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ECG for ACLS

NSR Parameters

Rate 60 - 100 bpm


Regularity regular
P waves normal
PR interval 0.12 - 0.20 s
QRS duration 0.04 - 0.12 s
Any deviation from above is sinus tachycardia, sinus bradycardia or an
arrhythmia
Rhythm #1

Rate? 30 bpm
Regularity? regular
P waves? normal
PR interval? 0.12 s
QRS duration? 0.10 s
Interpretation? Sinus Bradycardia
Rhythm #2

Rate? 130 bpm


Regularity? regular
P waves? normal
PR interval? 0.16 s
QRS duration? 0.08 s
Interpretation? Sinus Tachycardia
Rhythm #3

Rate? 70 bpm
Regularity? occasionally irreg.
P waves? 2/7 different contour
PR interval? 0.14 s (except 2/7)
QRS duration? 0.08 s
Interpretation? NSR with Premature Atrial
Contractions
Rhythm #4

Rate? 60 bpm
Regularity? occasionally irreg.
P waves? none for 7th QRS
PR interval? 0.14 s
QRS duration? 0.08 s (7th wide)
Interpretation? Sinus Rhythm with 1 PVC
Rhythm #5

Rate? 100 bpm


Regularity? irregularly irregular
P waves? none
PR interval? none
QRS duration? 0.06 s
Interpretation? Atrial Fibrillation
Rhythm #6

Rate? 70 bpm
Regularity? regular
P waves? flutter waves
PR interval? none
QRS duration? 0.06 s
Interpretation? Atrial Flutter
Rhythm #7

Rate? 74 148 bpm


Regularity? Regular regular
P waves? Normal none
PR interval? 0.16 s none
QRS duration? 0.08 s
Interpretation? Paroxysmal Supraventricular
Tachycardia (PSVT)
Rhythm #8

Rate? 160 bpm


Regularity? regular
P waves? none
PR interval? none
QRS duration? wide (> 0.12 sec)
Interpretation? Ventricular Tachycardia
Ventricular Fibrillation

Deviation from NSR

Completely abnormal.
Rhythm #10

Rate? 60 bpm
Regularity? regular
P waves? normal
PR interval? 0.36 s
QRS duration? 0.08 s
Interpretation? 1st Degree AV Block
Rhythm #11

Rate? 50 bpm
Regularity? regularly irregular
P waves? nl, but 4th no QRS
PR interval? lengthens
QRS duration? 0.08 s
Interpretation? 2nd Degree AV Block, Type I
Rhythm #12

Rate? 40 bpm
Regularity? regular
P waves? nl, 2 of 3 no QRS
PR interval? 0.14 s
QRS duration? 0.08 s
Interpretation? 2nd Degree AV Block, Type II
Rhythm #13

Rate? 40 bpm
Regularity? regular
P waves? no relation to QRS
PR interval? none
QRS duration? wide (> 0.12 s)
Interpretation? 3rd Degree AV Block
Ventricular fibrillation
Sinus bradycardia
Normal Sinus Rhythm
Second-degree AV block
(Mobitz Type II)
Sinus tachycardia
Sustained ventricular
tachycardia
First-degree AV block
Atrial flutter with high grade,
variable AV block
Atrial Flutter with multifocal
PVC's
Torsade de Pointes
Rate:70 beats/min.
Rhythm: sinus
P not exceed 3 small seq.
QRS complex: normal

ACLS - KKNGH NORMAL SINUS RHYTHM


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2017
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Rate: deflection rate is 150-500 beat /m
Rhythm: IRREGULAR AND COARSE, CHAOTIC.
P waves: No p wave DISCERNIBLE
QRS complex: Not DISCERNIBLE

ACLS - KKNGH VENTRICULAR FIBRILLATION


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FINE VENTRICULAR
ACLS - KKNGH
FIBRILLATION
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ACLS - KKNGH
Asystole 29 July,
2017
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Atrial rate 220-350 beats/min
Ventricular response= a function of AV node block or conduction of atrial impulses.
Venricular response rarely > 150-180 beats because of AV node conduction limits.
Ventricular rhythm often regular
Set ratio to atrial rhythm, eg, 2-to-1 or 3- to- 1
No true P waves seen
Flutter waves in sawtooth pattern is classic
PR: cannot be measured
QRS: Remains 0.10-0.12 sec unless QRS complex distorted by flutter
waves or by conduction defects through ventricles.

ACLS - KKNGH
ATRIAL FLUTTER 29 July,
2017
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Rate:> 140 beats/min.
Rhythm: sinus
PR:< 0.20 sec.
QRS complex: normal

SINUS TACHYCARDIA
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Rate: wide-ranging ventricular response to atrial rate of 300-400
beats/min.
Rhythm: irregular (classic irregularly irregular)
P waves: Chaotic atrial fibrillatory waves only
Creates disturbed baseline
PR: cannot be measured
QRS: Remains 0.10-0.12 sec unless QRS complex distorted by
fibrillation waves or by conduction defects through ventricles.

