Basic:

Rate:

-4c
QT interval to eart rate! "aster eart #eats "aster ventricles '!e!( )normal* QT varies wit Intervals:
re$olari%e & orter QT interval! eart rate!

"or eac eart rate( calc+late an ad,+sted QT interval( called t e-

PR
0.12 - 0.20 seconds (3 - 5 boxes)
< 0.12 s !i"# $%&% states 'ol((-Par)inson-'#ite 0.12-0.20 s $or*al 0.20 s +, nodal bloc)s

5corrected -46 (-4c)

$or*al 7 < 0.// s 8on" -4 : 0.// s

WPW syndrome (delta-wave)

1st Degree AV Block

4i0: -4

#al( RR interval 9 lon".

-R.
0.0/ - 0.12 seconds. (1 - 3 boxes)
< 0.10 s 0.10-0.12 s 0.12 s Inco*0lete BBB $or*al B1ndle Branc# P,2 Bloc) (BBB) ,entric1lar r#3t#*
'ncom$lete #+ndle #ranc #lock .rd degree AV #lock wit ventric+lar esca$e r yt m A prolonged QT may predispose a type of ventricular tachycardia called Torsades de Pointes. Causes include drugs, electrolyte abnormalities, CNS disease, post-M , and congenital heart disease.

!eart +rr#3t#*ias
1. .in1s R#3t#*s .in1s 4ac#3cardia .in1s Brad3cardia Rate: 100 b0* Rate: < :0 b0*

2. Pre*at1re 2ontraction & Beats

+trial (P+2s) ,entric1lar (P,2s) 2onto1r o( P; PR interval; ti*in" di((er /rom normal $+lse /rom &A node and -R. <ill be narro< (0.0/ 0.12 s) (nor*al i*01lse cond1ction in ventricles) 'ide and bi=arre -R. co*0lex(es). a! 0ni/orm - look alike( b. 1+lti/orm - look di//erent

3. .10raventric1lar +rr#3t#*ias

a. +trial >ibrillation (+>)

2o normal P waves( >l1tter <ave. (2o organi%ed atrial de$olari%ation( im$+lses are not /rom sin+s)( atrial activity is c aotic (irreg+lar rate)! 3ommon( a//ects 4-56( +$ to 7-186 i/ 9 :8 years old! D+e to m+lti$le reentry #etween ;A and <A! b. Parox3s*al .10raventric1lar4ac#3cardia (P.,4) !R s1ddenl3 s0eeds 10; o/ten d+e to PA3 and t e P waves are lost! D+e to reentry in AV node! c. +trial >l1tter 2o P waves( 5sa< toot#6 0attern at 250 - 350 b0*. ?nl3 some im$+lses cond+ct t ro+g AV node (+s+ally every ot er im$+lse)! D+e to reentry in <A wit every 4nd( .rd or 5t im$+lse generate a Q<& (ot ers are #locked in AV node as node re$olari%es)! /. ,entric1lar +rr#3t#*ias a. ,entric1lar >ibrillation 2o*0letel3 abnor*al. Ventric+lar cells are e=cita#le and de$olari%ing randomly! 3a+ses ra$id dro$ in 3> and deat b. ,entric1lar 4ac#3cardia 'm$+lse originates in ventricles (no P <aves; <ide -R.). D+e to reentry in ventricle. 5. +, @1nctional Bloc)s a. 1st Ae"ree +, Bloc) PR Interval: 0.20 s; Prolonged cond+ction delay in t e AV node or B+ndle o/ ?is!

b. 2nd Ae"ree +, Bloc); 430e I (Bobit= I& 'enc)ebac#)

PR interval 0ro"ressivel3 len"t#ens; t#en i*01lse is co*0letel3 bloc)ed (P <ave not (ollo<ed b3 -R.). @ac atrial im$+lse ca+ses longer delay in AV node +ntil one im$+lse (+s+ally .rd or 5t ) /ails to cond+ct to AV node!

