EKG 1. Is there a P wave for every QRS?

Interpretation 2. Are all waves (P, QRS, T) present? How to Calculate MEA:
3. Is the P wave Upright in Leads I, II, and III?
Algorithm (IF THE ANS TO EVEN ONE OF THESE IS NO, THEN FOLLOW THE no SIDE OF Semi-Quantitative Estimate:
(including THE CHART.)
Mean Electrical 1. Look for a lead with approx. net
electrical deviation = 0.
Axis Changes) 2. Draw a line on the MEA diagram that is
perpendicular to the net 0 lead
(dxs
dxs in light blue= YES to ALL =
3. Now you know it has to be either the
rythms text
shockable rythms, positive or the negative portion of that
in pink = don’t need to SINUS RHYTHM
perpendicular line .
know for Mini II) 4. Choose any one of the other leads and
draw the 3-segment on each side arc,
and whichever half of the perpendicular
line the arc crosses, is your MEA.
4. QRS Complex Semi-Quantitative Long Version:
1. Prolonged P-R interval? changes in net
2. ST-segment 3. Other P wave
(>.20sec, or 5 small electrical deviation
elevation? changes? 1. Establish the net negativity or positivity
boxes) from list ? of each lead on the six limb leads (I, II,
(Net + = Leads I, II, II, aVF, aVR, VL)
avF, aVL, V5, V6 2. On the MEA diagram, draw a “3-
Net - = aVR, V1) segment on each side “ on either the
positive or the negative portion of each
Yes Yes Yes 5. MEA < -90˚ or > lead, according to the EKG
+30˚? 3. The MEA must lie within the wedge
which has all six arcs spanning it. This
gives you a range of 30˚ for your actual
Yes to Any MEA.
ST SEGMENT ELEVATION
1st DEGREE
= DIASTOLIC CURRENT OF GENERAL
(INCOMPLETE) Quick and Dirty:
INJURY = ATRIAL
HEART BLOCK
TP SEGMENT and PR HYPERTROPHY MEAN ELECTRICAL AXIS
•PR-interval > .20 1. Leads I and aVF are both + = normal
SEGMENT DEPRESSION DEVIATION
sec 2. Lead I is – and aVF is + = Right Axis
•dead cells maintain constant (see R for calculation methods)
•SINUS RHYTHM Deviation (RAD)
negative charge **note, MEA deviations can be
•benign, no urgent 3. Lead I is + and aVF is - = LAD
•the only time the whole present in pts with non-sinus
intervention
heart is supposed to be neg rhythms, but they are not
required. Quantitative
is during ST segment reproduced on the next page.
(not desc. here b/c requires ruler)
(ventricles completely
depolarized) 1. MEA < -30˚ to > - 2. MEA < +90˚ to >
•thus, ST seg stays where 90˚? +150˚?
it’s supposed to be, on
isoelectric line, the rest of the
segments are depressed LEFT AXIS DEVIATION
RIGHT AXIS DEVIATION
with downward deflection. •pathologic causes include L
•pathologic causes include R
•SINUS RHYTHM Ventricular Hypertrophy,
Ventricular Hypertrophy, Lateral
•cath lab and/or lytics (cath Inferior MI, Emphysema,
MI, Pulmonary HTN, Pulmonary
preferred) Systemic HTN, Aortic
Valve Stenosis, VSD, Tetrology of
Valve Stensosis
Fallot
•physiologic causes include
•physiologic causes include tall, thin
athletic conditioning
adult, and childhood, high altitude
 1. Is there a P wave for every QRS? 1. Separate P wave and
Y
EKG 2. Are all waves (P, QRS, T) present? QRS complex rhythm?
3. Is the P wave Upright in Leads I, II, and III?
Interpretation (IF THE ANS TO EVEN ONE OF THESE IS NO, THEN FOLLOW THE no
3rd DEGREE (COMPLETE)HEART BLOCK
Algorithm PAGE OF THE CHART.)
aka Atrioventricular Dissociation
(not including
Mean Electrical •P wave has atrial rhythm, QRS wave has
NO to ONE or MORE = Junctional (AV node)or Ventricular (His-
Axis Changes) Purkinje or Ventricular Myocardium) rhythm
NON-SINUS RYTHM Yes •Hallmark: P wave and R wave are said to be
(dxs
dxs in light blue= “marching out” meaning they follow sep.
shockable rhythms)
rhythms rhythms, but are still highly regular (p-p and r-r
do not change)
•Hallmark: P wave found btx QRS and T wave
1. Dropped QRS
•sometimes: inverted T waves.
complexes?
