2330 EKG Rhythms

Vent. Rhythm = Reg Rate = 60-100 P waves = (+), 1 QRS PR Interval = .12 - .20 (norm) QRS Duration = <.11 (norm)

Normal Sinus R (binary/octet-stream)

Normal Sinus Rhythm

Sinus Bradycardia

Vent. Rhythm = Reg Rate less than < 60 bpm P wave = (+), 1 P wave / QRS PR Interval = .12 - .20 (norm) QRS less than < .11

Bradycardia (binary/octet-stream)

Ven Rhythm = Reg Rate greater than > 100 P wave = (+),  1 P wave/QRS PR Interval =.12 - .20 QRS less than < .11 (norm)

Tachycardia

Sinus Tachycardia (binary/octet-stream)

Sinus Arrhythmia

Ven Rhythm = Irreg Rate = 60-100bpm P wave = (+),  1 P wave/QRS PR Interval =.12 - .20 (norm) QRS less than < .11 (norm)   Reason: Autonomic nervous system causes small changes in HR associated with breathing Inspiration - Increased HR Expiration - Decreased HR   Sympathetic Stimulation of SA Node (Increased Pacing) - Activated by Inspiration Parasympathetic Stimulation of SA Node (Inhibits Pacing) - Activated by Expiration Variability is normal.  Reduced variability is pathological and indicates increased mortality, especially in heart disease or after infarction.

Sinus Arrhythmia (binary/octet-stream)

Sinoatrial Block

Ven Rhythm = Reg (Except for Event) Rate = Varies P wave = (+),  1 P wave/QRS PR Interval =.12 - .20 (norm) QRS less than < .11 (norm) Misc. = Same as distance between 2 P-P waves

Sinus Block (In Atria)

Unhealthy SA node temporarily fails for at least 1 cycle    -Missed beat has no P wave    -SA node resumes at same rate as before block  

AV Blocks: Slow / Block Impulse Completely

3 Types AV Blocks: 1st Degree AV Block: Lengthens delay between Atrial and Ventricular depolarization    -PR Interval longer than .20 sec (1 big block) (Each cycle is long)  2nd Degree AV Block: Allow some Atrial depolarizations to conduct Vent. while others are blocked.    -Result P wave with no QRS    -PR interval is longer and longer and Drop     2 Types of 2nd Degree AV Blocks: @ AV node & Below AV node          -

2nd Degree:     Type I: Wenkebock

3rd Degree AV Block or Complete AV Block

Sinus Arrest

Ven Rhythm = Reg (Except for Event) Rate = Varies P wave = (+), 1 P wave/QRS PR Interval =.12 - .20 QRS less than < .11 (norm) Misc. = Not the same as distance between 2 P-P intervals # of big boxes between P-P interval after SA arrest is not divisible by # of big boxes between normal P-P interval

Premature Atrial Contraction (PAC's)

Ven Rhythm = Reg (Except for Event) Rate = Varies on underlying rhythm P wave = Premature, (+), 1 precedes QRS, Differ from sinus P wave PR Interval = Normal or Prolonged QRS less than < .11 (norm)   -The Irritable Focus fires early producing a unique P wave. -Next P wave is the SA REST 

Vent. Rhythm = Usually Irreg Rate = 60 - 100bpm P wave = Size/Shape/Direction may Vary PR Interval = Varies QRS less than < .11 (norm) Misc. = If rate is > 100 then called Multifocal Atrial Tach    -Wandering = foci PPM wanders from one to another    -Multifocal Atrial Tach = foci PPM fire at once 

Wandering Atrial Pacemaker (WPM)

Multifocal Atrial Tachycardia (MAT)

Vent Rhythm = Usually Irregular Rate = Over 100 bpm P waves = P wave shape varies PR Interval =  QRS Complex =  Misc. =  MAT is Tachy but WAP (Wandering Atrial Pacemaker) is not Tachy   Seen in pt with COPD. Atrial automaticity foci show early signs of parasystole (entrance block)

Rate = 150 -250 bpm P wave = P waves differ from Sinus P waves PR Interval = Shorter or Longer than Normal QRS less than < .11 (norm)

Atrial Tachycardia

Rate = 150 - 250 bpm P wave = P waves often hidden in QRS PR Interval = Normal IF seen (.12 - .20) QRS less than < .11 (norm)

AVNRT (AV Nodal Re-entrant Tachy)

Ven Rhythm = Reg/Irreg Rate = Variable P wave = Saw Tooth PR Interval = n/a QRS less than < .11 (norm) Only 1, 2 or 3 series of Flutter waves reach Vent.: Result is Vent. don't depolarize at same rate  Identifying Atrial Flutter: Invert Tracing or Perform Vagal Maneuver

Atrial Flutter

Ven Rhythm = Reg/Irreg Rate = Variable Rate P wave = F waves present, No discernible P waves PR Interval = n/a QRS less than < .11 (norm) Misc. = Uncontrolled: >100 bpm & Controlled: <100 bpm Cause: Rapid firing of multiple atrial automaticity foci suffering from entrance block pacing rapidly. (the atrial foci are parasystolic so they are all insensitive to overdrive suppression)    -no single impulse depolarizes atria completely, and only occasional impulse reaches Vent.    -Result: No P waves just erratic spikes,    -Result: occasional impulse to Vent. may produce a rapid or                   slow Vent. rate, but is always Irregular

Atrial Fibrillation

Ven Rhythm = Reg (Unless a-fib present) Rate = 60-100 bpm if sinus is underlying P wave = (+), Normal (Unless a-fib) PR Interval less than < .12 if P waves are seen QRS  > .12 usually Misc. = If PR interval > .12, then Delta wave may be seen (wide slurred QRS)

Woff-Parkinson White (WPW)

Wolff Pw (binary/octet-stream)

Ven Rhythm = Reg with premature beat Rate = Usually Normal P wave = Occur before, during, or after QRS. If BEFORE then INVERTED PR Interval = if present, <.12, if no P wave then n/a QRS less than < .11 (norm)

Premature Junctional Contractions(PJC's)

Ven Rhythm =  Rate =  P wave =  PR Interval =.12 - .20 QRS less than < .11 (norm)

Junctional Escape Beat

Ven Rhythm =  Rate =  P wave =  PR Interval =.12 - .20 QRS less than < .11 (norm)

Junctional Escape Rhythm

Ven Rhythm =  Rate =  P wave =  PR Interval =.12 - .20 QRS less than < .11 (norm)

Accelerated Junctional Rhythm

Ven Rhythm =  Rate =  P wave =  PR Interval =.12 - .20 QRS less than < .11 (norm)

Junctional Tachycardia

Ven Rhythm =  Rate =  P wave =  PR Interval =.12 - .20 QRS less than < .11 (norm) R on T PVC: extra beat occurs on T wave of previous beat

Premature Ventricular Contraction (PVC)

Ventricular Escape Beat

Idioventricular Rhythm (IVR)

Watchout may accually be Agonal rhythm

Accelerated Junctional(s) - No P wave (What all have in common) Arrhythmia -  Vent. Tach Know diff Vent. Fib -  chaotic and not uniform Idoventricular - Slow rate Label EKG