Normal sinus rhythm
Regular
Rate: 60-100
P Wave: Present, upright
PR Interval: 0.12-0.20 sec
QRS: <0.12 sec<\/p>\n\n\n\n
Sinus Bradycardia
Regular
Rate: <60
P Wave: Present, upright
PR Interval: 0.12-0.20 sec
QRS: <0.12 sec<\/p>\n\n\n\n
Sinus Tachycardia
Regular
Rate: 100-150
P Wave: Present, upright
PR Interval: 0.12-0.20 sec
QRS: <0.12 sec<\/p>\n\n\n\n
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<\/p>\n\n\n\n
Atrial Fibrillation
IRREGULAR
Atrial rate: UNMEASURABLE
Ventricular rate: variable
P wave: unable to see
PR Interval: N\/A
QRS: <0.12 sec<\/p>\n\n\n\n
A fib RVR
IRREGULAR
Ventricular rate: 100-175
P wave: unable to see
PR Interval: N\/A
QRS <0.12 sec<\/p>\n\n\n\n
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<\/p>\n\n\n\n
Supraventricular Tachycardia
Regular
Rate: 150-350
P wave: Hidden in QRS or T wave
PR: unable to determine
QRS: <0.12 sec<\/p>\n\n\n\n
Junctional Rhythm
Regular
Rate: 40-60
P Wave: ABSENT or INVERTED
PR Interval: None or <0.12
QRS: <0.12 sec<\/p>\n\n\n\n
Accelerated Junctional Rhythm
Regular
Rate: 60-100
P Wave: NONE or INVERTED
PR Interval: None or <0.12
QRS: <0.12 sec<\/p>\n\n\n\n
Junctional Tachycardia
Regular
Rate: >100
P Wave: NONE or INVERTED
PR Interval: None or <0.12
QRS: <0.12 sec<\/p>\n\n\n\n
Premature Ventricular Contraction
IRREGULAR
Rate: refer to underlying rhythm
P Wave: NONE
PR Interval: N\/A
QRS: WIDE and BIZARRE , >0.12 sec<\/p>\n\n\n\n
Ventricular Tachycardia
Regular
Rate: >100
P Wave: NONE
PR Interval: N\/A
QRS: WIDE and BIZARRE, >0.12 sec<\/p>\n\n\n\n
Ventricular Fibrillation
Chaotic
Coarse: big waves
Fine: small waves
Rate: unmeasurable
P Wave: NONE
PR Interval: N\/A
QRS: N\/A<\/p>\n\n\n\n
Idioventricular
Regular
Rate: 20-50
P wave: NONE
PR Interval: N\/A
QRS: WIDE, >0.12 sec<\/p>\n\n\n\n
Accelerated Idoventricular Rhythm
Regular
Rate: 50-100
P wave: NONE
PR Interval: N\/A
QRS: WIDE, >0.12 sec<\/p>\n\n\n\n
1st Degree AV Block
Regular
Rate: 60-100
P Wave: Present, upright
PR interval: >0.20 sec CONSISTENTLY LONG
QRS: <0.12 sec<\/p>\n\n\n\n
Husband stays late till 9 consistently<\/p>\n\n\n\n
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<\/p>\n\n\n\n
Husband stays late till 9, then 11, then 1, then doesn’t come home at all<\/p>\n\n\n\n
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<\/p>\n\n\n\n
Husband stays late till 9 consistently, then wife goes out and doesn’t come home<\/p>\n\n\n\n
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>\n\n\n\n
P-P ad R-R consistent but NO correlation<\/p>\n\n\n\n
Husband and wife live separate lives and don’t communicate<\/p>\n\n\n\n
SA Node
1st
60-100<\/p>\n\n\n\n
AV Node
2nd
40-60<\/p>\n\n\n\n
Bundle of His
3rd
40-45<\/p>\n\n\n\n
Right and Left Bundle Branches
4th
40-45<\/p>\n\n\n\n
Purkinje Fibers
5th
20-50<\/p>\n\n\n\n
1 Small Box
0.04 sec<\/p>\n\n\n\n
1 Big Box
0.20 sec<\/p>\n\n\n\n
Junctional Rhythms
SA Node DID NOT FIRE
AV Node fired
NO P WAVE bc SA node didn’t fire
Narrow QRS<\/p>\n\n\n\n
P Wave
Amplitude 0.5-2.5 mm
Will be shorter than T wave
Shows firing of SA node<\/p>\n\n\n\n
QRS
0.06-0.10 sec SHOULD BE <0.12 sec<\/p>\n\n\n\n
Wide QRS: delay in ventricular contraction, delay of conduction through bundle branches or purkinje fibers
BUNDLE BRANCH BLOCK or BLOCK IN PURKINJE FIBERS (idioventricular)<\/p>\n\n\n\n
Calculate Regular Rate
1500\/ # boxes R-R<\/p>\n\n\n\n
Calculate Irregular Rate<\/p>\n\n\n\n
Unifocal PVCs
Only 1 shape PVC<\/p>\n\n\n\n
Bigeminy
PVC occurs every OTHER beat<\/p>\n\n\n\n
Trigeminy
PVC occurs every THIRD beat<\/p>\n\n\n\n
Couplet
2 PVCs together<\/p>\n\n\n\n
Triplet
3 PVCs together<\/p>\n\n\n\n
Multifocal
Multiple shapes<\/p>\n\n\n\n
Monomorphic V Tach
Same Shapes V Tach<\/p>\n\n\n\n
Polymorphic V Tach
Different Shapes V tach<\/p>\n\n\n\n
Coarse V Fib
Chopy but not as high as polymorphic V tach<\/p>\n\n\n\n
Fine V Fib
Fine and fibrillatory<\/p>\n\n\n\n
Idioventricular Rhythms
Only purkinje fibers firing
WIDE QRS always<\/p>\n\n\n\n
Atrially Paced
Spike comes before P<\/p>\n\n\n\n
Ventricularly Paced
Spike comes before QRS and QRS will be wide<\/p>\n\n\n\n
AV Paced
Spike before P and before QR<\/p>\n\n\n\n
Failure to Capture
Spikes with no QRS<\/p>\n\n\n\n
Failure to Sense
Spikes happen regardless of QRS on their own<\/p>\n\n\n\n
How to determine the rhythm
Regular or irregular?
