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Name That Rhythm!Name That Rhythm!
Sinus Bradycardia (SB)Sinus Bradycardia (SB)• Normal except HR<60
V-pacedV-paced
Spike before the QRS
What’s the Difference Between Heart What’s the Difference Between Heart BlockageBlockage & & BlockBlock??
Electricity blocked from traveling normally =
arrhythmia
Clogged blood vessels = oxygen to the heart
= heart attack
Idioventricular RhythmIdioventricular Rhythm
• Ventricular beats, but…
at a slow rate
Your patient isGoing down the Drain if he stays
In this rhythm very Long!
Pulseless Electrical Activity (PEA)Pulseless Electrical Activity (PEA)• Normal rhythm,
but…
* No Pulse*
Call Code!Gabriel is blowing
his horn!!
Mobitz I: WenkebachMobitz I: Wenkebach• PR interval gradually longer until a QRS is dropped
• Pattern repeats
normal longer longer dropped QRS
Every second beat is a PVC
BigeminyBigeminy
GeminyCricket!
Atrial Fibrillation (Afib)Atrial Fibrillation (Afib)
• Irregular• No definable P waves
unable to count the # of waves
Premature Ventricular Contraction Premature Ventricular Contraction (PVC)(PVC)
•Early ventricular beat
Normal ValuesNormal Values
Heart RateHeart Rate: 60-100 beats per minute
.12-.20 seconds
< .11 secondsQRS IntervalQRS Interval:
PR IntervalPR Interval:
CoupletCouplet
Failure to CaptureFailure to Capture
• Pacer spike is fired, but no beat follows
Mobitz IIMobitz II
• PR interval consistent except some QRS missing
Example PR intervals: .16 – B - .16 – B - .16 - .16 - B
Blocked QRS
Normal Sinus Rhythm (NSR)Normal Sinus Rhythm (NSR)• Rhythm is normal• Rate normal 60-100• PR normal .12-.20• QRS normal < .11
Junctional RhythmJunctional Rhythm
• No P wave or PR < .12
PausePause
• Period of no electrical activity, then resumes
6 Beats of VT6 Beats of VT
Paroxysmal Atrial Tachycardia (PAT)Paroxysmal Atrial Tachycardia (PAT)
• Sudden rate change > 150 bpm
• QRS shape is similar before & after rate change
QRS look similar in shape
1 º AVB PR interval >.20
.24 - .24 - .24 - .24 - .24
PR intervals:
Sinus Tachycardia (ST)Sinus Tachycardia (ST)• Normal except HR >100 bpm
Ventricular Tachycardia (VT)Ventricular Tachycardia (VT)
• Ventricular beats (wide QRS’s)
• Rate > 150 bpm
Call Code!
Sinus Arrhythmia (SA)Sinus Arrhythmia (SA)• Normal except irregular
AsystoleAsystole• No electrical activity
Call Code!
My heart may stop if This guy was swimming
With me!!!
TrigeminyTrigeminyEvery 3rd beat is a PVC
3rd Degree AV Block3rd Degree AV Block (3º AVB)(3º AVB)
Example PR intervals: .14 – B - .20 – B – B - .12 – B - .44 - .32 - B
blocked normal blocked blocked short blocked normal blocked
Atria & ventricles act independently
• Regular P waves
• Regular QRS complexes
But…P waves and QRS not working together
• PR interval varies (but not in Wenkebach pattern)
• Harmful -- patient needs a pacemaker soon!
Torsades de Pointes
• A form of VTach which looks like the rhythm strip is twisting
Call CODE!
Steps to Interpret RhythmsSteps to Interpret Rhythms
SINUS
ATRIAL
VENTRICULAR
JUNCTIONAL 3. What is the HEART RATE?
4. What is the PR interval?
5. What is the QRS interval?
1. Are the beats at regular or irregular intervals apart?
2. Do you see P, QRS, T pattern?
A-pacedA-paced
A spike before the P wave site
Mobitz IIMobitz IIPR regular except some QRS are dropped
.12 – B - .12 - .12 – B - .12 – BPR intervals:
QRS
Atrial FlutterAtrial Flutter
• Numerous P waves that you can count
Premature BeatsPremature Beats
PVC
PJC
PAC
Wide QRS
PR<.12
PR=.12-.20
Wenkebach
PR gradually longer until QRS dropped
.12 - .18 - .24 – B - .12 - .18 - .24 – B
PR intervals:
Ventricular Fibrillation (VF)Ventricular Fibrillation (VF)
• Squiggly line
Call CODE!
Failure to SenseFailure to Sense• Heart is beating just fine, but pacemaker fires anyway• Spikes are not in a consistent place before P or QRS
--seen in many different places
enters
exits
QRS exits higher than it starts
ST ElevationST Elevation
Wandering Atrial Pacemaker (WAP)Wandering Atrial Pacemaker (WAP)
• P waves vary in shape (at least 3 different P waves)
3º AVB PR interval varies, but not in Wenkebach pattern
.12 – B - .20 – B – B - .16 - .44 – B - .32
PR intervals:
Premature BeatsPremature Beats
Premature Atrial Contraction (PAC)
Premature Junctional Contraction (PJC)
Premature Ventricular Contraction (PVC)
3 Types
Bundle Branch Blocks (BBB)Bundle Branch Blocks (BBB)
QRS >.11
AV-pacedAV-paced
Spikes before the P wave site & QRS
Premature Premature JunctionalJunctional Contraction (PContraction (PJJC)C)
• Early beat
• No P wave or PR interval is <.12
First Degree AV BlockFirst Degree AV Block(1º AVB)(1º AVB)
• PR interval > .20
Example PR intervals: .28 - .28 - .28 - .28 - .28 - .28
A V//
enters
exits
QRS exits lower than it starts
ST DepressionST Depression
Paroxysmal Supraventricular Tachycardia Paroxysmal Supraventricular Tachycardia (PSVT)(PSVT)
• Sudden rate change >150 bpm
• QRS may look different after rate change
QRS look different in shape
Types of AV BlocksTypes of AV Blocks
•First Degree 1°AVB
•Second Degree
•Third Degree 3°AVB
Wenkebach
Mobitz II
Premature Premature AtrialAtrial Contraction (P Contraction (PAAC)C)
• Early beat
• Normal PR interval
The alarm clockAlways goes off
PREMATURELY!!
TripletTriplet
• VT
• VFib
• Asystole
• Torsades
• PEA
Which rhythms are a CODE Blue?
WAY TO GO!WAY TO GO!You’re catching on!You’re catching on!