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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
QRS duration: less than 0.12
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
QRS duration: less than 0.12
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
QRS duration: less than 0.12
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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):
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: 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:
Rhythm: Regular Rate: 120-200 bpm
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
QRS duration: less than 0.12
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):
Rhythm: Underlying sinus rhythm is usually regular; premature beats will be
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:
Rhythm: Regular Rate: 140-200 bpm
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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