Understanding Different EKG Rhythms

Introduction

The electrocardiogram (EKG or ECG) is a crucial tool in diagnosing heart conditions. It records the electrical activity of the heart, providing insight into various heart rhythms. Understanding different EKG rhythms is key for detecting arrhythmias and other cardiac disorders.

Normal Sinus Rhythm (NSR)

  • Definition: A healthy, regular rhythm originating from the sinus node.
  • EKG Features:
    • Rate: 60-100 bpm
    • Regular P waves before each QRS complex
    • Normal PR interval (0.12-0.20 sec)

Sinus Bradycardia

  • Definition: A slow heart rate (<60 bpm) with normal sinus rhythm.
  • Causes:
    • Increased vagal tone (e.g., in athletes)
    • Medications (e.g., beta-blockers, calcium channel blockers)
    • Hypothyroidism, hypothermia

Sinus Tachycardia

  • Definition: A fast heart rate (>100 bpm) with normal sinus rhythm.
  • Causes:
    • Fever, dehydration, pain
    • Anemia, hyperthyroidism
    • Physical exertion, stress

Atrial Fibrillation (AFib)

  • Definition: Irregular, rapid atrial impulses without distinct P waves.
  • EKG Features:
    • Irregularly irregular rhythm
    • No identifiable P waves
    • Variable ventricular response

Atrial Flutter

  • Definition: Atrial rhythm with a sawtooth pattern due to rapid atrial depolarization.
  • EKG Features:
    • Regular atrial activity (~250-350 bpm)
    • Sawtooth flutter waves
    • Variable AV conduction (e.g., 2:1, 3:1 block)

Ventricular Tachycardia (VT)

  • Definition: A dangerous, rapid ventricular rhythm originating from the ventricles.
  • EKG Features:
    • Wide QRS complexes (>0.12 sec)
    • Rate usually >100 bpm
    • Monomorphic (same shape) or polymorphic (different shapes)

Ventricular Fibrillation (VFib)

  • Definition: Disorganized ventricular electrical activity causing cardiac arrest.
  • EKG Features:
    • Chaotic waves with no organized QRS complexes
    • No cardiac output – requires immediate defibrillation

Conclusion

Recognizing different EKG rhythms is essential for diagnosing and managing cardiac conditions. Some arrhythmias are benign, while others require urgent intervention. If you experience symptoms like palpitations, dizziness, or fainting, seek medical care immediately.

Source recommendations

1. American Heart Association Guidelines on ECG Interpretation

  1. https://www.heart.org/en/health-topics/heart-attack/diagnosing-a-heart-attack/electrocardiogram-ecg-or-ekg
  2. https://www.ahajournals.org/doi/10.1161/circulationaha.108.191095
  3. https://www.heart.org/-/media/files/affiliates/mwa/kansas-city/kc-cardiac-and-stroke-symposium/2020-event-documents/cardiac-presentations/2-ecg-hockstad.pdf?la=en
  4. https://www.ahajournals.org/doi/10.1161/circulationaha.108.191098
  5. https://pubmed.ncbi.nlm.nih.gov/19281932/

2. European Society of Cardiology Guidelines on Arrhythmias

  1. https://www.escardio.org/Guidelines/Clinical-Practice-Guidelines/Ventricular-Arrhythmias-and-the-Prevention-of-Sudden-Cardiac-Death
  2. https://academic.oup.com/eurheartj/article/43/40/3997/6675633
  3. https://www.escardio.org/Guidelines/Clinical-Practice-Guidelines/Supraventricular-Tachycardia
  4. https://pubmed.ncbi.nlm.nih.gov/36017572/
  5. https://www.ahajournals.org/doi/10.1161/01.cir.0000091380.04100.84

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