Normal sinus rhythm
Regular
Rate: 60-100
P Wave: Present, upright
PR Interval: 0.12-0.20 sec
QRS: <0.12 sec
Sinus Bradycardia
Regular
Rate: <60
P Wave: Present, upright
PR Interval: 0.12-0.20 sec
QRS: <0.12 sec
Sinus Tachycardia
Regular
Rate: 100-150
P Wave: Present, upright
PR Interval: 0.12-0.20 sec
QRS: <0.12 sec
Premature Atrial Contraction
IRREGULAR
Rate: depends on underlying rhythm
P wave: Present or hidden in T wave
PR Interval: 0.12-0.20 sec
QRS: <0.12 sec
Atrial Fibrillation
IRREGULAR
Atrial rate: UNMEASURABLE
Ventricular rate: variable
P wave: unable to see
PR Interval: N/A
QRS: <0.12 sec
A fib RVR
IRREGULAR
Ventricular rate: 100-175
P wave: unable to see
PR Interval: N/A
QRS <0.12 sec
Atrial Flutter
Usually REGULAR can be irregular
Atrial rate: 250-350
Ventricular rate: variable BUT < atrial rate
P Wave: Flutter
PR Interval: N/A
QRS: <0.12 sec
Supraventricular Tachycardia
Regular
Rate: 150-350
P wave: Hidden in QRS or T wave
PR: unable to determine
QRS: <0.12 sec
Junctional Rhythm
Regular
Rate: 40-60
P Wave: ABSENT or INVERTED
PR Interval: None or <0.12
QRS: <0.12 sec
Accelerated Junctional Rhythm
Regular
Rate: 60-100
P Wave: NONE or INVERTED
PR Interval: None or <0.12
QRS: <0.12 sec
Junctional Tachycardia
Regular
Rate: >100
P Wave: NONE or INVERTED
PR Interval: None or <0.12
QRS: <0.12 sec
Premature Ventricular Contraction
IRREGULAR
Rate: refer to underlying rhythm
P Wave: NONE
PR Interval: N/A
QRS: WIDE and BIZARRE , >0.12 sec
Ventricular Tachycardia
Regular
Rate: >100
P Wave: NONE
PR Interval: N/A
QRS: WIDE and BIZARRE, >0.12 sec
Ventricular Fibrillation
Chaotic
Coarse: big waves
Fine: small waves
Rate: unmeasurable
P Wave: NONE
PR Interval: N/A
QRS: N/A
Idioventricular
Regular
Rate: 20-50
P wave: NONE
PR Interval: N/A
QRS: WIDE, >0.12 sec
Accelerated Idoventricular Rhythm
Regular
Rate: 50-100
P wave: NONE
PR Interval: N/A
QRS: WIDE, >0.12 sec
1st Degree AV Block
Regular
Rate: 60-100
P Wave: Present, upright
PR interval: >0.20 sec CONSISTENTLY LONG
QRS: <0.12 sec
Husband stays late till 9 consistently
2nd Degree AV Block Type I Mobitz, Wenckebach
IRREGULAR
Rate: 60-100
P wave: Present, upright
PR Interval: Progressively longer until drop (PR interval longer and longer until drop)
QRS: <0.12 sec
Husband stays late till 9, then 11, then 1, then doesn’t come home at all
2nd Degree AV Block Type II
Irregular or regular
Rate: <60
P wave: Present, upright
PR Interval: PR interval consistently LONGER like type 1 but then a QRS will drop
QRS: <0.12 sec
Husband stays late till 9 consistently, then wife goes out and doesn’t come home
3rd Degree AV Block
Atrials and ventricles don’t communicate
Rate: regular atrial
P wave: Present, upright
No relationship between P waves and QRS
PR Interval: VARIABLE
QRS: variable
P-P ad R-R consistent but NO correlation
Husband and wife live separate lives and don’t communicate
SA Node
1st
60-100
AV Node
2nd
40-60
Bundle of His
3rd
40-45
Right and Left Bundle Branches
4th
40-45
Purkinje Fibers
5th
20-50
1 Small Box
0.04 sec
1 Big Box
0.20 sec
Junctional Rhythms
SA Node DID NOT FIRE
AV Node fired
NO P WAVE bc SA node didn’t fire
Narrow QRS
P Wave
Amplitude 0.5-2.5 mm
Will be shorter than T wave
Shows firing of SA node
QRS
0.06-0.10 sec SHOULD BE <0.12 sec
Wide QRS: delay in ventricular contraction, delay of conduction through bundle branches or purkinje fibers
BUNDLE BRANCH BLOCK or BLOCK IN PURKINJE FIBERS (idioventricular)
Calculate Regular Rate
1500/ # boxes R-R
Calculate Irregular Rate
of Rs in 6 sec strip X 10
Unifocal PVCs
Only 1 shape PVC
Bigeminy
PVC occurs every OTHER beat
Trigeminy
PVC occurs every THIRD beat
Couplet
2 PVCs together
Triplet
3 PVCs together
Multifocal
Multiple shapes
Monomorphic V Tach
Same Shapes V Tach
Polymorphic V Tach
Different Shapes V tach
Coarse V Fib
Chopy but not as high as polymorphic V tach
Fine V Fib
Fine and fibrillatory
Idioventricular Rhythms
Only purkinje fibers firing
WIDE QRS always
Atrially Paced
Spike comes before P
Ventricularly Paced
Spike comes before QRS and QRS will be wide
AV Paced
Spike before P and before QR
Failure to Capture
Spikes with no QRS
Failure to Sense
Spikes happen regardless of QRS on their own
How to determine the rhythm
Regular or irregular?
Rate?
P before every QRS? QRS for every P?
QRS wide or narrow?
QT Interval
0.34-0.43
P Wave
0.06-0.12 sec
PR Interval
0.12-0.20 sec
SA Node Firing Rhythms
Fires normally @ 60-100
-SR 60-100
-SB <60
-ST 100-150
-SVT 150-350
AV Node Firing, SA Node Failed Rhythms
Fires normally @ 40-60
-Junctional rhythm 40-60
-Accelerated junctional rhythm 60-100
-Junctional tachycardia 100-150
Only Purkinje Fibers Firing Rhythms (Everything else has failed)
Fires normally @ 20-50
-Idioventricular 20-50
-Accelerated idioventricular 50-100