•Junctional Rhythm = narrow QRS < 3 small
boxes
•Accelerated Idioventricular Rhythm =
widened QRS
1. Has P
Yes No •tx = pacing, transvenous or transcutaneous
Waves?
•NON-SINUS RYTHM

2. P waves unclear, Y
erratic baseline?
1. Total Absence 2. Prolonged PR
of any waveform Interval? No
ATRIAL FIBRILLATION
pattern?
•no clear P waves, still have QRS. no reg.
HR
No •atria contract erratically, causes irregular
Yes 1. Wide QRS
baseline
Complex?
•not directly fatal, but causes clots
•Pulmonary Embolism thrombus formed in
Yes
2nd DEGREE 2nd DEGREE atria goes to pulmonary circ and lungs
(INCOMPLETE) (INCOMPLETE) •Coronary or Cerebral Embolism
Yes No
HEART BLOCK HEART BLOCK thrombus formed in atrium goes to coronary
MOBITZ type 1 MOBITZ type 2 art. or brain
aka Wenkebach •NON-SINUS RHYTHM
VENTRICULAR rhythm •PR-interval = no ∆
FIBRILLATION •sudden, unpredictable
•PR-interval > .25 sec loss of QRS complex.
•Highly erratic •PR-intervals often get •disease of bundle of VENTRICULAR SVT
pattern progressively longer till His-purkinje system TACHYCARDIA SUPRA –VENTRICULAR
•fatal if not tx’d you lose one, then it TACHYCARDIA
•can be 2:1 or 3:1 (p
•NON- SINUS re-sets and then they •150-250 bpm
wave:QRS compl.)
RHYTHM start to get longer •frequently due to a re- •>150 bpm
•NON-SINUS
again entrant ventricular •frequently due to a re-entrant pathway
RHYTHM
•AV node is disfctl pathway caused by •origin of electrical impulse is in the atria
•can degrade to 3rd
•NON-SINUS scar tissue from or the AV node
deg. heart block
RHYTHM!!! previous MI, etc.
 1. Is there a P wave for every QRS?
EKG 2. Are all waves (P, QRS, T) present? How to Calculate MEA:
3. Is the P wave Upright in Leads I, II, and III?
Interpretation (IF THE ANS TO EVEN ONE OF THESE IS NO, THEN FOLLOW THE no SIDE OF Semi-Quantitative Estimate:
Algorithm THE CHART.)
(including 1. Look for a lead with approx. net
Mean Electrical electrical deviation = 0.
2. Draw a line on the MEA diagram that is
Axis Changes) perpendicular to the net 0 lead
YES to ALL =
3. Now you know it has to be either the
( dxs in light blue= positive or the negative portion of that
shockable) SINUS RHYTHM
perpendicular line .
4. Choose any one of the other leads and
draw the 3-segment on each side arc,
and whichever half of the perpendicular
line the arc crosses, is your MEA.
4. QRS Complex Semi-Quantitative Long Version:
1. Prolonged P-R interval? changes in net
2. ST-segment 3. Other P wave
(>.20sec, or 5 small electrical deviation
elevation? changes? 1. Establish the net negativity or positivity
boxes) from list ? of each lead on the six limb leads (I, II,
(Net + = Leads I, II, II, aVF, aVR, VL)
avF, aVL, V5, V6 2. On the MEA diagram, draw a “3-
Net - = aVR, V1) segment on each side “ on either the
positive or the negative portion of each
Yes Yes Yes 5. MEA < -90˚ or > lead, according to the EKG
+30˚? 3. The MEA must lie within the wedge
which has all six arcs spanning it. This
gives you a range of 30˚ for your actual
Yes to Any MEA.
ST SEGMENT ELEVATION
1st DEGREE
= DIASTOLIC CURRENT OF GENERAL
(INCOMPLETE) Quick and Dirty:
INJURY = ATRIAL
HEART BLOCK
TP SEGMENT and PR HYPERTROPHY MEAN ELECTRICAL AXIS
•PR-interval > .20 1. Leads I and aVF are both + = normal
SEGMENT DEPRESSION DEVIATION
sec 2. Lead I is – and aVF is + = Right Axis
•dead cells maintain constant (see R for calculation methods)
•SINUS RHYTHM Deviation (RAD)
negative charge **note, MEA deviations can be
•benign, no urgent 3. Lead I is + and aVF is - = LAD
•the only time the whole present in pts with non-sinus
intervention
heart is supposed to be neg rhythms, but they are not
required. Quantitative
is during ST segment reproduced on the next page.
