HEART RATE ON ECGHEART RATE ON ECG

BYBY

Dr.KashifDr.Kashif

CALCULATION OF HEART RATECALCULATION OF HEART RATE

After checking the label, speed and ECG standard After checking the label, speed and ECG standard move to the rate and rhythm lead ( lead II ) which is move to the rate and rhythm lead ( lead II ) which is given as a long strip at the end. given as a long strip at the end.

Determine whether the rhythm is regular or irregular Determine whether the rhythm is regular or irregular by noticing the distance between successive QRS by noticing the distance between successive QRS complexes. complexes.

If distance is equal between all QRS complexes If distance is equal between all QRS complexes rhythm is regular and if distance between QRS rhythm is regular and if distance between QRS complexes is unequal rhythm is irregular.complexes is unequal rhythm is irregular.

There are separate methods for regular rhythm and There are separate methods for regular rhythm and irregular rhythmirregular rhythm

RULE OF 1500 FOR REGULAR RHYTHMRULE OF 1500 FOR REGULAR RHYTHMHeart Rate = 1500 Heart Rate = 1500 No: of small boxes between two QRS complexesNo: of small boxes between two QRS complexes

Heart Rate = 1500 / 32 = 46 Heart Rate = 1500 / 32 = 46 beats per minutebeats per minute

RULE OF 300 FOR REGULAR RYTHMRULE OF 300 FOR REGULAR RYTHM

Heart Rate = 300 Heart Rate = 300 No: of large boxes between two QRS complexesNo: of large boxes between two QRS complexes

Hear rate = 300 / 6.2 = 48 beats per minuteHear rate = 300 / 6.2 = 48 beats per minute

The Rule of 300The Rule of 300

It may be easiest to memorize the following table:It may be easiest to memorize the following table:

# of big boxes# of big boxes

Between QRS Between QRS complexescomplexes

Heart RateHeart Rate

11 300300

22 150150

33 100100

44 7575

55 6060

66 5050

Q. CALCULATE THE HEART RATE USING RULE Q. CALCULATE THE HEART RATE USING RULE OF 300OF 300

HEART RATE IN IRREGULAR RYTHMHEART RATE IN IRREGULAR RYTHM

First mark the distance between two QRS complexes. ThisFirst mark the distance between two QRS complexes. This distance should be equal between all QRS complexes. If it is distance should be equal between all QRS complexes. If it is unequal it means rhythm is irregular & following methodsunequal it means rhythm is irregular & following methods are used to calculate heart rate.are used to calculate heart rate.

A. RULE OF 10 SECONDA. RULE OF 10 SECOND H.R = Number of QRS complexes in 10 seconds x 6H.R = Number of QRS complexes in 10 seconds x 6

B. RULE OF 6 SECONDSB. RULE OF 6 SECONDS H.R = Number of QRS complexes in 6 second strip x 10 H.R = Number of QRS complexes in 6 second strip x 10

C. RULE OF 3 SECONDC. RULE OF 3 SECOND

H.R = Number of QRS complexes in 3 second strip x 20H.R = Number of QRS complexes in 3 second strip x 20

Q. CALCULATE THE HEART RATE USING 6 SECOND Q. CALCULATE THE HEART RATE USING 6 SECOND RULERULE

1. 6 second strip is selected between two red arrows1. 6 second strip is selected between two red arrows

2. Number of QRS complexes counted in 6 seconds is 142. Number of QRS complexes counted in 6 seconds is 14 3. Heart rate= 13 x 10 = 130 beats per minute3. Heart rate= 13 x 10 = 130 beats per minute

Q. CALCULATE THE HEART RATE USING 3 SECOND Q. CALCULATE THE HEART RATE USING 3 SECOND METHODMETHOD

SINUS RHYTHMSINUS RHYTHM

Normal rhythm of heart is called as Sinus rhythmNormal rhythm of heart is called as Sinus rhythm

As the impulse normally originates from Sinus node so As the impulse normally originates from Sinus node so it is called Sinus rhythmit is called Sinus rhythm

Heart rate is between 60 ---- 100 beats per minuteHeart rate is between 60 ---- 100 beats per minute

NORMAL ECG AND SINUS RHYTHMNORMAL ECG AND SINUS RHYTHM

Arrhythmias

Disorders of rhythm

SINUS TACHYCARDIASINUS TACHYCARDIA

In this the impulse originates in SA node so it is also In this the impulse originates in SA node so it is also sinus rhythm.sinus rhythm.

But the firing rate of SA node is increased to more than But the firing rate of SA node is increased to more than 100. So the heart rate is more than 100 beats per minute.100. So the heart rate is more than 100 beats per minute.

There is no other abnormality in ECG except the fast There is no other abnormality in ECG except the fast heart rate.heart rate.

SINUS TACHYCARDIASINUS TACHYCARDIA

SINUS BRADYCARDIASINUS BRADYCARDIA

In this rhythm also the impulse originates from SA NODE In this rhythm also the impulse originates from SA NODE SO IT IS Sinus rhythm.SO IT IS Sinus rhythm.

Firing rate of SA node is decreased below 60. So heart rate Firing rate of SA node is decreased below 60. So heart rate is also less than 60 beats per minute.is also less than 60 beats per minute.

There is no other abnormality in ECG except heart rate less There is no other abnormality in ECG except heart rate less than 60 beats per minutethan 60 beats per minute

Sinus bradycardiaSinus bradycardia

SINUS ARRYHTYHMIASINUS ARRYHTYHMIA

Rhythm strip of ECG shows variation in rhythm with Rhythm strip of ECG shows variation in rhythm with different phases of respirationdifferent phases of respiration

During inspiration the heart rate is increased while during During inspiration the heart rate is increased while during expiration heart rate is decreased.expiration heart rate is decreased.

Therefore during inspiration rhythm is fast and during Therefore during inspiration rhythm is fast and during expiration rhythm is slow. This variation in ECG rhythm expiration rhythm is slow. This variation in ECG rhythm with respiration is called as Sinus arrhythmiawith respiration is called as Sinus arrhythmia

Expiration Expiration inspirationinspiration

Sinus Arrhythmia

Inspiration Expiration

PREMATURE BEATS OR EXTRASYSTOLES Any part of heart other than SA node may discharge an

occasional impulse This part is called as ectopic focus and

beat which is produced by it is called as premature beat.

TYPES OF PREMATURE BEATS

TYPE FOCUS P WAVE QRS

COMPLEX Compensatory

pause

APC Atria present normal present

JPC AV node absent normal present

VPC ventricle absent Wide &

bizarre

Present /

absent

APC

JPC

VPC

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