Download - EKG Flowchart Mini II Version and Regular
8/19/2019 EKG Flowchart Mini II Version and Regular
http://slidepdf.com/reader/full/ekg-flowchart-mini-ii-version-and-regular 1/4
1. Is there a P wave for every QRS?2. Are all waves (P, QRS, T) present?
3. Is the P wave Upr !ht n "ea#s I, II, an# III?(I$ T%& A'S T & &' '& $ T%&S& IS ' , T%&' $ "" * T%& no
SI+& $ T%& %ART.)
-&S to A""
SI'US R%-T%/
1. Prolon!e# P0Rnterval? ( .2 se , or 4
s5all 6o7es)
2. ST0se!5entelevat on?
1st DEGREE(INCOMPLETE)HEART BLOCK
8PR0 nterval .2se
8SI'US R%-T%/86en !n, no 9r!ent
ntervent onre:9 re#.
ST SEGMENT ELEVATION =DIASTOLIC CURRENT OF
INJURY =TP SEGMENT an PR
SEGMENT DEPRESSION8#ea# ells 5a nta n onstant
ne!at ve har!e8the only t 5e the whole heart
s s9ppose# to 6e ne! s#9r n! ST se!5ent (ventr les
o5pletely #epolar ;e#)8th9s, ST se! stays where t<ss9ppose# to 6e, on soele trl ne, the rest of the se!5entsare #epresse# w th #ownwar#
#efle t on.8SI'US R%-T%/
8 ath la6 an#=or lyt s ( athpreferre#)
EKGInt!"#"!tat$%n
A&'%"$t($n*&+ $n'
M!an E&!*t"$*a&A,$s C an'!s)
( ,s $n &$' t -&+!=,s $n &$' t -&+!=s %*.a-&! "/t ss %*.a-&! "/t s 0 t!,t$n #$n. = %n t n!! t%
.n%2 3%" M$n$ II)
-es -es
3. ther P wavehan!es?
-es
GENERALATRIAL
HYPERTROPHY
>. QRS o5ple7han!es n net
ele tr al #ev at onfro5 l st ?
('et "ea#s I, II,av$, a ", 4, @'et 0 a R, 1)
4. /&A 0B C or 3 C?
-es to Any
MEAN ELECTRICAL A4ISDEVIATION
(see R for al 9lat on 5etho#s)**note, MEA deviations can be
present in pts with non-sinusrhythms, but they are notreproduced on the next page.
LEFT A4IS DEVIATION8patholo! a9ses n l9#e L
V!nt"$*+&a" H/#!"t"%# /0In3!"$%" MI0 E # /s! a0
S/st! $* HTN0 A%"t$*Va&5! St!ns%s$s
8phys olo! a9ses n l9#eathlet on# t on n!
RIGHT A4IS DEVIATION8patholo! a9ses n l9#e R
V!nt"$*+&a" H/#!"t"%# /0 Lat!"a&MI0 P+& %na"/ HTN0 P+& %na"/
Va&5! St!n%s$s0 VSD0 T!t"%&%'/ %3
Fa&&%t8phys olo! a9ses n l9#e tall, th na#9lt, an# h l#hoo#, h !h alt t9#e
1. /&A 03 C to 0B C?
2. /&A B C to 14 C?
H%2 t% Ca&*+&at! MEA6
S! $78+ant$tat$5! Est$ at!6
1."ooD for a lea# w th appro7. net ele tr al#ev at on .
2.+raw a l ne on the /&A # a!ra5 that sperpen# 9lar to the net lea#
3.'ow yo9 Dnow t has to 6e e ther thepos t ve or the ne!at ve port on of that
perpen# 9lar l ne .>. hoose any one of the other lea#s an#
#raw the 30se!5ent on ea h s #e ar , an#wh hever half of the perpen# 9lar l ne the
ar rosses, s yo9r /&A.
S! $78+ant$tat$5! L%n' V!"s$%n6
1.&sta6l sh the net ne!at v ty or pos t v ty ofea h lea# on the s 7 l 56 lea#s (I, II, II, a $,
a R, ")2. n the /&A # a!ra5, #raw a E30se!5ent
on ea h s #e E on e ther the pos t ve or thene!at ve port on of ea h lea#, a or# n! to
the &FG3.The /&A 59st l e w th n the we#!e wh hhas all s 7 ar s spann n! t. Th s ! ves yo9 a
ran!e of 3 C for yo9r a t9al /&A.
