ECG Rhythm Interpretation-How to Analyze a Rhythm



Objectives
          To recognize the normal rhythm of the heart - “Normal Sinus Rhythm.”
          To recognize the 13 most common rhythm disturbances.
          To recognize an acute myocardial infarction on a 12-lead ECG.

Steps in Analyzing a ECG rhythem

          ECG Basics
          How to Analyze a Rhythm
          Normal Sinus Rhythm
          Heart Arrhythmias
          Diagnosing a Myocardial Infarction
          Advanced 12-Lead Interpretation

Rhythm Analysis


          Step 1:  Calculate rate.
          Step 2:  Determine regularity.
          Step 3:  Assess the P waves.
          Step 4:  Determine PR interval.
          Step 5:  Determine QRS duration.

Step 1:Calculate rate.


Option 1
          Count the # of R waves in a 6 second rhythm strip, then multiply by 10.
          Reminder: all rhythm strips in the Modules are 6 seconds in length.

Interpretation- 9 x 10 = 90 bpm

Option 2
        Find a R wave that lands on a bold line.
        Count the # of large boxes to the next R wave. If the second R wave is 1 large box away the rate is 300, 2 boxes - 150, 3 boxes - 100, 4 boxes - 75, etc.


Step 2:  Determine regularity.

          Look at the R-R distances (using a caliper or markings on a pen or paper).
          Regular (are they equidistant apart)? Occasionally irregular? Regularly irregular? Irregularly irregular?
Interpretation-Regular

Step 3: Assess the P waves


          Are there P waves?
          Do the P waves all look alike?
          Do the P waves occur at a regular rate?
          Is there one P wave before each QRS?

Interpretation- Normal P waves with 1 P wave for every QRS

Step 4: Determine PR interval


          Normal: 0.12 - 0.20 seconds.(3 - 5 boxes)
Interpretation-0.12 seconds

Step 5: QRS duration


          Normal: 0.04 - 0.12 seconds. (1 - 3 boxes)

Interpretation-0.08 seconds

Rhythm Summary


          Rate                                                     90-95 bpm          
          Regularity                                          regular
          P waves                                               normal
          PR interval                                         0.12 s
          QRS duration                                     0.08 s

Interpretation-Normal sinus rhythem









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