Help with cardiomegaly arrhythmias EKG interpretation

  1. Hi, I have not had a course of any sort in interpretation of EKG's, and I am relying solely on my lab diagnostic manual, which is not very helpful. I was wondering if somebody could help me.

    My pt was a 61F, and she had Hx of cardiomegaly, HTN, arrhythmias, and chest pain. SHe was admitted for suspected TIA, which was ruled out. Her EKG results are as follows:
    Vent rate 65 BPM, PR 160 MS, QRS 86 ms, QT/QTC 430/447 ms.
    sinus rhythm with occasional premature ventricular complexes.
    Left axis deviation.

    Nonspecific T-wave abnormality
    The results for the next one taken 5h later are as follows:
    vent rate 67 BPM, PR 166 ms, QRS duration 86 ms, QT/QTC 384/405 ms
    normal sinus rhythm, left axis deviation. Minimal voltage criteria for LVH, may be normal variant. Anterior infarct, age undetermined.

    I know that the premature vent complexes account for her arrhythmias. I also know that the LVH indicates thickening of the left ventricle. This is indicated in HTN, CAD, and valvular disease. I also know that the Anterior infarct indicates cell death in the anterior surface of the heart, and a possible minor MI.

    I was wondering if someone could help me determine what this means. I haven't the slightest idea what the nonspecific t wave abnormality could be related to,

    and I don't know how to look at the values and determine which ones are abnormal. Also, what does the minimal voltage thing mean? Also, what does left axis deviation mean, and what could this indicate?

    If it matters, this woman had a very irregular pulse without a rhythm.

    Thank you for trying to help me!
  2. 9 Comments

  3. by   tlc2u
    Sorry this message was not clear I rewrote it and posted again.
    Last edit by tlc2u on Oct 11, '09 : Reason: To clear and rewrite for more clarity
  4. by   tlc2u
    look at this picture of an ekg graph to understand this
    your 1st ekg: what the terms and numbers mean:
    vent rate 65 bpm, pr 160 ms, qrs 86 ms, qt/qtc 430/447 ms.
    sinus rhythm with occasional premature ventricular complexes.
    left axis deviation.
    nonspecific t-wave abnormality

    heart rate (state atrial and ventricular, if different)
    vent rate 65 bpm= heart rate -the ventricals are beating at 65 beats
    per minute. heart rate below 60 would be bradycardia, heart rate above
    100 would be tachycardia.

    pr interval (beginning of p to beginning of qrs) (atrial depolarization)
    pr 160 ms or 0.16 seconds pr interval norm range is 0.12-0.20seconds
    pr interval correlates with atrial depolarization or the time it takes for
    the atria to contract. (if the pr interval is greater than 0.20seconds this
    indicates an av conduction block or a block of the electrical conduction
    system between the atria and the ventrical. also called first degree
    block. a block would be an area of damage to the heart that prevents
    the electrical conduction from flowing through correctly. kind of like a
    short in your tv's electrical wire.)

    qrs duration (0.06-0.10) (ventrical depolarization)
    qrs 86 ms or 0.86 seconds
    the qrs duration begins at the base of the q and ends at the base of
    the s. it correlates with the time it takes the ventricle to contract. a
    wide qrs indicates a left or right bundle branch block.

    qt interval (from beginning of qrs to end of t)
    (ventrical depolarization and repolarization)
    qt/qtc 430/447 ms
    the qt interval begins at the onset of the qrs complex to the end
    of the t wave. correlates with the time it takes for the ventricles to
    contract and relax.
    it is useful as a measure of the duration of repolarization. the qt
    interval will vary depending on the heart rate, age and gender. it
    increases with bradycardia and decreases with tachycardia. men have
    shorter qt intervals (0.39 sec) than women (0.41 sec). the qt interval
    is influenced by electrolyte balance, drugs, and ischemia. a qt duration
    above 440ms for your female patient is an abnormally long qt duration.
    considering that your patient had occassional pvc's or premature
    ventricular contractions if the ventricals were firing early i would think
    this may account for a long qt duration

    sinus rhythm with occasional premature ventricular complexes.
    left axis deviation.

    nonspecific t-wave abnormality

    what the nonspecific t wave abnormality could be related to
    non specific t wave changes means there was some changes noted with the t wave but they are non specific and there could be one of many reasons for the changes.
    st segment elevation indicates an mi. since the patient had a history of mi i would wonder if this has anything to do with the t wave changes. however t wave changes are also common in hypothyroidism too among other things.

    what does the minimal voltage thing mean? voltage is the heighth of the p wave, qrs complex, or t wave. we really did not get into the voltage and what it means in my rn course.

    also, what does left axis deviation mean, and what could this indicate?
    when a 12 lead ekg is done a lead is put on with a sticky onto different areas of the chest and on the arms and legs. a 12 lead ekg can then look at different areas of the heart say for an mi or area of infarct. how these are read has something to do with the left and right axis. again this is not something we covered futher than this in my rn program.

    interpretation: normal sinus rhythm
  5. by   ghillbert
    She had a pulse without a rhythm? What does that mean?
  6. by   tlc2u
    She had a pulse without a rhythm? What does that mean?

    Do you suppose whoever wrote that meant that she had a very thready or uneven pulse.
    Until you asked the question I was wondering what that meant as well. When I read your queston then I wondered could it mean she had a pulse but her pulse was thready or uneven like it did not have a steady rhythm to the pulse.

    If that is not it then maybe someone else has a better explanation.
  7. by   RNstudentc/o2010
    Hi, yeah, I mean that her pulse had an irregular rhythm, but that the irregularity did not have a pattern. Like, instead of a pause in between every fourth beat, there would be a pause after the 4th beat, then after the 11th beat, then after the 14th, then after the 24th, then not again until after the 43rd, etc. Sorry, I may have used the wrong terminology. If so, what should I have called this?
  8. by   RNstudentc/o2010
    Thanks, by the way. That really helped me a lot. I get it now. Maybe I was getting into depth a little...
  9. by   ghillbert
    When you say "rhythm" it means the pattern on the ECG.

    I think what you're describing is what I would call "irregularly irregular" as opposed to "regularly irregular".
  10. by   Toto7891
    QRS duration of 86 ms is actually .086 which is within normal duration. A T-wave inversion on an EKG strip indicates ischemia on a portion of the myocardium. (T -waves can be flattened which may also may indicate ischemia or an R-on-T phenomenon in which a QRS complex fires during repolarization) ST segment elevation indicates injury and permanent abnormal Q wave would indicate a MI.
  11. by   Toto7891
    Also P-R interval and QRS duration may be within the normal duration value but since you mentioned that she had irregular pulse, this would be indicated with irregular rhythm on the EKG by measuring the R to R interval which is the peak of the QRS to the next QRS. You can also do this to the P wave and measuring the length of the P wave from the first beat to the next beat and seeing if the P to P interval is fairly the same. By doing this you can kind of see that if the P-to-P interval is off meaning the SA node is firing irregularly or if its a R-to-R interval is off; origin is somewhere in the ventricles.