For more detailed videos of each rhythm analysis step:
Determining the Regularity of an ECG/EKG Rhythm - • Determining the Regula...
Determining the heart rate in an EKG rhythm tracing using 3 methods - • Determining the heart ... Identifying and describing P waves in an EKG rhythm - • Identifying and descri...
Identifying and Measuring the PR Interval in an EKG Rhythm Strip - • Identifying and Measur... Describing and measuring the QRS complex in an EKG rhythm strip - • Describing and measuri...
How to analyze an EKG rhythm strip in 6 steps - • How to analyze an EKG ...
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Welcome to this tutorial on how to analyze Multifocal Atrial Rhythm in an EKG strip. Multifocal Atrial Rhythm, also known as Wandering Atrial Pacemaker, is an irregular heart rhythm that can be seen on an EKG rhythm. In this video, we will show you how to identify and analyze this type of rhythm.
In Multifocal Atrial Rhythm, the P waves are not uniform in shape, size, or duration. This is because they are originating from different sites in the atria. As a result, the P waves have a "multifocal" appearance, meaning the P waves vary in size and shape, and the rhythm is irregular. The multiple discrete p wave morphologies with variable PR intervals suggest atrial pacemaker activity originating from multiple ectopic foci within the atria.
There are several causes of MAR, including lung disease such as chronic obstructive pulmonary disease, heart disease such as coronary artery disease, electrolyte imbalances such as hypomagnesemia and hypokalemia, and medication side effects such as theophylline and isoproterenol. It is more commonly seen in elderly patients, mainly appearing around the age of 70, or those with other underlying medical conditions such as chronic renal failure.
The symptoms of MAR can include shortness of breath, chest pain, palpitations, and fatigue. In some cases, patients may not experience any symptoms at all.
Step 1: Check the regularity of the rhythm. Using your EKG caliper, measure the R to R intervals and determine if they are all equal or consistent. Multifocal Atrial Rhythm is an irregular rhythm, so make sure the distance between each P wave varies.
Step 2: Determine the heart rate. In Multifocal Atrial Rhythm, the heart rate is between 60 to 100 beats per minute, similar to a normal sinus rhythm. In this example, since this rhythm is irregular, we use the six second method. We have a six second strip with six QRS complexes. We multiply 6 by 10 and we get 60 beats per minute.
Step 3: Identify the P waves. Look for P waves that are not uniform in shape, size, or duration. In Multifocal Atrial Rhythm, there should be at least 3 different morphologies or forms of your P wave. It is important that you are able to discern the P waves. If the P waves are not identifiable, it is not multifocal atrial rhythm, and could be atrial fibrillation instead. And there should still be one P wave in front of every QRS, despite having varying morphologies. This example has three distinct P wave morphologies.
Step 4: Measure the PR interval. The PR interval is the time between the start of the P wave and the start of the QRS complex. In Multifocal Atrial Rhythm, the PR interval varies considerably because your P waves have different morphologies, as exemplified by this EKG strip.
Step 5: Measure the QRS duration. The QRS duration is the time it takes for the electrical signal to travel through the ventricles. In Multifocal Atrial Rhythm, it should be less than 0.12 seconds, just like in a Normal Sinus Rhythm. This EKG strip shows QRS complexes that are less than 0.12 seconds.
The treatment of MAR depends on the underlying cause and severity of the symptoms. In mild cases, no treatment may be necessary, but if the symptoms are severe, treatment may include medications to control the heart rate or cardioversion, which is a procedure that uses electricity to reset the heart's rhythm.
Thank you for watching this tutorial on Multifocal Atrial Rhythm. We hope you found it informative. If you have any questions or concerns, please consult your healthcare provider.
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28 авг 2024
