EKG Strips Overview

Introduction

• Presenter: Michelle Cuns
• Previous topics: Basic EKG picture and heart blocks
• Focus: Overview of different EKG strips

Normal Sinus Rhythm

• Heart rate: 60 - 100 bpm
• PR interval: Normal
• QRS: Usually narrow
• Regular rhythm: R-R intervals and P waves are consistent

Sinus Tachycardia

• Heart rate: 100 - 150 bpm
• Characteristics: Faster rhythm, narrow QRS; difficult to differentiate between P's and T's
• Regular rhythm

Sinus Bradycardia

• Heart rate: Below 60 bpm
• Patient may be symptomatic
• Regular rhythm; normal PR interval

Atrial Flutter

• Description: Rapid firing in the atrium, resembling a "sawtooth" pattern
• Characteristics: Narrow R-R intervals, usually regular

Atrial Fibrillation

• Description: Multiple rapid firing areas in the atrium
• Characteristics: Chaotic baseline, never regular R-R intervals, no discernible P waves

Premature Atrial Contractions (PACs)

• Description: Ectopic firing in the atrium
• Effect: Causes irregular rhythm but usually asymptomatic

Premature Ventricular Contractions (PVCs)

• Description: Ectopic originating in the ventricles
• Types: Unifocal (same appearance) or multifocal (different appearances)
• Example: Sinus rhythm with couplet (two PVCs in a row)

Ventricular Tachycardia (VTach)

• Description: Sinus rhythm with a run of VTach
• Action: Check for pulse; if present, use medications and synchronized cardioversion

Ventricular Fibrillation (V-Fib)

• Description: A pulseless rhythm; chaotic electrical activity

Heart Blocks

• First Degree Heart Block

  • PR interval: > 0.20 seconds
  • Characteristics: Groupings of QRS's with dropped beats

• Second Degree Heart Block Type I (Wenckebach)

  • Characteristics: Progressive elongation of PR interval until a QRS is dropped

• Second Degree Heart Block Type II

  • Characteristics: More P's than Q's, wide QRS, no consistent relationship between P's and Q's

• Third Degree Heart Block (Complete Heart Block)

  • Characteristic: AV dissociation; more P's than Q's, wide QRS, often slow rhythm

Idioventricular Rhythm

• Description: Slow rhythm originating in the ventricles; may or may not have a pulse

Junctional Rhythm

• Description: Inverted P waves before or after QRS, may be hidden

Pacemaker Rhythms

• Ventricular Pacemaker

  • Description: Spike followed by QRS

• Dual Chamber Pacemaker

  • Description: Multiple spikes with both P waves and QRS complexes

End of Life Rhythms

• Description: Agonal rhythm; indicates poor prognosis during CPR

Conclusion

• Importance of recognizing various EKG patterns for patient care.