T Nation

EKG Interpretation

T-Nation,

I know that this is probably not the place to ask such a question, but I have stumbled upon a bit of a mental block with my exams this week. I know there are a lot of medically trained people on this website so I figured that I may be able to get a simple answer.

My question is, how do I tell a regular rhytm apart from an regular irregular, or irregularly irregular ekg?

Thank you all for your time. Any help is greatly appreciated.

You talking about electrocardiogramme? (ECG/EKG) You got ventricular fibrilation and stuff. Go and research it, you’ll probably learn it better.

But from what I remember:

on a reular rythm there will be a heart rate o6 60-100 bpm witha normal QRS complex witht he wa vidible before the complex. Also the interval between P and R would be normal (less than 5 litle squares) then anything irregular from this will be the different problems like atrial and ventricular fibrilation (I also think I remember atrial flutter etc)

It’s all to do with the hearts conduction system, (bundle of his, AV node, SA node blah blah blah)

Heres a good start point (I’m actually gonna use these for revision)

Actual Abnormalities (simple)
http://www.ambulancetechnicianstudy.co.uk/rhythms.html

What are you studying, if you don’t mind me asking?

You iz going to die.

It iz practically garantueed.

Sorry.

Look at the rhythm strip at the bottom of the EKG…
–If a) every P/QRS/T grouping looks the same, AND b) the spacing between groupings is the same throughout, the rhythm is ‘regular.’
–If either a) or b) fails to hold, the rhythm is ‘irregular.’

Once you’ve determined that the rhythm is irregular…
–If the same pattern (however weird it may be) occurs over and over again, the rhythm is ‘regularly irregular.’
–If there is no discernible repeating pattern, the rhythm is ‘irregularly irregular.’

Thanks for the replies. I am just struggling with the concept. I can memorize what they are, but that doesnt stick with me as long as if I understand the concept of something.

[quote]EyeDentist wrote:
Look at the rhythm strip at the bottom of the EKG…
–If a) every P/QRS/T grouping looks the same, AND b) the spacing between groupings is the same throughout, the rhythm is ‘regular.’
–If either a) or b) fails to hold, the rhythm is ‘irregular.’

Once you’ve determined that the rhythm is irregular…
–If the same pattern (however weird it may be) occurs over and over again, the rhythm is ‘regularly irregular.’
–If there is no discernible repeating pattern, the rhythm is ‘irregularly irregular.’
[/quote]

I am going to go and look back at the heart blocks. This makes sense for a 2nd degree mobitz type 1, but I am not sure if it will be like that for 3rd degree, or a couple others I have been told are defined as “regular.”

[quote]pgtips wrote:
You talking about electrocardiogramme? (ECG/EKG) You got ventricular fibrilation and stuff. Go and research it, you’ll probably learn it better.

But from what I remember:

on a reular rythm there will be a heart rate o6 60-100 bpm witha normal QRS complex witht he wa vidible before the complex. Also the interval between P and R would be normal (less than 5 litle squares) then anything irregular from this will be the different problems like atrial and ventricular fibrilation (I also think I remember atrial flutter etc)

It’s all to do with the hearts conduction system, (bundle of his, AV node, SA node blah blah blah)

Heres a good start point (I’m actually gonna use these for revision)

Actual Abnormalities (simple)
http://www.ambulancetechnicianstudy.co.uk/rhythms.html

What are you studying, if you don’t mind me asking?[/quote]

Physician assistant. I am an accelerated masters program, and I’m in my last few months before rotations. (1st clinical rotation will be seen on July 29th).

[quote]trivium wrote:

[quote]EyeDentist wrote:
Look at the rhythm strip at the bottom of the EKG…
–If a) every P/QRS/T grouping looks the same, AND b) the spacing between groupings is the same throughout, the rhythm is ‘regular.’
–If either a) or b) fails to hold, the rhythm is ‘irregular.’

Once you’ve determined that the rhythm is irregular…
–If the same pattern (however weird it may be) occurs over and over again, the rhythm is ‘regularly irregular.’
–If there is no discernible repeating pattern, the rhythm is ‘irregularly irregular.’
[/quote]

I am going to go and look back at the heart blocks. This makes sense for a 2nd degree mobitz type 1, but I am not sure if it will be like that for 3rd degree, or a couple others I have been told are defined as “regular.”[/quote]

Mobitz I is the standard example of a ‘regularly irregular’ rhythm, which is why it can be described with respect to its p:qrs ratio (eg, 5:4). OTOH, Mobitz II is irregularly irregular, as there is no repeating relationship between the number of p waves and qrs complexes.