FAST ATRIAL FIBRILLATION


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CONTROLLED A.F.

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Rate: >70 beats/min; usually > 130 bpm
Rhythm: irregular atrial firing
P waves: by definition must have 3 or more P waves that differ in polarity
(up/down).
Shape, and size since the atrial impulse is generated from multiple foci
QRS complex: narrow; 0.10 sec in absense of intraventricular conduction defect.

ACLS - KKNGH
PACs 29 July,
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Rate: exceeds upper limit of sinus tachycardia (>120
beats/min); seldom <150 beats/min: up to 250 beats/min.
Rhythm: regular

P waves: seldom seen because rapid rate causes P waves


loss in preceding T waves or because the origin is low in
the atrium.

QRS complex: normal, narrow (10 sec. usually)

(Paroxysmal Supraventricular Tachycardia)


ACLS - KKNGH
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Key: position of the P wave; may show antegrade or retograde propagation
because origin is at the junction; may arise before, after, or with the QRS
Rhythm: regular atrial and ventricular firing
PR: often not measurable unless P wave comes before QRS; will be short 0.12 sec
P waves: often obscured; may arise before, after, or with the QRS
QRS complex: narrow;0.10 secs in absence of intraventricular conduction defect

ACLS - KKNGH
JUNCTIONAL RYTHM 29 July,
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Rhythm: irregular
P waves: is usually obscured by the QRS,ST,or T wave of the PVC s
QRS complex: not normal looking (wider than 0.12 s )
Rate: variable
unifocal or multifocal Beats

ACLS - KKNGH
PVCs 29 July,
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Rate: ventricular rate> 100 bpm; typically 120 to 250 bpm
Rhythm: only regular ventricular
PR: nonexistent
P waves: seldom seen but present;
QRS complexes: marked variation and inconsistency seen in the QRS complexes

ACLS - KKNGH
V.T. 29 July,
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Atrial Rate: cannot determine atrial rate
Ventricular rate: 150-250 complexes/min.
Rhythm: only irregular ventricular rhythm
PR: nonexistent
P waves: noneexistent
QRS complexes: display classic spindle-node

ACLS - KKNGH
TORSADES de POINTES 29 July,
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Rate: <60 beats/min
Rhythm: regular sinus
PR: regular; <0.20 sec.
P waves: size and shape normal;
QRS complex: narrow; sec in absence of intraventricular
conduction defect

Sinus Bradycardia
ACLS - KKNGH
Muscle Tremor Artefact 29 July,
2017
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Rate: First-degree heart block can be seen with
both sinus bradycardia and sinus tachycardia
Rhythm: sinus, regular, both atria and ventricles
PR: prolonged, >0.20 sec, but does not vary
(fixed)
P waves: size and shape normal
QRS complex: narrow ; 0.10 sec in absence of
intraventricular conduction defect

ACLS - KKNGH First Degree Heart Block 29 July,


2017
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Rate: atrial rate just slightly faster than ventricular (because of dropped
beats;
Rhythm: regular for atrial beats; irregular for ventricular
PR: There is progressive lengthening of the PR interval until one P
wave is not followed by a QRS complex (the dropped beat)
P waves: size and shape remain normal
QRS complex: 0.10 sec most often, but a QRS drops out periodically

2nd Degree AV Block Mobitz (Type I) AV Block


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Atial Rate: usually 60-100 beats/min
Ventricular rate: by definition (due to the blocked impulses)
slower than atrial rate
Rhythm: atrial = regular; ventricular= irregular (because of
blocked impulses)
PR: constant and set; no progressive prolongation as with type I-
P waves: typical in size and shape
QRS complex: narrow ( 0.10 sec)implies high block relative to
the AV node

2nd Degree Heart Block Mobitz Type 2


ACLS - KKNGH
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Atrial rate: usually 60-100 beats/min; impulses completely independent (dissociated)
from ventricular rate
Rhythm: both atrial rhythm and ventricular rhythm are regular but independent
(dissociated)
PR: by definition there is no relationship between P wave and R wave
P waves: typical in size and shape
QRS complex: narrow (0.10 sec) implies high block relative to the AV node:
wide (>0.12 sec) implies low block relative to the AV node

ACLS - KKNGH
Complete Heart Block 29 July,
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Idvoventricular Rhythm at 55 bpm -
ACLS - KKNGH Accelerated
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ACLS - KKNGH
Pacemaker Rhythm
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ACLS - KKNGH
ARTEFACT 29 July,
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THANK YOU

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