Dr.

Carmen Carrillo Cabn, MS IV

 Discuss concepts EKG, depolarization,

repolarization and
Identify the electrocardiographic waves
P,Q,R,S,T, ST, PR segments and QT,PR and
ST intervals.
Analyzed the characteristics of any disritmia
and the MD management.

Dr. Carmen Carrillo Cabn, MS IV

 Disritmia- anormal electric conduction of the heart.

Depolarization- when the cardiac muscle cells
changed of the intracellular condition with large
negative charge to a state of large positive charge.
(systole)
Repolarization- process in that the cardiac muscle
cells return of one intracellular condition with large
negative charge or its estate of repose. (diastole)

Dr. Carmen Carrillo Cabn, MS IV

 P wave- initiates of atrial depolarization

PR Interval- time that occur the atrial depolarization and
time that retain the AV nodule impulses. Measure of P to
QRS.
Q wave- First negative deflection after P wave, time 0.03
sec and include 25 % of the R wave.
R wave- first positive deflection, after P wave.
S wave- first negative deflection after R.

Dr. Carmen Carrillo Cabn, MS IV

 QRS- ventricular depolarization, duration

< 0.12 sec. Measure Q to S.
ST Segment- synchronic grade of
ventricular depolarization to
repolarization.
Measure of S wave final to T wave starts.
T wave- ventricular repolarization
Dr. Carmen Carrillo Cabn, MS IV

 U wave- reflexes the repolarization of the

Purkinje fibers. Present in Hypokalemia.
QT Interval- represents the total time of
ventricular depolarization and repolarization,
Duration: 0.32 0.40 seconds
When its prolonged indicates torsade's the
pointes. Measure Q initiates to final of a T
wave.
Dr. Carmen Carrillo Cabn, MS IV

Dr. Carmen Carrillo Cabn, MS IV

Dr. Carmen Carrillo Cabn, MS IV

Dr. Carmen Carrillo Cabn, MS IV

http://lifeinthefastlane.com/ecg-library/basics/pr-segment/

Dr. Carmen Carrillo Cabn, MS IV

http://www.bem.fi/book/15/fi/1504.gif

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http://4.bp.blogspot.com/- dBSEJFB51U/TZqPOJzcboI/AAAAAAAAARI/21Kdu343WCs/s320/stelevation.jpg

Dr. Carmen Carrillo Cabn, MS IV

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Count big squares between two R waves

(R-R interval) and divide between 300.

Dr. Carmen Carrillo Cabn, MS IV

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Six seconds or rule of tens(10)

Count the number of QRS complex in a 6 sec.
period and multiply per ten. Its useful for regulars rhythms.

http://sapiensmedicus.org/wp-content/uploads/2014/04/FrecuenciaCardiacaECG.jpg
Dr. Carmen Carrillo Cabn, MS IV

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1.
2.
3.
4.
5.
6.

Establish:
Ventricular frequency
Ventricular rhythm.
QRS duration and morphology.
Identify the morphology of P waves.
Measure the auricular rhythm and Frequency.
Measure the PR interval, if are consistent or
irregulars.
7. Determine the P:QRS ratio
Dr. Carmen Carrillo Cabn, MS IV

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Dr. Carmen Carrillo Cabn, MS IV

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Cardiac rhythm: regular

Frequency: 60 100 bpm
Auricular Frequency: 80 bpm
Ventricular Frequency: 90 bpm
PR Interval: normal
P wave: one P before QRS
PR Interval : 0.12 - 0.20 sec
QRS interval: 0.06 - 0.10 sec
Etiology: normal conduction
Treatment: Not require
Dr. Carmen Carrillo Cabn, MS IV

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 HR_____________
Rhythm _________________
Atrial Frequency:_____________
Ventricular Frequency: ________________

Dr. Carmen Carrillo Cabn, MS IV

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Characteristics sinus bradycardia

Cardiac rhythm: regular

Frequency: < 60 bpm
Auricular Frequency: 80 bpm
Ventricular Frecuency:90 bpm
PR Interval: 0.12- 0.20 sec
P wave: one P before QRS
PR Interval PR: 0.12 - 0.20 sec
QRS interval: 0.06 - 0.10 sec

Dr. Carmen Carrillo Cabn, MS IV

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Vagal stimulation
PIC
Synusal node ischemia
Secondary effects to medications(digoxin)
Normal in athletes

Dr. Carmen Carrillo Cabn, MS IV

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 Asymptomatic: No treatment, only observation.

Symptomatic: (hipoperfusion, hypotension,
weakness, chest pain, conscious alterations)
Oxygen, EKG
Atropine 0.5mg 1mg in I.V. bolus, repeat q
3- 5 min., max. 3 mg
If atropine is ineffective: dopamine infusion 210 mcg\kg I.V.\min., or adrenaline 2-20
mcg\kg\min. I.V.
Transvenous Pacemaker
Dr. Carmen Carrillo Cabn, MS IV

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Cardiac rhythm: regular

Frequency: >100 bpm
Auricular Frequency: >100 bpm
Ventricular Frequency:>100 bpm
PR Interval: 0.12- 0.20 sec
P wave: one P before QRS
PR Interval PR: 0.12 - 0.20 sec
QRS interval: 0.06 - 0.10 sec
QRS: stretch

Dr. Carmen Carrillo Cabn, MS IV

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Pain
Fever
Hemorrhage
shock
Anemia
Anxiety
Exercise
Acute Cardiac Insufficiency
Drugs: aminophylline, dopamine, nitroglycerine,
adrenaline y atropine and others.
Dr. Carmen Carrillo Cabn, MS IV

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Treatment synusal tachycardia