3rd degree block is a classic ‘irregularly irregular’ rhythm, as there is a complete decoupling between the occurrence of p waves and that of qrs complexes. The p waves march along at one rate (usually dictated by the SA node), while the qrs complexes march along at another (usually much slower) rate. Because these two rates are independent of one another, there is no coordination between them; hence the overall (ie, p + qrs/t) rhythm is irregularly irregular.

[quote]EyeDentist wrote:

[quote]trivium wrote:

[quote]EyeDentist wrote:
Look at the rhythm strip at the bottom of the EKG…
–If a) every P/QRS/T grouping looks the same, AND b) the spacing between groupings is the same throughout, the rhythm is ‘regular.’
–If either a) or b) fails to hold, the rhythm is ‘irregular.’

Once you’ve determined that the rhythm is irregular…
–If the same pattern (however weird it may be) occurs over and over again, the rhythm is ‘regularly irregular.’
–If there is no discernible repeating pattern, the rhythm is ‘irregularly irregular.’
[/quote]

I am going to go and look back at the heart blocks. This makes sense for a 2nd degree mobitz type 1, but I am not sure if it will be like that for 3rd degree, or a couple others I have been told are defined as “regular.”[/quote]

Mobitz I is the standard example of a ‘regularly irregular’ rhythm, which is why it can be described with respect to its p:qrs ratio (eg, 5:4). OTOH, Mobitz II is irregularly irregular, as there is no repeating relationship between the number of p waves and qrs complexes.

3rd degree block is a classic ‘irregularly irregular’ rhythm, as there is a complete decoupling between the occurrence of p waves and that of qrs complexes. The p waves march along at one rate (usually dictated by the SA node), while the qrs complexes march along at another (usually much slower) rate. Because these two rates are independent of one another, there is no coordination between them; hence the overall (ie, p + qrs/t) rhythm is irregularly irregular. [/quote]

Thanks man. Is there any other examples of stuff that can show up as a regular irregular? Also, what is the difference between idiojunctional and idioventricular rhythm? Doesn’t idiojunctional lack the inverted P wave? It looks the same to me. Maybe it is a wider QRS?

[quote]trivium wrote:

[quote]EyeDentist wrote:

[quote]trivium wrote:

[quote]EyeDentist wrote:
Look at the rhythm strip at the bottom of the EKG…
–If a) every P/QRS/T grouping looks the same, AND b) the spacing between groupings is the same throughout, the rhythm is ‘regular.’
–If either a) or b) fails to hold, the rhythm is ‘irregular.’

Once you’ve determined that the rhythm is irregular…
–If the same pattern (however weird it may be) occurs over and over again, the rhythm is ‘regularly irregular.’
–If there is no discernible repeating pattern, the rhythm is ‘irregularly irregular.’
[/quote]

I am going to go and look back at the heart blocks. This makes sense for a 2nd degree mobitz type 1, but I am not sure if it will be like that for 3rd degree, or a couple others I have been told are defined as “regular.”[/quote]

Mobitz I is the standard example of a ‘regularly irregular’ rhythm, which is why it can be described with respect to its p:qrs ratio (eg, 5:4). OTOH, Mobitz II is irregularly irregular, as there is no repeating relationship between the number of p waves and qrs complexes.

3rd degree block is a classic ‘irregularly irregular’ rhythm, as there is a complete decoupling between the occurrence of p waves and that of qrs complexes. The p waves march along at one rate (usually dictated by the SA node), while the qrs complexes march along at another (usually much slower) rate. Because these two rates are independent of one another, there is no coordination between them; hence the overall (ie, p + qrs/t) rhythm is irregularly irregular. [/quote]

Thanks man. Is there any other examples of stuff that can show up as a regular irregular? Also, what is the difference between idiojunctional and idioventricular rhythm? Doesn’t idiojunctional lack the inverted P wave? It looks the same to me. Maybe it is a wider QRS?[/quote]

I can’t imagine they’d give you anything besides an obvious Mobitz I as an example of a regular-irregular rhythm.

