Systemic Analysis of Cardiac Rhythms

8/22/2019 Systemic Analysis of Cardiac Rhythms

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Systematic Analysis of Cardiac Rhythms

Module One: Sinus Rhythms

Normal Sinus Rhythm:Rhythm: Regular

Rate: 60-100 bpm

P Wave: Uniform in appearance; Small, rounded and precedes each QRSPR interval: 0.12-0.20QRS duration: less than 0.12

Sinus Dysrhythmia:

Rhythm: Irregular in a cyclic, predictable way; related to respiration

Rate: Typically 60-100 bpm, but may also occur in sinus bradycardiaP Wave: Small, rounded and precedes each QRSPR interval: 0.12-0.20

QRS duration: less than 0.12

Sinus Bradycardia:

Rhythm: Regular

Rate: Less than 60 bpmP Wave: Small, rounded and precedes each QRSPR interval: 0.12-0.20


Sinus Tachycardia:

Rhythm: Regular

Rate: 101-160 bpm

P Wave: Small, rounded and precedes each QRSPR interval: 0.12-0.20QRS duration: less than 0.12

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Module Two: Atrial RhythmsPremature Atrial Complexes (PACs):

Rhythm: Underlying sinus rhythm is usually regular; premature beats will be

associated with a pause making rhythm irregular.Rate: Underlying rhythm is usually 60-100

P Wave: Premature P wave will be unlike the normal sinus P wavePR interval: Normal of 0.12-0.20 in underlying rhythm, interval may be shorter for PACs

QRS duration: 0.12 or greater

Atrial Tachycardia: (Also known as Supra-ventricular tachycardia/SVT)

Rhythm: Regular Rate: 160-220 bpm

P Wave: P wave not like the normal sinus P wave; abnormal P wave that is oftenpointed, precedes each QRS

PR interval: Shortened and may not be able to be measured

QRS duration: 0.06-0.10

Atrial Flutter:

Rhythm: VariesRate: Two rates are measured: (1) atrial flutter waves will usually have a rate of

220-350 bpm; (2) ventricular rate varies , 1/3, or of atrial rate but usuallybetween 60-150bpm.

P Wave: No identifiable P wave; saw- tooth or flutter or F waves are present

PR interval: Not measurable


Atrial Fibrillation:

Rhythm: IrregularRate: Atrial rate cannot be counted, ventricular rate will vary but about 120-160 impulses.

P Wave: No identifiable P wave

PR interval: Not measurable


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Wandering Atrial Pacemaker:

Rhythm: Irregular

Rate: Usually 60-100, not greater than 100P Wave: P wave vary in appearance.

PR interval: VariesQRS duration: less than 0.12

Module Three: Junctional Rhythms and AV Blocks

Premature Junctional Contractions (PJCs):


associated with a pause making rhythm irregular.Rate: Underlying rhythm is usually 60-100

P Wave: The premature P wave is unlike the normal sinus P wave; P wave may be

absent or inverted; if a P wave is present it may occur close to the QRS,may be hidden in the QRS, or occur after the QRS

PR interval: Normal of 0.12-0.20 in underlying rhythm, shorter for PACs; less than

QRS duration: Usually normal

Junctional Rhythm: (Also called Junctional Escape Rhythm)

Rhythm: Regular

Rate: Underlying rhythm is usually 40-60P Wave: If a P wave is present it is unlike the normal sinus P wave; P wave may be

absent or inverted; if a P wave is present it may occur before, during, or

after the QRSPR interval: Shorter than 0.12 or shorter than 0.10QRS duration: less than 0.12

Junctional Tachycardia:


P Wave: If a P wave is present it is unlike the normal sinus P wave; P wave may beabsent or inverted; if a P wave is present it may occur before, during, orafter the QRS

PR interval: Shorter than 0.12

QRS interval: less than 0.12

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First-Degree AV Block:

Rhythm: Regular

Rate: Usually 60-100, but may be slower

P Wave: NormalPR interval: Prolonged, greater than 0.20 sec


Second-Degree AV Block Type I: Wenkebach, also known as Mobitz I

Rhythm: Irregular, irregularity may appear predictable or patterned (regularlyirregular)

Rate: Usually within normal range

P Wave: Normal

PR interval: Prolongs beat to beat until you see a P wave with no QRS to followQRS duration: less than 0.12

Second-Degree AV Block Type II: also known as Mobitz II

Rhythm: Irregular

Rate: Usually within normal range

P Wave: Normal

PR interval: PR is greater than 0.20; prolonged PR is consistent beat to beat thenunexpectedly you see a P wave with no QRS to follow

QRS duration: 0.12 or greater

Third Degree AV Block or complete heart block:

Rhythm: P to P is regular, QRS to QRS is regular

Rate: There are two different rates; must measure P to P to find atrial rate and

QRS to QRS to find ventricular rate. These two rates will usually bedifferent.

P Wave: Normal

PR interval: Do not measure the PR in Third Degree AV Block. There is no

relationship between the Ps and QRSs.QRS duration: it could be narrow less than 0.12 seconds or wide 0.12 seconds or greater

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Module Four: Ventricular Rhythms

Premature Ventricular Complexes (PVCs):


associated with a pause making rhythm irregularRate: Underlying rhythm is usually 60-100

P Wave: P wave is normal in the underlying rhythm; no P wave with premature

beats; pause to follow premature beats

PR interval: Normal of 0.12-0.20 in underlying rhythmQRS duration: 0.06-0.10 in the underlying rhythm; QRS of the PVC will be 0.12 or

greater

Ventricular Tachycardia:


P Wave: None; because they are buried in the QRS complexes making themobscure

PR interval: None

QRS duration: Greater than 0.12 sec

Ventricular Fibrillation:

Rhythm: Chaotic rhythm, wavy baseline

Rate: No ability to measure atrial or ventricular rate

P Wave: NonePR interval: NoneQRS duration: None

Asystole:

Rhythm: No rhythm, flat line

Rate: No ability to measure atrial or ventricular rateP Wave: None

PR interval: None

QRS duration: Non3

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Systemic Analysis of Cardiac Rhythms