c. 2nd Ae"ree +, Bloc); 430e II & Bobit= II

is ?ccasional P <aves are co*0letel3 bloc)ed (P <ave not (ollo<ed b3 -R.). 3ond+ction all or not ing (no $rolongation o/ P< interval)A ty$ically #lock occ+rs in t e B+ndle o/ ?is!

d. 3rd Ae"ree +, Bloc)

P <aves are co*0letel3 bloc)ed in t e AV ,+nctionA -R. ori"inate inde$endently (ro* belo< t#e C1nction. (Ventricles $acemaker: aro1nd 30-/5 b0*; cond+ction t ro+g ventricles is ine//icient and t e Q<& will #e wide and #i%arre!)

+xis
A=is re/ers to t e mean -R. axis (or vector) d+ring ventric+lar de$olari%ation! An a#normal a=is can s+ggest disease s+c as $+lmonary y$ertension /rom a $+lmonary em#olism! T e Q<& a=is is determined #y overlying a circle(in t e /rontal $lane! By convention( t e degrees o/ t e circle are as s own! A D+ick way to determine t e Q<& a=is is to look at t e Q<& com$le=es in leads ' and ''! -R. 2o*0lexes I (8) II (R) +xis B B normal B le/t a=is deviation B rig t a=is deviation rig t s+$erior a=is deviation Aia"nosin" a B3ocardial In(arction (BI) >ne way to diagnose an ac+te 1' is to look /or elevation o/ t e &T segment! BI 8ocation BI 8ead Anterior V1 - V5 ;ateral '( aV;( V7 - VC 430es o( BI: 'n/erior ''( ''' aV" .4 (Transm+ral E Q wave) $on-.4 (&+#endocardial E 2on-Q-wave) Isc#e*ia &T de$ression( $eaked T-waves( t en T-wave &T de$ression F T-wave inversion inversion In(arct .4 elevation F a$$earance o/ Q-waves >ibrosis &T and T-waves normali%e( Q-waves $ersist &T normali%e( #+t T-wave inversion $ersists

!eart !30ertro0#3
8e(t atrial enlar"e*ent (8+%)
P wave - atrial de$olari%ation '' - P 9 8!85 s (1 #o=) #etween notc ed $eaks( or

V1 - P 2eg! de/lection 9 1 =1 #o=

3a+se - ;V? /rom y$ertension!

Ri"#t atrial enlar"e*ent (R+%)

'' - P 94!7mm( or V1EV4 - P 91!7mm

3a+se - <V? /rom $+lmonary y$ertension

8e(t ventric1lar #30ertro0#3 (8,!)

< in V7 (or VC) B & in V1 (or V4) 9 .7 mm( or av;- < 9 1. mm

3a+se- y$ertension!

Ri"#t ventric1lar #30ertro0#3 (R,!)

< wave is normally small in V1( V4 #eca+se <V does not ave a lot o/ m+scle mass! B+t in <V? t e < wave is tall in V1( V4! <ig t a=is deviation( and V1 - < 9Gmm tall
3a+se- le/t eart /ail+re!

B1ndle Branc# Bloc)s (BBB)

-R. co*0lex <iden #eca+se w en t e
cond+ction $at way is #locked it will take longer /or t e electrical signal to $ass t ro+g o+t t e ventricles!

8e(t B1ndle Branc# Bloc)s (8BBB)

V1-V4 - Broad( dee$ & waves E W wave

Ri"#t B1ndle Branc# Bloc)s (RBBB)

V1-V4 - )<a##it @ars* E 1 wave

Bi(ascic1lar bloc) H <BBB B le/t #+ndle emi#lock( mani/est as an a=is deviation( eg ;AD in t e case o/ le/t ant! emi#lock! 4ri(ascic1lar bloc) H #i/ascic+lar #lock B 1st degree eart #lock!