There are two main differences between junctional- and ventricular-paced EKGs:

  1. The rate. Junctional pacing will be at ~40-60 BPM, whereas ventricular pacing will be 20-40.
  2. The width of the qrs complexes. Because junctional pacing originates ‘above’ the normal ventricular conduction pathways (ie, the bundle branches), the ventricles will be ‘fired’ in the usual and customary fashion. Because of this, the qrs complex will be normal (ie, narrow) in appearance. OTOH, ventricular pacing does NOT propagate in a normal anterograde manner along the bundle branches; rather, depolarization ‘crawls’ around the ventricles from muscle cell to muscle cell. Thus, it takes much longer for the entire ventricle(s) to receive the ‘contract’ order, and contraction therefore occurs in ‘slow motion’ (relatively speaking of course). Because of this, the qrs complexes in ventricular pacing are very wide (they look like PVC complexes).

[quote]trivium wrote:
Thanks man. Is there any other examples of stuff that can show up as a regular irregular? Also, what is the difference between idiojunctional and idioventricular rhythm? Doesn’t idiojunctional lack the inverted P wave? It looks the same to me. Maybe it is a wider QRS?[/quote]

Bigeminy will be regularly irregular.

I’m not sure what you’re referring to by idiojunctional. Inverted P waves are seen in ectopic atrial rhythms. They can also be seen when the atria are activated in a retrograde fashion from the lower parts of the conduction system.

[quote]NOLAlift wrote:

[quote]trivium wrote:
Thanks man. Is there any other examples of stuff that can show up as a regular irregular? Also, what is the difference between idiojunctional and idioventricular rhythm? Doesn’t idiojunctional lack the inverted P wave? It looks the same to me. Maybe it is a wider QRS?[/quote]

Bigeminy will be regularly irregular.

[/quote]

Good one–I totally forgot about the ‘geminies.’ (I haven’t had to read my own EKGs since intern year.)

[quote]trivium wrote:

[quote]pgtips wrote:
You talking about electrocardiogramme? (ECG/EKG) You got ventricular fibrilation and stuff. Go and research it, you’ll probably learn it better.

But from what I remember:

on a reular rythm there will be a heart rate o6 60-100 bpm witha normal QRS complex witht he wa vidible before the complex. Also the interval between P and R would be normal (less than 5 litle squares) then anything irregular from this will be the different problems like atrial and ventricular fibrilation (I also think I remember atrial flutter etc)

It’s all to do with the hearts conduction system, (bundle of his, AV node, SA node blah blah blah)

Heres a good start point (I’m actually gonna use these for revision)

Actual Abnormalities (simple)
http://www.ambulancetechnicianstudy.co.uk/rhythms.html

What are you studying, if you don’t mind me asking?[/quote]

Physician assistant. I am an accelerated masters program, and I’m in my last few months before rotations. (1st clinical rotation will be seen on July 29th).[/quote]
When are you done and where are you going to work.

All your other answers are already done in here.

[quote]Derek542 wrote:

[quote]trivium wrote:

[quote]pgtips wrote:
You talking about electrocardiogramme? (ECG/EKG) You got ventricular fibrilation and stuff. Go and research it, you’ll probably learn it better.

But from what I remember:

on a reular rythm there will be a heart rate o6 60-100 bpm witha normal QRS complex witht he wa vidible before the complex. Also the interval between P and R would be normal (less than 5 litle squares) then anything irregular from this will be the different problems like atrial and ventricular fibrilation (I also think I remember atrial flutter etc)

It’s all to do with the hearts conduction system, (bundle of his, AV node, SA node blah blah blah)

Heres a good start point (I’m actually gonna use these for revision)

Actual Abnormalities (simple)
http://www.ambulancetechnicianstudy.co.uk/rhythms.html

What are you studying, if you don’t mind me asking?[/quote]

Physician assistant. I am an accelerated masters program, and I’m in my last few months before rotations. (1st clinical rotation will be seen on July 29th).[/quote]
When are you done and where are you going to work.

All your other answers are already done in here.[/quote]

Thanks for the post, this one is good.

I graduate on May 4th with my bachelors of health sciences, and next may with my masters. Do you hire?

I am a Family Nurse Practitioner. Started out as a RT and then nursing then masters. Worked ER for 14 years, family practice for almost three and last 5 years in occupational medicine. I’m a regional manager for an OC Med company. I currently have about 35 employees with about 5 PAs and FNPs working for me. Yes I hire, and we have jobs across the nation.

