ECG READING

SINUS RHYTHMs

NORMAL SINUS RHYTM

The electrical impulse is formed in the SA node and conducted normally. This is the normal rhythm of the heart; other rhythms that do not conduct via the typical

pathway are called arrhythmias. Rate 60 - 100 bpm (adult) age dependent in pediatrics Regularity regular P waves normal PR interval 0.12 - 0.20 s QRS duration 0.04 - 0.12 s Any deviation from above is sinus tachycardia, sinus bradycardia or an arrhythmia

SINUS BRADYCARDIA

A heart rate less than 60 beats per minute (BPM). Looking at the ECG you'll see that: Rhythm - Regular Rate - less than 60 beats per minute QRS Duration - Normal P Wave - Visible before each QRS complex P-R Interval - Normal Usually benign and often caused by patients on beta blockers

SINUS TACHYCARDIA

Looking at the ECG you'll see that: Rhythm - Regular Rate Greater then norm for childs age QRS Duration - Normal P Wave - Visible before each QRS complex P-R Interval - Normal The impulse generating the heart beats are normal, but they are occurring at a faster pace

than normal.

SINUS ARRHYTHMIA

Sinus rhythm with a beat-to-beat variation in the P-P interval (the time between successive P

waves), producing an irregular ventricular rate. Variation in the P-P interval of more than 120 ms (3 small boxes). The P-P interval gradually lengthens and shortens in a cyclical fashion, usually corresponding to the phases of the respiratory cycle. Normal sinus P waves with a constant morphology (i.e. no evidence of premature atrial contractions). Constant P-R interval (i.e. no evidence of Mobitz I AV block).

PREMATURE ATRIAL CONTRACTION

They are premature. That is they occur earlier than you would expect if you were to measure

the previous P to P intervals. They are ectopic. Meaning originating outside of the SA node. Thus the P wave morphology would be different than the normal sinus P wave. They are narrow complexes. Since they come from the atrium, they will eventually travel through the AV node and use the normal conduction system to spread to the ventricles. Unlike a premature ventricular contraction, which is wide-complexed since it does not use the normal ventricular conduction system. There is a compensatory pause after the PAC. The extra atrial action potential causes the SA node to become refractory to generating its next scheduled beat. Thus it must "skip a beat" and it will resume exactly 2 P to P intervals after the last normal sinus beat.

Resources
American Heart Association, (2005) Pediatric Advance Life Support Provider Manual . Dallas,

TX: American Heart Association. Guntheroth, W., & Park, M., ( 3rd) (1992) How to Read Pediatric ECGs. St. Louis, MO: Mosby http://www.ambulancetechnicianstudy.co.uk/edgbasics.html
http://apma-nc.com/PatientEducation/premature-atrial_contractions.htm http://library.med.utah.edu/kw/ecg/ecg_outline/Lesson1/index.html http://www.skillstat.com/library.htm

http://www.learntheheart.com/ecg-review/ecg-topic-reviews-and-criteria/premature-

atrial-contractions-review/