8+$*. an D$"t/6
1."ea#s I an# a $ are 6oth nor5al2."ea# I s H an# a $ s R !ht A7 s
+ev at on (RA+)3."ea# I s an# a $ s 0 "A+
8+ant$tat$5!8+ant$tat$5!(not #es . here 6= re:9 res r9ler)(not #es . here 6= re:9 res r9ler)
8/19/2019 EKG Flowchart Mini II Version and Regular
http://slidepdf.com/reader/full/ekg-flowchart-mini-ii-version-and-regular 2/4
1. Is there a P wave for every QRS?2. Are all waves (P, QRS, T) present?
3. Is the P wave Upr !ht n "ea#s I, II, an# III?(I$ T%& A'S T & &' '& $ T%&S& IS ' , T%&' $ "" * T%&
no PAG& $ T%& %ART.)
' to '& or / R&
' '0SI'US R-T%/
1. +roppe# QRSo5ple7es?
VENTRICULARFIBRILLATION
8% !hly erratpattern
8fatal f not t7<#8' '0 SI'US
R%-T%/
9n DEGREE(INCOMPLETE)%&ART " FMOBIT: t/#! 1
a.a ;!n.!-a*" /t
8PR0 nterval .24 se8PR0 ntervals often !etpro!ress vely lon!er t llyo9 lose one, then t re0sets an# then they start
to !et lon!er a!a n8 A no#e s # sf tl
8' '0SI'USR%-T%/JJJ
1. Total A6sen eof any wavefor5
pattern?
2. Prolon!e# PRInterval?
9n DEGREE(INCOMPLETE)%&ART " FMOBIT: t/#! 9
8PR0 nterval no K8s9##en, 9npre# ta6leloss of QRS o5ple7.8# sease of 69n#le of% s0p9rD nLe syste5
8*an -! 961 %" <61 (pwaveMQRS o5pl.)
8' '0SI'US R%-T%/8 an #e!ra#e to 3 r# #e!.
heart 6lo D
1. Separate P wave an#QRS o5ple7 rhyth5?
2. P waves
9n lear, errat6asel ne?
-
-
-es
'o-es
-es
'o
<" DEGREE (COMPLETE)HEART BLOCKa.a At"$%5!nt"$*+&a" D$ss%*$at$%n
8P wave has atr al rhyth5, QRS wave hasN9n t onal (A no#e)or entr 9lar (% s0
P9rD nLe or entr 9lar /yo ar# 95) rhyth58%all5arDM P wave an# R wave are sa # to 6e
E5ar h n! o9tO 5ean n! they follow sep.rhyth5s, 69t are st ll h !hly re!9lar (p0p an# r0r#o not han!e)
8%all5arDM P wave fo9n# 6t7 QRS an# T wave8so5et 5esM nverte# T waves.
8J+n*t$%na& R /t narrow QRS 3 s5all6o7es
8A**!&!"at! I $%5!nt"$*+&a" R /tw #ene# QRS
8t7 pa n!, transveno9s or trans 9taneo9s8' '0SI'US R-T%/
ATRIAL FIBRILLATION
8no lear P waves, st ll have QRS. no re!.%R
8atr a ontra t errat ally, a9ses rre!9lar6asel ne
8not # re tly fatal, 69t a9ses lots8P+& %na"/ E -%&$s thro569s for5e# n
atr a !oes to p9l5onary r an# l9n!s8C%"%na"/ %" C!"!-"a& E -%&$s
thro569s for5e# n atr 95 !oes to oronaryart. or 6ra n
8' '0SI'US R%-T%/
1. %as P*aves?
EKGInt!"#"!tat$%n
A&'%"$t(n%t $n*&+ $n'
M!an E&!*t"$*a&A,$s C an'!s)
( ,s $n &$' t -&+!=,s $n &$' t -&+!=s %*.a-&! " /t ss %*.a-&! " /t s )
-es
'o
1. * #e QRSo5ple7?
'o-es
VENTRICULARTACHYCARDIA
814 024 6p58fre:9ently #9e to a re0
entrant ventr 9larpathway a9se# 6y
s ar t ss9e fro5prev o9s /I, et .
