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Ecg Handout

The document describes various common cardiac rhythms and abnormalities that can be seen on an electrocardiogram (ECG). It provides details on normal sinus rhythm as well as descriptions of abnormalities such as sinus bradycardia, sinus tachycardia, atrial fibrillation, ventricular tachycardia, ventricular fibrillation, various types of heart block, premature ventricular contractions, ST segment changes, and more. The summary section at the end outlines when a personal trainer should stop an exercise session, call emergency services, or modify the intensity based on certain ECG findings during a session.

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Leah Dee
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41 views24 pages

Ecg Handout

The document describes various common cardiac rhythms and abnormalities that can be seen on an electrocardiogram (ECG). It provides details on normal sinus rhythm as well as descriptions of abnormalities such as sinus bradycardia, sinus tachycardia, atrial fibrillation, ventricular tachycardia, ventricular fibrillation, various types of heart block, premature ventricular contractions, ST segment changes, and more. The summary section at the end outlines when a personal trainer should stop an exercise session, call emergency services, or modify the intensity based on certain ECG findings during a session.

Uploaded by

Leah Dee
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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ECG

NORMAL SINUS RHYTHM


P-wave Uniform in appearance, upright, normal shape, one preceding
each QRS complex
QRS Upright, normal in configuration
T-wave Upright
Rate 60-100 bpm
Rhythm Regular
SINUS BRADYCARDIA
P-wave Uniform in appearance, upright, normal shape, one preceding
each QRS complex
QRS Upright, normal in configuration
T-wave Upright
Rate <60 bpm
Rhythm Regular
SINUS TACHYCARDIA
P-wave Uniform in appearance, upright, normal shape, one preceding
each QRS complex
QRS Upright, normal in configuration
T-wave Upright
Rate >100 bpm
Rhythm Regular
SINUS DYSRHYTHMIA
P-wave Uniform in appearance, upright, normal shape, one preceding
each QRS complex
QRS Upright, normal in configuration
T-wave Upright
Rate Normal
Rhythm Irregular
ATRIAL FLUTTER
P-wave No definite P-wave, looks like a sawtooth or picket fence
QRS Identifiable
T-wave No definite T-wave (Not clear if it is P or T)
Rate Over 150 bpm (250-350)
Rhythm More regular than atrial fibrillation
ATRIAL FIBRILLATION
P-wave No definite P-wave
QRS Identifiable
T-wave No definite T-wave (Not clear if it is P or T)
Rate Over 150 bpm
Rhythm Not only irregular but HIGHLY IRREGULAR
ATRIAL TACHYCARDIA/ SUPRAVENTRICULAR TACHYCARDIA
P-wave No definite P-wave
QRS Upright, normal in configuration
T-wave No definite T-wave (Not clear if it is P or T)
Rate Over 150 bpm
Rhythm Regular
PVC
❑ Absent P-wave
❑ Wide and bizarre QRS
Multifocal PVC

Couplet PVC

Trigeminy PVC
VENTRICULAR TACHYCARDIA
P-wave No P-wave
QRS All QRS, wide and bizarre
T-wave Absent T-wave
Rate Over 150 bpm
Rhythm Regular or slightly irregular
VENTRICULAR FIBRILLATION
P-wave No P-wave
QRS Rapid, chaotic, disorganized
T-wave Absent T-wave
Rate Hard to determine
Rhythm Highly irregular
VENTRICULAR FIBRILLATION
P-wave No P-wave
QRS Rapid, chaotic, disorganized
T-wave Absent T-wave
Rate Hard to determine
Rhythm Highly irregular
FIRST DEGREE AV BLOCK
P-wave Normal in size & shape, one positive (upright) P-wave before
each QRS in leads II, III & AVF.
PR interval PROLONGED (>0.20 seconds) but constant
QRS Usually 0.10 secs or less unless an intraventricular conduction
delay exists.
Rate Usually WNL, but depends on the underlying rhythm.
Rhythm Regular
SECOND DEGREE AV BLOCK, TYPE I (WENCKEBACH, MOBITZ TYPE I)
P-wave Normal in size & shape. Some P-waves are not followed by a QRS
complex (more Ps than QRS)
PR interval LENGTHENS with each cycle until a P-wave appears without QRS.
QRS Usually 0.10 seconds or less but is periodically dropped.
Rate Atrial rate is greater than ventricular rate.
Rhythm Atrial regular/Ventricular irregular
SECOND DEGREE AV BLOCK, TYPE II (MOBITZ TYPE II)
P-wave Normal in size & shape. Some P-waves are not followed by a QRS complex (more
Ps than QRS)
PR interval WNL or slightly prolonged but constant for the conducted beats. There may be
some shortening of PR interval that follows a non-conducted P-wave
QRS Usually 0.10 seconds or greater, periodically absent after P-waves.

Rate Atrial rate is greater than ventricular rate (slow)

Rhythm Atrial regular/Ventricular irregular


THIRD DEGREE AV BLOCK
P-wave Normal in size & shape.

PR interval None. Atria & ventricles beat independently of each other thus there is NO PR interval.

QRS Narrow or wide depending on the location of the escape pacemaker & the condition of the
intraventricular conduction system.

Rate Atrial rate is greater than ventricular rate. Ventricular rate is determined by the origin of the
escape rhythm.

Rhythm Atrial regular. Ventricular regular. There is NO relationship between atrial and ventricular
rhythms.
Myocardial Ischemia
❑ ST-depression >2mm
❑ Inverted T-wave
Hypocalcemia
❑ Lengthened QT-interval
❑ Causes: Calcium channel blockers,
hypoparathyroidism
Hypercalcemia
❑ Shortened QT-interval
❑ Causes: Hyperparathyroidism
❑ Shortened QT-interval can also be due to
digitalis to improve contractility of heart
Hyperkalemia
❑ Tall T-wave
❑ Causes: Addison’s disease, potassium-sparing
diuretics, ACE inhibitors, ARBs
Myocardial injury
❑ ST segment elevation >1mm
Transmural MI
❑ Sharp Q-wave
SUMMARY of PT ACTIONS
STOP and call EMS STOP and refer (Not Monitor & continue with
immediately) same/lower intensity
More than 6 PVC/minute 1st degree AV block
1 couplet
(same intensity)
3rd degree AV block 2nd degree Type 1 AV
2nd degree type 2 AV block
block/Wenckebach (same
More than 2-4 intensity if on a maximal stress
couplets/minute Atrial fibrillation test, otherwise lower intensity)
Asymptomatic atrial flutter,
Ventricular Tachycardia Symptomatic atrial flutter Premature atrial contraction,
Supraventricular tachycardia
Ventricular Fibrillation Multifocal PVC (lower intensity)
Bigeminy, trigeminy,
ST-depression >2mm quadrigeminy (lower intensity)

ST-elevation >1mm

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