Rate?
P before every QRS? QRS for every P?
QRS wide or narrow?<\/p>\n\n\n\n
QT Interval
0.34-0.43<\/p>\n\n\n\n
P Wave
0.06-0.12 sec<\/p>\n\n\n\n
PR Interval
0.12-0.20 sec<\/p>\n\n\n\n
SA Node Firing Rhythms
Fires normally @ 60-100
-SR 60-100
-SB <60
-ST 100-150
-SVT 150-350<\/p>\n\n\n\n
AV Node Firing, SA Node Failed Rhythms
Fires normally @ 40-60
-Junctional rhythm 40-60
-Accelerated junctional rhythm 60-100
-Junctional tachycardia 100-150<\/p>\n\n\n\n
Only Purkinje Fibers Firing Rhythms (Everything else has failed)
Fires normally @ 20-50
-Idioventricular 20-50
-Accelerated idioventricular 50-100<\/p>\n\n\n\n
normal sinus rhythm
heart rhythm originating in the sinoatrial node with a rate in patients at rest of 60 to 100 beats per minute<\/p>\n\n\n\n
Sinus Arrhythmia
Appearance is ALMOST NORMAL:
Respiratory – Circulatory interaction
Rate INCREASES with INSPIRATION (IN=IN)<\/p>\n\n\n\n
Sinus Bradycardia
<60
normal sinus rhythm<\/p>\n\n\n\n
Sinus Tachycardia<\/p>\n\n\n\n
\n100 (100-150)
normal sinus rhythm<\/p>\n<\/blockquote>\n\n\n\nPremature Atrial Contraction (PAC)
Heart Rate: Depends on underlying rhythm
Regularity: Interrupts the regularity of underlying rhythm
P-Wave: can be flattened, notched, or unusual. May be hidden within the T wave
PRI: measures between .12-.20 seconds and can be prolonged; can be different from other complexes
QRS: <.12 seconds<\/p>\n\n\n\nSinus Arrest\/Pause<\/p>\n\n\n\n
\n
- SA node doesn’t fire<\/li>\n\n\n\n
- notice absence of P-wave for a complete cycle (a missed cycle)
length of pause \u2260 multiple of normal rate (block)<\/li>\n<\/ul>\n\n\n\nAtrial Fibrillation (A-Fib)
an irregular and often very fast heart rate originating from abnormal conduction in the atria<\/p>\n\n\n\nAtrial Flutter
irregular beating of the atria; often described as “a-flutter with 2 to 1 block or 3 to 1 block”<\/p>\n\n\n\nJunctional Rhythm
40-60 Regular!