SVTSUPRA VENTRICULAR
TACHYCARDIA
8 14 6p58fre:9ently #9e to a re0entrant pathway8or ! n of ele tr al 5p9lse s n the atr a
or the A no#e
8/19/2019 EKG Flowchart Mini II Version and Regular
http://slidepdf.com/reader/full/ekg-flowchart-mini-ii-version-and-regular 3/4
1. Is there a P wave for every QRS?2. Are all waves (P, QRS, T) present?
3. Is the P wave Upr !ht n "ea#s I, II, an# III?(I$ T%& A'S T & &' '& $ T%&S& IS ' , T%&' $ "" * T%& no
SI+& $ T%& %ART.)
-&S to A""
SI'US R%-T%/
1. Prolon!e# P0Rnterval? ( .2 se , or 4
s5all 6o7es)
2. ST0se!5entelevat on?
1st DEGREE(INCOMPLETE)HEART BLOCK
8PR0 nterval .2se
8SI'US R%-T%/86en !n, no 9r!ent
ntervent onre:9 re#.
ST SEGMENT ELEVATION =DIASTOLIC CURRENT OF
INJURY =TP SEGMENT an PR
SEGMENT DEPRESSION8#ea# ells 5a nta n onstant
ne!at ve har!e8the only t 5e the whole heart
s s9ppose# to 6e ne! s#9r n! ST se!5ent (ventr les
o5pletely #epolar ;e#)8th9s, ST se! stays where t<ss9ppose# to 6e, on soele trl ne, the rest of the se!5entsare #epresse# w th #ownwar#
#efle t on.8SI'US R%-T%/
8 ath la6 an#=or lyt s ( athpreferre#)
EKGInt!"#"!tat$%n
A&'%"$t($n*&+ $n'
M!an E&!*t"$*a&A,$s C an'!s)
( ,s $n &$' t -&+!=s %*.a-&!)
-es -es
3. ther P wavehan!es?
-es
GENERALATRIAL
HYPERTROPHY
>. QRS o5ple7han!es n net
ele tr al #ev at onfro5 l st ?
('et "ea#s I, II,av$, a ", 4, @'et 0 a R, 1)
4. /&A 0B C or 3 C?
-es to Any
MEAN ELECTRICAL A4ISDEVIATION
(see R for al 9lat on 5etho#s)**note, MEA deviations can be
present in pts with non-sinusrhythms, but they are notreproduced on the next page.
LEFT A4IS DEVIATION8patholo! a9ses n l9#e L
V!nt"$*+&a" H/#!"t"%# /0In3!"$%" MI0 E # /s! a0
S/st! $* HTN0 A%"t$*Va&5! St!ns%s$s
8phys olo! a9ses n l9#eathlet on# t on n!
RIGHT A4IS DEVIATION8patholo! a9ses n l9#e R
V!nt"$*+&a" H/#!"t"%# /0 Lat!"a&MI0 P+& %na"/ HTN0 P+& %na"/
Va&5! St!n%s$s0 VSD0 T!t"%&%'/ %3
Fa&&%t8phys olo! a9ses n l9#e tall, th na#9lt, an# h l#hoo#, h !h alt t9#e
1. /&A 03 C to 0B C?
2. /&A B C to 14 C?
H%2 t% Ca&*+&at! MEA6
S! $78+ant$tat$5! Est$ at!6
1."ooD for a lea# w th appro7. net ele tr al#ev at on .
2.+raw a l ne on the /&A # a!ra5 that sperpen# 9lar to the net lea#
3.'ow yo9 Dnow t has to 6e e ther the
pos t ve or the ne!at ve port on of thatperpen# 9lar l ne .
>. hoose any one of the other lea#s an##raw the 30se!5ent on ea h s #e ar , an#wh hever half of the perpen# 9lar l ne the
ar rosses, s yo9r /&A.
S! $78+ant$tat$5! L%n' V!"s$%n6
1.&sta6l sh the net ne!at v ty or pos t v ty ofea h lea# on the s 7 l 56 lea#s (I, II, II, a $,
a R, ")2. n the /&A # a!ra5, #raw a E30se!5ent
on ea h s #e E on e ther the pos t ve or thene!at ve port on of ea h lea#, a or# n! tothe &FG
3.The /&A 59st l e w th n the we#!e wh hhas all s 7 ar s spann n! t. Th s ! ves yo9 a
ran!e of 3 C for yo9r a t9al /&A.
