Electrocardiogram

Rhythm Interpretation

by
Evan M. Hodell 12/00
 What is an EKG?
• An EKG is a method of measuring,
displaying and recording the electrical
activity of a heart

• Electrical stimuli is amplified to create a

“rhythm strip” by a machine that consistently
produces representations of the heart’s
electrical activity
 BASIC TERMINOLOGY

• Arrhythmia: Abnormal rhythm

• Baseline: Flat, straight, isoelectric line
• Waveform: Movement away from the
baseline, up or down
• Segment: A line between waveforms
• Interval: A waveform plus a segment
• Complex: Combination of several waveforms
Electrical System of Heart
Components of a NSR
Components of a NSR
Point of Origin Name
• SA Node- Sinus rhythm
– Causes regular, rounded P waves, and normal, narrow QRS
complexes
• Atria- Atrial rhythm
– Causes irregularly shaped P waves, but still normal, narrow
QRS complexes
• AV Node- Junctional rhythm
– Normal, narrow QRS complexes with no P waves
• Perkinjie Fibers- Ventricular rhythm
– No P waves, and irregular, wide QRS complexes
 Beginning to
Recognize Rhythms
• Step 1: Are there P waves?

• Step 2: Are there QRS complexes?

• Step 3: Are the P waves and QRS

complexes related?
 Example 1

• STEP 1.
–Are there P waves?
 Example 1 Continued
• Are there P waves?
– Yes, P waves are easily identifiable
and regular in rate.
 Example 1 Continued
• STEP 2.
– Are there QRS complexes?
 Example 1 Continued
• STEP 2.
– Yes there are normal, narrow, QRS
complexes.
 Example 1 Continued
• STEP 3
– Are they related, 1:1?
 Example 1 Continued
• STEP 3
– Are they related, 1:1?
• Yes, there is one P wave for every QRS.

• This is called a sinus rhythm

 Example 2
• Follow steps 1-3 as demonstrated in Ex. 1.
• This is also a sinus rhythm.

• Note: The P waves are smaller, yet their regularity

in relation to the QRS complexes gives them away.
 Example Three

• Following the same steps, this one doesn’t

match up!?!?
 Example 3 continued
• Step 1
– Are there P waves?
• Yes,

– Note: notice the dotted arrows indicate the location of P waves

buried in the stronger electrical activity of the QRS complexes.
 Example 3 Continued
• STEP 2
– Are there QRS complexes?
• Yes, there are normal, narrow
QRS complexes.
 Example 3 Continued
• STEP 3.
– Are they related?
• NO, they are both regular in shape and rate, but there is no relation
between them.

– This shows a Complete Heart Block, also called a 3rd degree block.
– Can the Heart effectively pump blood if the Atria and Ventricles are
not working together?
 Case Study of Beau
• Beau is an 11 y/o 45 lb. Male Australian
Shepard.
• Physical exam: see overhead
• Beau presents with a moderate, chronic, nocturnal
cough with mild dyspnea. Secondary exam also
reveals a pounding irregular heartbeat and Grade 4
murmur.

• Electrocardiogram was ordered in addition to other

tests. Result:
 Case Study of Beau
• EKG reveals a Sinus Arrhythmia,
– Beaus heart is “firing off” Premature Atrial
Contractions, “PAC’s.

• Potentially indicative of atrial enlargement, or other

heart irritability, which may or may not be related to
Beau’s cough and current presentation.
 4. Normal Intervals for the Human, Dog and Cat
• Human- HR- 60-100 bpm
» PR interval- 0.12-0.20 sec
» QRS width max= 0.11 sec
» QT interval= 0.36-0.44 sec
• Dog- HR- 60-220 bpm
» PR interval= 0.06-0.13 sec
» QRS width max= 0.06 sec for large 0.05 sec for
small
» QT interval= 0.15-0.25 sec
• Cat- HR = 120-240 bpm
» PR interval= 0.05-0.09 sec
» QRS width max= 0.04 sec
» QT interval= 0.12-0.18 sec

» -Tilley L.P. et al 1995

 References
• Aehlert RN Ph. ECG’s Made Easy, Mosby Year Book 1995

• Bledsoe, B. Brady Paramedic Emergency Care, Prentice Hall New

Jersey, 1988

• Foster, Bruce D.O. Twelve-Lead Electrocardiography for the ACLS Provide,

Waynesboro PA, W.B. Saunders Co., 1996

• Fox. P.R. and Kaplan P. Contemporary Cardiology Issues in Small

Animal Practice, Churchill Livingston, New York 1987

• Smith F.W.K, D.J. Hallock, Manual of Canine and Feline Cardiology

W.B. Saunders, Philadelphia 1995

• Tilley, L.P. Essentials of Canine and Feline

Electrocardiography, 3rd edition Williams and Wilkins, Baltimore 1995