-impulse from AV node w\/ retro\/antegrade transmission<\/p>\n\n\n\n\n
- P wave often inverted\/buried\/follow QRS<\/li>\n\n\n\n
- slow rate<\/li>\n\n\n\n
- narrow QRS (not wide like ventricular)<\/li>\n<\/ul>\n\n\n\n
Junctional Tachycardia<\/p>\n\n\n\n
\n60 bpm (ms. K; 150-250)<\/p>\n\n\n\n
\n
- KEY: will be regular (consistent)<\/li>\n\n\n\n
- AV junction produces a rapid sequence of QRS-T cycles<\/li>\n\n\n\n
- p-wave often inverted\/buried\/follow QRS<\/li>\n<\/ul>\n<\/blockquote>\n\n\n\n
Premature Junctional Contraction
Inverted p wave or hidden p wave
PRI<0.12 or none
Normal QRS<\/p>\n\n\n\nSupraventricular Tachycardia (SVT)
an abnormal heart rhythm arising from aberrant electrical activity in the heart; originates at or above the AV node<\/p>\n\n\n\nFirst degree heart block
atrioventricular (AV) block in which the atrial electrical impulses are delayed by a fraction of a second before being conducted to the ventricles<\/p>\n\n\n\n2nd degree heart block type 1 (Wenkebach)
Progressively longer PR interval until the P wave is not followed by a QPR<\/p>\n\n\n\n2nd Degree Heart Block (Mobitz II)
Rare, but more serious
Sudden appearance of a nonconducted P-wave
P-waves are nl, but some aren’t followed by a QRS complex
PR & RR intervals are constant<\/p>\n\n\n\n3rd degree heart block
no obvious correlation between p and qrs, need pace maker<\/p>\n\n\n\npremature ventricular contraction (PVC)
a ventricular contraction preceding the normal impulse initiated by the SA node (pacemaker)<\/p>\n\n\n\nBigeminy PVC
every other beat is a PVC<\/p>\n\n\n\nPVC couplets
PVC occurring in pairs, no adequate C.O. when this occurs<\/p>\n\n\n\nmonomorphic ventricular tachycardia
presents with wide QRS complexes of a common shape.<\/p>\n\n\n\nTorsades de pointes
Rate: 120 – 200 usually
P wave: Obscured by ventricular waves
QRS: Wide QRS – “Twisting of the Points”
Conduction: Ventricular only
Rhythm: Slightly irregular<\/p>\n\n\n\nVentricular fibrillation (V-fib)
abnormal heart rhythm which results in quivering of ventricles<\/p>\n\n\n\nIdioventricular Rhythm
<40
looks like vtach but slow<\/p>\n\n\n\n\n
- no P waves (from vent foci)<\/li>\n\n\n\n
- Wide QRS
(serious, death like rhythm)<\/li>\n\n\n\n- called “dying heart” rhythm\u2026occasional ventric beat b4 death (asystole)<\/li>\n<\/ul>\n\n\n\n
Accelerated Idioventricular Rhythm
Rate: 50 – 100 usually (usually slow)
P wave: Obscured by ventricular waves (occur during ventricular contraction) – SA node slower than faster ventricular pacing than should be
QRS: Wide QRS
Conduction: Ventricular only
Rhythm: Regular<\/p>\n\n\n\n\n
- benign rhythm that is sometimes seen during acute MI or early after reperfusion. – Rarely sustained, does not progress to vfib, rarely requires treatment<\/li>\n<\/ul>\n\n\n\n
asystole
absence of contractions of the heart<\/p>\n\n\n\nFailure to capture (pacemaker)<\/p>\n\n\n\n
failure to sense (pacemaker)<\/p>\n\n\n\n
Atrial paced rhythm
spike before P wave<\/p>\n\n\n\nVentricular paced rhythm
ventricular contractions which occur in cases of complete heart block.<\/p>\n","protected":false},"excerpt":{"rendered":"Normal sinus rhythmRegularRate: 60-100P Wave: Present, uprightPR Interval: 0.12-0.20 secQRS: <0.12 sec Sinus BradycardiaRegularRate: <60P Wave: Present, uprightPR Interval: 0.12-0.20 secQRS: <0.12 sec Sinus TachycardiaRegularRate: 100-150P Wave: Present, uprightPR Interval: 0.12-0.20 secQRS: <0.12 sec Premature Atrial ContractionIRREGULARRate: depends on underlying rhythmP wave: Present or hidden in T wavePR Interval: 0.12-0.20 secQRS: <0.12 sec Atrial FibrillationIRREGULARAtrial […]<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"site-sidebar-layout":"default","site-content-layout":"","ast-site-content-layout":"default","site-content-style":"default","site-sidebar-style":"default","ast-global-header-display":"","ast-banner-title-visibility":"","ast-main-header-display":"","ast-hfb-above-header-display":"","ast-hfb-below-header-display":"","ast-hfb-mobile-header-display":"","site-post-title":"","ast-breadcrumbs-content":"","ast-featured-img":"","footer-sml-layout":"","ast-disable-related-posts":"","theme-transparent-header-meta":"","adv-header-id-meta":"","stick-header-meta":"","header-above-stick-meta":"","header-main-stick-meta":"","header-below-stick-meta":"","astra-migrate-meta-layouts":"default","ast-page-background-enabled":"default","ast-page-background-meta":{"desktop":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"tablet":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"mobile":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""}},"ast-content-background-meta":{"desktop":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"tablet":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"mobile":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""}},"footnotes":""},"categories":[],"tags":[],"class_list":["post-110344","post","type-post","status-publish","format-standard","hentry"],"_links":{"self":[{"href":"https:\/\/www.learnexams.com\/blog\/wp-json\/wp\/v2\/posts\/110344","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.learnexams.com\/blog\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.learnexams.com\/blog\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.learnexams.com\/blog\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.learnexams.com\/blog\/wp-json\/wp\/v2\/comments?post=110344"}],"version-history":[{"count":0,"href":"https:\/\/www.learnexams.com\/blog\/wp-json\/wp\/v2\/posts\/110344\/revisions"}],"wp:attachment":[{"href":"https:\/\/www.learnexams.com\/blog\/wp-json\/wp\/v2\/media?parent=110344"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.learnexams.com\/blog\/wp-json\/wp\/v2\/categories?post=110344"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.learnexams.com\/blog\/wp-json\/wp\/v2\/tags?post=110344"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}