8+$*. an D$"t/6
1."ea#s I an# a $ are 6oth nor5al2."ea# I s H an# a $ s R !ht A7 s
+ev at on (RA+)3."ea# I s an# a $ s 0 "A+
8+ant$tat$5!(not #es . here 6= re:9 res r9ler)
8/19/2019 EKG Flowchart Mini II Version and Regular
http://slidepdf.com/reader/full/ekg-flowchart-mini-ii-version-and-regular 4/4
1. Is there a P wave for every QRS?2. Are all waves (P, QRS, T) present?
3. Is the P wave Upr !ht n "ea#s I, II, an# III?(I$ T%& A'S T & &' '& $ T%&S& IS ' , T%&' $ "" * T%&
no PAG& $ T%& %ART.)
' to '& or / R&
' '0SI'US R-T%/
1. +roppe# QRSo5ple7es?
VENTRICULARFIBRILLATION
8% !hly erratpattern
8fatal f not t7<#8' '0 SI'US
R%-T%/
9n DEGREE(INCOMPLETE)%&ART " FMOBIT: t/#! 1
a.a ;!n.!-a*" /t
8PR0 nterval .24 se8PR0 ntervals often !etpro!ress vely lon!er t llyo9 lose one, then t re0sets an# then they start
to !et lon!er a!a n8 A no#e s # sf tl
8' '0SI'USR%-T%/JJJ
1. Total A6sen eof any wavefor5
pattern?
2. Prolon!e# PRInterval?
9n DEGREE(INCOMPLETE)%&ART " FMOBIT: t/#! 9
8PR0 nterval no K8s9##en, 9npre# ta6leloss of QRS o5ple7.8# sease of 69n#le of% s0p9rD nLe syste5
8*an -! 961 %" <61 (pwaveMQRS o5pl.)
8' '0SI'US R%-T%/8 an #e!ra#e to 3 r# #e!.
heart 6lo D
1. Separate P wave an#QRS o5ple7 rhyth5?
2. P waves
9n lear, errat6asel ne?
-
-
-es
'o-es
-es
'o
<" DEGREE (COMPLETE)HEART BLOCKa.a At"$%5!nt"$*+&a" D$ss%*$at$%n
8P wave has atr al rhyth5, QRS wave hasN9n t onal (A no#e)or entr 9lar (% s0
P9rD nLe or entr 9lar /yo ar# 95) rhyth58%all5arDM P wave an# R wave are sa # to 6e
E5ar h n! o9tO 5ean n! they follow sep.rhyth5s, 69t are st ll h !hly re!9lar (p0p an# r0r#o not han!e)
8%all5arDM P wave fo9n# 6t7 QRS an# T wave8so5et 5esM nverte# T waves.
8J+n*t$%na& R /t narrow QRS 3 s5all6o7es
8A**!&!"at! I $%5!nt"$*+&a" R /tw #ene# QRS
8t7 pa n!, transveno9s or trans 9taneo9s8' '0SI'US R-T%/
ATRIAL FIBRILLATION
8no lear P waves, st ll have QRS. no re!.%R
8atr a ontra t errat ally, a9ses rre!9lar6asel ne
8not # re tly fatal, 69t a9ses lots8P+& %na"/ E -%&$s thro569s for5e# n
atr a !oes to p9l5onary r an# l9n!s8C%"%na"/ %" C!"!-"a& E -%&$s
thro569s for5e# n atr 95 !oes to oronaryart. or 6ra n8' '0SI'US R%-T%/
1. %as P*aves?
EKGInt!"#"!tat$%n
A&'%"$t(n%t $n*&+ $n'
M!an E&!*t"$*a&A,$s C an'!s)
( ,s $n &$' t -&+!=s %*.a-&! " /t s)
-es
'o
1. * #e QRSo5ple7?
'o-es
VENTRICULARTACHYCARDIA
814 024 6p58fre:9ently #9e to a re0
entrant ventr 9larpathway a9se# 6y
s ar t ss9e fro5prev o9s /I, et .
SVTSUPRA VENTRICULAR
TACHYCARDIA
8 14 6p58fre:9ently #9e to a re0entrant pathway8or ! n of ele tr al 5p9lse s n the atr a
or the A no#e