[quote]Derek542 wrote:
I am a Family Nurse Practitioner. Started out as a RT and then nursing then masters. Worked ER for 14 years, family practice for almost three and last 5 years in occupational medicine. I’m a regional manager for an OC Med company. I currently have about 35 employees with about 5 PAs and FNPs working for me. Yes I hire, and we have jobs across the nation. [/quote]

Do you have specific locations? I originally wanted to do dermatology (easy hours, no stress, good pay), but now that I am more toward the end of things I am much more interested in general practice.

[quote]trivium wrote:

[quote]Derek542 wrote:
I am a Family Nurse Practitioner. Started out as a RT and then nursing then masters. Worked ER for 14 years, family practice for almost three and last 5 years in occupational medicine. I’m a regional manager for an OC Med company. I currently have about 35 employees with about 5 PAs and FNPs working for me. Yes I hire, and we have jobs across the nation. [/quote]

Do you have specific locations? I originally wanted to do dermatology (easy hours, no stress, good pay), but now that I am more toward the end of things I am much more interested in general practice. [/quote]
You need to do some family practice for experience. When you are ready to gear down for easy hours, no stress and good pay, give me a call. Currently I have Az, Houston, Beaumont but the company has places in La, SC, Tenn, Al and a few others. Mostly in the South.

[quote]Derek542 wrote:

[quote]trivium wrote:

[quote]Derek542 wrote:
I am a Family Nurse Practitioner. Started out as a RT and then nursing then masters. Worked ER for 14 years, family practice for almost three and last 5 years in occupational medicine. I’m a regional manager for an OC Med company. I currently have about 35 employees with about 5 PAs and FNPs working for me. Yes I hire, and we have jobs across the nation. [/quote]

Do you have specific locations? I originally wanted to do dermatology (easy hours, no stress, good pay), but now that I am more toward the end of things I am much more interested in general practice. [/quote]
You need to do some family practice for experience. When you are ready to gear down for easy hours, no stress and good pay, give me a call. Currently I have Az, Houston, Beaumont but the company has places in La, SC, Tenn, Al and a few others. Mostly in the South.[/quote]

Sounds like the life. How much experience do you require? I am assuming my rotations aren’t going to be sufficient.

[quote]trivium wrote:

[quote]Derek542 wrote:

[quote]trivium wrote:

[quote]Derek542 wrote:
I am a Family Nurse Practitioner. Started out as a RT and then nursing then masters. Worked ER for 14 years, family practice for almost three and last 5 years in occupational medicine. I’m a regional manager for an OC Med company. I currently have about 35 employees with about 5 PAs and FNPs working for me. Yes I hire, and we have jobs across the nation. [/quote]

Do you have specific locations? I originally wanted to do dermatology (easy hours, no stress, good pay), but now that I am more toward the end of things I am much more interested in general practice. [/quote]
You need to do some family practice for experience. When you are ready to gear down for easy hours, no stress and good pay, give me a call. Currently I have Az, Houston, Beaumont but the company has places in La, SC, Tenn, Al and a few others. Mostly in the South.[/quote]

Sounds like the life. How much experience do you require? I am assuming my rotations aren’t going to be sufficient.[/quote]
That was why I was saying you need some experience. I have taken new grads and trained them, however they had previous medical experience like EMT, Nurse etc.

Do your PM’s work?

[quote]Derek542 wrote:

[quote]trivium wrote:

[quote]Derek542 wrote:

[quote]trivium wrote:

[quote]Derek542 wrote:
I am a Family Nurse Practitioner. Started out as a RT and then nursing then masters. Worked ER for 14 years, family practice for almost three and last 5 years in occupational medicine. I’m a regional manager for an OC Med company. I currently have about 35 employees with about 5 PAs and FNPs working for me. Yes I hire, and we have jobs across the nation. [/quote]

Do you have specific locations? I originally wanted to do dermatology (easy hours, no stress, good pay), but now that I am more toward the end of things I am much more interested in general practice. [/quote]
You need to do some family practice for experience. When you are ready to gear down for easy hours, no stress and good pay, give me a call. Currently I have Az, Houston, Beaumont but the company has places in La, SC, Tenn, Al and a few others. Mostly in the South.[/quote]

Sounds like the life. How much experience do you require? I am assuming my rotations aren’t going to be sufficient.[/quote]
That was why I was saying you need some experience. I have taken new grads and trained them, however they had previous medical experience like EMT, Nurse etc.

Do your PM’s work?[/quote]

Im not sure what you mean by PM. I am still relatively new to the game here haha.