Clk. Alexander L.

Gonzales II
December 14, 2010
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EKG Characteristics: Regular narrow-complex rhythm

Rate 60-100 bpm
Each QRS complex is proceeded by a P wave
P wave is upright in lead II & downgoing in lead
aVR
 HR< 60 bpm; every QRS narrow, preceded by p wave
 ETIOLOGIES:
• Normal aging
• 15-25% Acute MI, esp. affecting inferior wall
• Hypothyroidism, infiltrative diseases
• Hypothermia, hypokalemia
• SLE, collagen vasc diseases
• Situational: micturation, coughing
• Drugs
 HR > 100 bpm, regular
 ETIOLOGIES:
• Fever
• Hyperthyroidism
• Effective volume depletion
• Anxiety
• Pheochromocytoma
• Sepsis
• Anemia
• Exposure to stimulants or illicit drugs
• Hypotension and shock
• Pulmonary embolism
• Acute coronary ischemia and myocardial infarction
• Heart failure
• Chronic pulmonary disease
• Hypoxia
 Variations in the cycle lengths between p waves/ QRS
complexes
 Normal p waves, PR interval, normal, narrow QRS
 Usually respiratory--Increase in heart rate
during inspiration
 Exaggerated in children, young adults and
athletes—decreases with age
 Usually asymptomatic, no treatment or referral
 Can be non-respiratory, often in normal or
diseased heart, seen in digitalis toxicity
• All result in bradycardia
• Sinus bradycardia (rate of ~43 bpm) with a sinus pause
• Tachy-brady syndrome
 ETIOLOGY:
• Often due to sinus node fibrosis, Sinus Node
arterial atherosclerosis, inflammation
(Rheumatic fever, amyloid, sarcoid)
• Occurs in congenital and acquired heart disease
and after surgery
• Hypothyroidism, hypothermia
• Drugs: digitalis, lithium, cimetidine, methyldopa,
reserpine, clonidine, amiodarone
• Most patients are elderly, may or may not have
symptoms
P wave is altered in
shape compared to
other P waves and
comes early.
 QRS complex –
normal shape and
duration
 Cycle comes early
 Single ectopic beat
that originates in the
AV node or Bundle of
His area of the
condunction system
 Retrograde P waves
immediately preceding
the QRS
 Retrograde P waves
immediately following
the QRS
 Absent P waves
 Digitalistoxicity
 Myocardial Infarction
 Myocardial Ischemia
 Ingestion of caffeine or amphetamines
 Regular rhythm with P
waves appearing at a
rate of 250 to 300
beats/min
 P waves are noted for
there “saw tooth” pattern,
and or flutter waves
 Can be in normal hearts
or in those with disease
 Most likely due to AV
block, creating a reentry
circuit
 In this rhythm the AV node
is bombarded with
impulses at a rate of 300 +
times per min.
 P waves are not
distinguishable on the
ECG, and appear as
“fibrillation waves or f
waves.”
 QRS complexes are
irregular in rhythm with
normal duration
 Causes – mitral valve or
coronary artery disease,
long standing hypertension
is still the most common
cause
 Rate: 40 to 60
beats/minute (atrial and
ventricular)
 Rhythm: regular atrial
and ventricular rhythm
 P wave: usually inverted,
may be upright; may
precede, follow or be
hidden in the QRS
complex; may be absent
 PR interval: not
measurable or less than
.20 sec
 QRS and T wave : usually
normal
 CAUSES
• Digitalis toxicity
• Inferior wall MI
• Myocardial Ischemia
• Increased vagal tone
• Rheumatic heart disease
• Valvular disease
• Organic disease of the SA node
• Verapamil toxicity
• Anticholinesterase toxicity
• May occur immediately after surgery
 Rate: 160 to 240
beats/minute
 Rhythm: regular atrial
and ventricular
 P wave: usually inverted,
may be upright; may
precede, follow or be
hidden in the QRS
complex; may be absent
 PR interval: not
measurable or less than
.12 sec
 QRS and T wave : usually
normal
 Supraventricular area fails to fire, which
results in ventricular ectopic beat
 Premature ventricular contraction (PVC)
– most common.
• No visible P wave
• QRS > 0.12 seconds in length and is bizarre in
morphology
 Uniform
 Multiform
 PVC rhythm patterns
• Bigeminy – PVC
occurs every other
complex
• Couplets – 2 PVCs in a
row
• Trigeminy – Two PVCs
for every three
complexes
 Ventricular tachycardia
(VTach)
• 3 or more PVCs in a row at
a rate of 120 to 200
beats/min
• Most likely due to acute
infarction and/ or ischemia
 Ventricular fibrillation
(VFib)
• Preterminal event in which
myocardium is “dying”
• No visible P or QRS
complexes. Waves appear
as fibrillating waves