EKG Interpretation

Sinus Rhythm
  • Rate: 60-100
  • Rhythm: Regular
  • P waves: Uniform, upright in lead II, one for each QRS
  • PR: 0.12-0.20 seconds
  • QRS: less than or equal to 0.10 seconds
Cause
  • Normal
Treatment
  • None
Sinus Bradycardia
  • Rate: <60 BPM
  • Rhythm: Regular
  • P waves: Uniform, upright in lead II, one for each QRS
  • PR: 0.12-0.20
  • QRS: less than or equal to 0.10
Cause
  • May be normal for athletic patients
  • Inferior & Posterior MI
  • Increased parasympathetic tone
    • Vomiting
    • Increased ICP
  • Hypoxia
  • Medications
    • Ca Channel Blockers
    • B-Blockers
    • Digoxin
    • Antiarrhythmics
  • Myxedema
Treatment
  • None if normal for patient
  • Treat the cause
  • Consider Atropine 0.5 mg IV
    • Q 3-5 minutes
    • Total of 3 mg
  • Pacing
  • Dopamine 2-10 mcg/kg/min
  • Epinephrine 2-10 mcg/min
Sinus Tachycardia
  • Rate: >100
  • Rhythm: Regular
  • P waves: Uniform, upright in lead II, may be difficult to distinguish P and T, due to fast rate.
  • PR: 0.12-0.20
  • QRS: less than or equal to 0.10
Cause
  • Normal response of body to increased oxygen demand
  • Anxiety
  • Pain
  • Fever
  • Shock
  • Heart Failure
  • Thyroid Storm
  • Medications
  • Tobacco, Caffeine
Treatment
  • Treat the cause
  • B-Blockers (Poor results)

Atrial Rhythms

Premature Atrial Contractions (PAC)
  • Rate: 60-100
  • Rhythm: Regular with premature beats
  • P waves: Premature and often differ in shape from sinus P’s
  • PR: May be normal or prolonged
  • QRS: Usually < 0.10 seconds, but may be wide or absent
Cause
  • Pulmonary disease
  • Heart Failure
  • AMI
  • Hypokalemia
  • Hypomagnesemia
  • Dig toxicity
  • Hyper metabolic states
  • Caffeine, nicotine, ETOH
  • Anxiety, emotional distress
Treatment
  • Benign, no treatment needed
  • If persistent and symptomatic
    • Catheter Ablation
    • Beta Blockers (studies show mixed results) B-Blockers may help with PAC’s if they are due to enhanced automaticity related to enhanced sympathetic output
Atrial Tachycardia
  • Rate: 160-250
  • Rhythm: Regular
  • P waves: Precede each QRS, may be similar to sinus P waves or buried (look for P’s hidden in T waves)
  • QRS: Usually < 0.10, usually narrow, but may be widened, 1:1 ratio
Cause
  • MI
  • Heart Failure
  • Hypoxemia
  • Electrolyte imbalances
  • Caffeine, tobacco, ETOH
  • Excess Catecholamine’s
  • Emotional stress
  • Dig toxicity
Treatment
  • Asymptomatic
    • Observation
  • Hemodynamically Stable & Symptomatic
    • B-Blockers
    • Diltiazem
    • Verapamil
  • Unstable & Symptomatic
    • Amiodarone (used if patient is borderline hypotensive)
Atrial Flutter
  • Rate:
    • Atrial 250-300 (HR will hold steady)
    • Ventricular 60-180
  • Rhythm: Regular
  • P waves: Replaced with multiple F (flutter) waves, usually at a ration of 2:1 or 3:1, seen in lead II
  • PR: Not measurable
  • QRS: Usually normal
Cause
  • Pulmonary Embolism
  • Mitral/ Tricuspid Valve Disease
  • Pericarditis
  • Cor Pulmonale
  • Hyperthyroidism, Thyrotoxicosis
  • Chronic Lung Disease
  • Dig Toxicity
Treatment
  • Rhythm Control
    • Amiodarone
    • Class III, 1A, and IC Agents
  • Rate Control (B-Blockers, first line)
    • Esmolol
    • Atenolol (Tenormin)
    • Metoprolol (Lopressor)
  • Rate Control (CC-Blockers, second line)
    • Diltiazem
    • Verapamil
Atrial Fibrillation
  • Rate:
    • Atrial: >400-600
    • Ventricular 100-160
  • Rhythm: Irregularly Irregular
  • P waves: Not distinguishable
  • PR: Not measurable
  • QRS: Usually normal
Cause
  • Valve Disease
  • Rheumatic Heart Disease
  • HTN
  • Pulmonary Disease
  • CHF,¬†Cardiomypoathy
  • Ischemia
  • AMI
  • Open Heart Surgery
Treatment
  • Rhythm Control
    • Amiodarone
    • Class III, 1A, and IC Agents
  • Rate Control (B-Blockers, first line)
    • Esmolol
    • Atenolol (Tenormin)
    • Metoprolol (Lopressor)
  • Rate Control (CC-Blockers, second line)
    • Diltiazem
    • Verapamil
SVT

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Junctional Rhythms

Junctional Rhythm
  • Rate: 40-60
    • Considered “Accelerated Junctional Rhythm” if: 61-100
    • Considered “Junctional Tachycardia” if: 101-180
  • Rhythm: Regular
  • P waves: Inverted before or after QRS, Absent, in leads II, III, and aVF
  • PR: If P wave occurs before the QRS, it’s usually < 0.12
  • QRS: Usually <0.10 if wide, most likely not juncitonal
Cause
Treatment
Junctional Escape Rhythm
  • Arises from an ectomi
Cause
Treatment
Premature Junctional Contraction

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Cause
Treatment