Physical examination
Eliminate the cause.
Calcium channel blockers

Dr. Carmen Carrillo Cabn, MS IV

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 Cardiac rhythm: irregular increase with inspiration and

decrease with expiration.
Frequency: 60-100 bpm
Auricular Frequency: 60-100 bpm
Ventricular Frequency: 60- 100 bpm
PR Interval: 0.12- 0.20 sec
P wave: one P before QRS
PR Interval : 0.12 - 0.20 sec
QRS interval: 0.06 - 0.10 sec
Treatment: None
Dr. Carmen Carrillo Cabn, MS IV

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 Cardiac rhythm: variable, irregular

Frequency: determinate by the subjacent rhythm, relationship
with sinus node.
PR Interval: 0.12 0.20 sec., more long or short or equal than
one sinus beat.
P wave: present with different morphology than others P
waves, inverted or masked T wave.
QRS interval: 0.06- 0.10 sec.
Etiology: emotional problems, caffeine and nicotine
consumption, digitalis, mitral valve insufficiency and cardiac
insufficiency
Treatment: if frequents treat the cause
Dr. Carmen Carrillo Cabn, MS IV

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 Auricular Frequency: 250-400\min. Therapeutic blocked AV

node.
Ventricular frequency: 75-150\min.
Auricular Rhythm : regular
Ventricular Rhythm : regular and others time irregular
P wave: saw-toothed appearance, F waves.
PR Interval : if multiple P waves are present, difficult to
determiner
QRS interval: abnormal, normal or absent
P QRS ratio: 2:1, 3:1 4:1
Treatment: diltiazem, verapamil, beta blockers, digitalis IV. To
decrease ventricular frequency.
Amiodarone. If patient do not respond to medications;
cardioversion
Dr. Carmen Carrillo Cabn, MS IV

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Cardiac rhythm: irregular

Auricular Frequency: 300-600 bpm
Ventricular Frequency: 120-200 bpm
P wave: not identify, F waves
P QRS ratio: to much P for one QRS
PR Interval : no measure
QRS interval: 0.06 - 0.10 sec
Dr. Carmen Carrillo Cabn, MS IV

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Dr. Carmen Carrillo Cabn, MS IV

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Tx. FA

Digitalis
Verapamil
Diltiazem
Propranolol
Quinidine
Procainamide
ASA, warfarine
Cardioversion

Corvert IV
Adenosine
Flecainidine
Sotalol
Amiodarone
Other antidisritmics
Pacemaker, surgery
(ablation) if patient do not
respond to tx.

Dr. Carmen Carrillo Cabn, MS IV

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Cardiac rhythm: irregular

Ventricular Frequency: 150-350 bpm
PR Interval: long
P wave: visible or absents; different from sinus rythm
P QRS ratio: 1:1 if P waves and visible
QRS interval:0.04 12 sec.
Etiology: caffeine, emotional alterations, nicotine, digitalis, mitral
valve prolapse and Cardiac Insufficiency, related with sudden
interruption of auricular repetitive ectopic focus and sudden
sensation of impulse.
Treatment: vagal maneuver or carotid massage, adenosine,
verapamil or cardioversion synchronized.(50J)
Dr. Carmen Carrillo Cabn, MS IV

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Cardiac rhythm: regular

Frequency: 100- 200 bpm
Auricular Frequency: no measurable
Ventricular Frequency: 120-200 bpm
P wave: difficult to detect
PR Interval : no measure
QRS interval: 0.12 or more, wide and aberrant
Treatment: amiorodarone, lidocaine, cardio version, if
patient is unconscious and do not has a pulse;
defibrillate
Dr. Carmen Carrillo Cabn, MS IV

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Ventricular and auricular rhythms: irregular and

chaotic
Ventricular frequency: > 300 bpm
Characteristics: No palpable or audible pulse,
apnea
Treatment: Defibrillation, CPR

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Cardiac rhythm: absent

Auricular frequency: none
Ventricular Frequency: none
Tx. CPR, intubation

Dr. Carmen Carrillo Cabn, MS IV

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Frequency and ventricular and auricular rhythm depends of the

subjacent rhythm.
Morphology and duration of QRS: normal or abnormal
P wave: before QRS with synusal rhythm
PR Interval: 0.20 sec or more, measure of RR interval is constant
Ratio P:QRS: 1:1
Treatment: observation

Dr. Carmen Carrillo Cabn, MS IV

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Cardiac rhythm: irregular

Frequency: depend the subjacent rhythm
Auricular Frequency: 80 bpm
Ventricular Frequency: 60 bpm
PR Interval: is lengthened with each succeeding complex until a Pwave does not lead to a QRS missing, which makes the irregular PR
interval.
P wave: before QRS
P QRS ratio: 3:2, 4:3, 5:4
Treatment: pacemaker
Dr. Carmen Carrillo Cabn, MS IV

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Cardiac rhythm: irregular

Frequency: depend the subjacent rhythm
Auricular Frequency: 70 bpm
Ventricular Frequency: 30 bpm
PR Interval: irregular.
P wave: before QRS
P: QRS ratio: 2:1, 3:1,4:1, 5:1
Treatment: pacemaker

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Treatment: pacemaker
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http://cdn.medgadget.com/wp-content/uploads/2012/05/Reocor-external-pacemaker.jpg
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 Davis, D.(1992). Interpretacin de la arritmia, Editorial mdica

Panamericana.
Haddix,K.,DeiTos,P.(2001).Electrocardiography for
Health Personnel. Glencoe, McGraw-Hill,
Interamericana.
http://www.med.nyu.edu/content?ChunkIID=103804
Roy, P.(2004) An Atlas of Heart Rhythms, CD Room.
http://www.hxbenefit.com/wp-content/uploads/2012/07/Atrial-flutterPicture.gif

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