(not desc. here b/c requires ruler)
(ventricles completely
depolarized) 1. MEA < -30˚ to > - 2. MEA < +90˚ to >
•thus, ST seg stays where 90˚? +150˚?
it’s supposed to be, on
isoelectric line, the rest of the
segments are depressed LEFT AXIS DEVIATION
RIGHT AXIS DEVIATION
with downward deflection. •pathologic causes include L
•pathologic causes include R
•SINUS RHYTHM Ventricular Hypertrophy,
Ventricular Hypertrophy, Lateral
•cath lab and/or lytics (cath Inferior MI, Emphysema,
MI, Pulmonary HTN, Pulmonary
preferred) Systemic HTN, Aortic
Valve Stenosis, VSD, Tetrology of
Valve Stensosis
Fallot
•physiologic causes include
•physiologic causes include tall, thin
athletic conditioning
adult, and childhood, high altitude
 1. Is there a P wave for every QRS? 1. Separate P wave and
Y
EKG 2. Are all waves (P, QRS, T) present? QRS complex rhythm?
3. Is the P wave Upright in Leads I, II, and III?
Interpretation (IF THE ANS TO EVEN ONE OF THESE IS NO, THEN FOLLOW THE no
3rd DEGREE (COMPLETE)HEART BLOCK
Algorithm PAGE OF THE CHART.)
aka Atrioventricular Dissociation
(not including
Mean Electrical •P wave has atrial rhythm, QRS wave has
NO to ONE or MORE = Junctional (AV node)or Ventricular (His-
Axis Changes) Purkinje or Ventricular Myocardium) rhythm
NON-SINUS RYTHM Yes •Hallmark: P wave and R wave are said to be
(dxs in light blue= “marching out” meaning they follow sep.
shockable rhythms) rhythms, but are still highly regular (p-p and r-r
do not change)
•Hallmark: P wave found btx QRS and T wave
1. Dropped QRS
•sometimes: inverted T waves.
complexes?
•Junctional Rhythm = narrow QRS < 3 small
boxes
•Accelerated Idioventricular Rhythm =
widened QRS
1. Has P
Yes No •tx = pacing, transvenous or transcutaneous
Waves?
•NON-SINUS RYTHM

2. P waves unclear, Y
erratic baseline?
1. Total Absence 2. Prolonged PR
of any waveform Interval? No
ATRIAL FIBRILLATION
pattern?
•no clear P waves, still have QRS. no reg.
HR
No •atria contract erratically, causes irregular
Yes 1. Wide QRS
baseline
Complex?
•not directly fatal, but causes clots
•Pulmonary Embolism thrombus formed in
Yes
2nd DEGREE 2nd DEGREE atria goes to pulmonary circ and lungs
(INCOMPLETE) (INCOMPLETE) •Coronary or Cerebral Embolism
Yes No
HEART BLOCK HEART BLOCK thrombus formed in atrium goes to coronary
MOBITZ type 1 MOBITZ type 2 art. or brain
aka Wenkebach •NON-SINUS RHYTHM
VENTRICULAR rhythm •PR-interval = no ∆
FIBRILLATION •sudden, unpredictable
•PR-interval > .25 sec loss of QRS complex.
•Highly erratic •PR-intervals often get •disease of bundle of VENTRICULAR SVT
pattern progressively longer till His-purkinje system TACHYCARDIA SUPRA –VENTRICULAR
•fatal if not tx’d you lose one, then it TACHYCARDIA
•can be 2:1 or 3:1 (p
•NON- SINUS re-sets and then they •150-250 bpm
wave:QRS compl.)
RHYTHM start to get longer •frequently due to a re- •>150 bpm
•NON-SINUS
again entrant ventricular •frequently due to a re-entrant pathway
RHYTHM
•AV node is disfctl pathway caused by •origin of electrical impulse is in the atria
•can degrade to 3rd
•NON-SINUS scar tissue from or the AV node
deg. heart block
RHYTHM!!! previous MI, etc.