree of AV block
( irregular RR interval )
Atrial
Atrial Flutter
Flutter
Atrial
Atrial Fibrillation
Fibrillation
No discernible P waves
Irregular RR interval
Atrial
Atrial Fibrillation
Fibrillation
Junctional
Junctional Rhythm
Rhythm
Impulses from the AV node
P wave inverted or buried w/in
QRS or follows the QRS
Rate slow
QRS narrow
Junctional
Junctional Rhythm
Rhythm
Junctional
Junctional Premature
Premature
Contraction
Contraction
Prematurely occurring PQRST.
Inverted P wave that may precede,
be incorporated within, or may follow
the QRS complex.
QRS narrow.
Atrioventricular Blocks
R
T
P
Q
S
First Degree
Atrioventricular Blocks
R
T
P
Q
Do you have a normal P wave?
Do you have a normal PR segment?
Do you have a normal PR interval?
Do you have a normal QRS-T?
Yes
No
Prolonged (> 0.20 sec)
Yes
FIRST
FIRST DEGREE
DEGREE
AV
AV BLOCK
BLOCK
PR interval > 0.20 sec
0.28
0.28sec
sec
0.28
0.28sec
sec
0.28
0.28sec
sec
FIRST
FIRST DEGREE
DEGREE AV
AV BLOCK
BLOCK
Second Degree
Atrioventricular Blocks
Do you have a normal P wave?
Yes
Do you have a normal PR segment?
No
Do you have a normal PR interval?
No
Will there be intermittent P waves not
followed by QRS complex? Yes (dropped beats)
Second Degree
Atrioventricular Block
SECOND
SECOND DEGREE
DEGREE AV
AV BLOCK
BLOCK
MOBITZ
MOBITZ II
Progressive lengthening
of PR interval w/ intermittent
drop beats .
0.20
0.20sec
sec
0.28
0.28sec
sec
0.20
0.20sec
sec
SECOND
SECOND DEGREE
DEGREE
AV
AV BLOCK
BLOCK
MOBITZ
MOBITZ IIII
Fixed PR interval
w/ intermittent
drop beats .
0.18
0.18sec
sec
0.18
0.18sec
sec
BLOCK AT THE
Bundle of His
Bilateral bundle
branches
Trifascicle
0.18
0.18sec
sec
SECOND
SECOND DEGREE
DEGREE AV
AV BLOCK
BLOCK
MOBITZ
MOBITZ IIII
22 :: 11 AV
AV BLOCK
BLOCK
P waves present
QRS complexes present
P wave morphology and axis usual for the
subject
QRS morphology and axis usual for the subject
and the lead
HIGH
HIGH GRADE
GRADE AV
AV BLOCK
BLOCK
THIRD
THIRD DEGREE
DEGREE
AV
AV BLOCK
BLOCK
Atrial
Atrialrate
rate==100
100BPM
BPM
Atrial
Atrialrate
rate==100
100BPM
BPM
Atrial
Atrialrate
rate==100
100BPM
BPM
THIRD
THIRD DEGREE
DEGREE AV
AV BLOCK
BLOCK
WITH
WITH SUPRAVENTRICULAR
SUPRAVENTRICULAR ESCAPE
ESCAPE RHYTHM
RHYTHM
THIRD
THIRD DEGREE
DEGREE AV
AV BLOCK
BLOCK
WITH
WITH VENTRICULAR
VENTRICULAR ESCAPE
ESCAPE RHYTHM
RHYTHM
oo
AV
Dissociation
w/o
3
AV Dissociation w/o 3 AV
AV Block
Block
Yes
Ventricular Tachycardia
At least 3 consecutive PVCs
Rapid, bizarre, wide QRS complexes
(> 0.10 sec)
No P wave (ventricular impulse
origin)
Rate > 140 / min
Ventricular Tachycardia
Ventricular Tachycardia
Ventricular Fibrillation
Ventricular Fibrillation
Idioventricular Rhythm
Impulse ventricular in origin
Absence of (N), upright P wave
associated with QRS complexes
QRS > 0.10 sec
T wave opposite in direction to QRS
Rate < 40 / min
Rate < 40 / min
Accelerated
Accelerated Idioventricular
Idioventricular Rhythm
Rhythm
Impulse ventricular in origin
Absence of (N), upright P wave
associated with QRS complexes
QRS > 0.10 sec
T wave opposite in direction to QRS
Rate = 40-120 / min
Rate = 40-120 / min
Accelerated
Accelerated Idioventricular
Idioventricular Rhythm
Rhythm
With 2 foci of ventricular activity
Agonal Rhythm
Extreme sinus bradycardia with irregular, idioventricular
rhythm and occasional atrial activity
Pacemaker Rhythm
No P wave (ventricular impulse origin)
Wide QRS complex (>0.10 sec)
Pacemaker spike precede the wide
QRS complexes
Thank you