EKG- 30 common rhythms
Regular sinus - answer rate 60-100
Regular
narrow QRS
upright P
PRI: .12-.20 seconds
QRS: .06 -.12 seconds
Sinus bradycardia - answer Rate: < 60 bpm
Every P has a QRS and every QRS has a P
PRI: .12 - .20 seconds
QRS: .8 - .12 seconds, narrow
sinus Tachycardia - answer Rhythm: regular/fast
Rate: > 100 bpm, below 150
Every P has a QRS and every QRS has a P
PRI: .12 - .20 seconds
QRS: normal
sinus arrhythmia - answer The irregular pattern of this rhythm fluctuates with inspiration
(HR increases) and expiration (HR decreases). A narrow QRS and upright P waves in
Lead II is expected.
Sinus exit block - answerSinus exit block (sinoatrial block) results from blocked sinus
impulses - impulses not getting through to depolarize the atria. While the sinus is firing
on schedule, the tissue around the SA node is not carrying the impulse. The
seriousness of this dysrhythmia is related to the frequency and duration of the blocks.
Note that each pause is equal to a multiple of previous P-P intervals.
sinus arrest - answeroccurs when the SA node fails to fire. The resulting pause is often
NOT equal to the multiple of P-P intervals seen in Sinus Exit Block. Instead, often an
escape pacemaker such as the AV junction will assume control of the heart. Again, like
Sinus Exit Block, treatment is related to the frequency and duration of the periods of
sinus arrest.
NSR with PACs - answerRhythm: Irregular with PAC's
Rate: dependent on rhythm
Every P has a QRS and every QRS has a P
PRI: .12 - .20, may differ from underlying rhythm
QRS: dependent on rhythm
SVT - answerRhythm: Regular
, Rate: 150-250 bpm
PRI: Dependent on location of "circuit"
QRS: Normal, if accessory pathway used - prolonged (>.12) with delta wave (WPW)
A fib - answerMost common cardiac arrhythmia.
May occur with hypertension, ischemia, mitral valve and pericardial disease, MI, aging.
Increased risk for developing atrial thrombus and systemic embolism. Treatment
includes anticoagulation, drugs to slow ventricular conduction (rate control) and/or
chemical or d/c cardioversion.
Rhythm: irregularly irregular
Rate: slow or fast
No identifiable P's
QRS usually narrow but may be wide with conduction defect
A flutter - answerCharacterized by "saw tooth" atrial activity
Conduction ratio to the ventricles 2:1 - 8:1. ( usually 2:1-4:1)
Caused by a reentrant circuit located in the right atrium.
May occur in COPD, hypoxia, intrinsic cardiac disease, valve disease, pericarditis or
post operatively.
If >150 bpm, may seriously compromise cardiac output.
Treatment is rate control, cardioversion, surgical or catheter ablation.
Rate: atrial rate 250-400 (generally 300bpm)
A paced - answerresults from the electronic pacing of an atrium. Note the vertical spike
before the P wave. An electronic pacemaker lead repeatedly generates a small but
sufficient current to begin depolarization of the atria...and the resulting P wave.
1st degree AV block - answerresults from a prolonged transmission of the electrical
impulse through the AV junction (AV node and the Bundle of His). The significant finding
of this rhythm is a prolonged PR interval of more than .20 seconds. The underlying
rhythm should be identified and named prior to claiming a first degree AV block. For
example, this rhythm is a normal sinus rhythm WITH a first degree AV block.
2nd degree AVB type 1 - answerresults from a cyclical and progressive conduction
delay through the AV junction. The ECG presents with a cyclical lengthening of the PR
interval followed by a dropped QRS - a P wave not partnered with a QRS. The QRS
complexes yield an irregular rhythm. Second degree AV block Type I may be caused by
enhanced vagal tone, myocardial ischemia or the effects of drugs such as calcium-
channel blockers, digitalis and beta-blockers.
2nd degree AVB type 2 - answerypically caused by an intermittent block (interrupted
supraventricular impulse) below the AV node. One or more QRS complexes are
dropped with PR intervals that do not change (fixed PR interval). This irregular rhythm
requires close monitoring: 1) low cardiac output is likely when multiple dropped QRS
complexes occur; and 2) this rhythm can progress to complete heart block (third degree
AVB).
Regular sinus - answer rate 60-100
Regular
narrow QRS
upright P
PRI: .12-.20 seconds
QRS: .06 -.12 seconds
Sinus bradycardia - answer Rate: < 60 bpm
Every P has a QRS and every QRS has a P
PRI: .12 - .20 seconds
QRS: .8 - .12 seconds, narrow
sinus Tachycardia - answer Rhythm: regular/fast
Rate: > 100 bpm, below 150
Every P has a QRS and every QRS has a P
PRI: .12 - .20 seconds
QRS: normal
sinus arrhythmia - answer The irregular pattern of this rhythm fluctuates with inspiration
(HR increases) and expiration (HR decreases). A narrow QRS and upright P waves in
Lead II is expected.
Sinus exit block - answerSinus exit block (sinoatrial block) results from blocked sinus
impulses - impulses not getting through to depolarize the atria. While the sinus is firing
on schedule, the tissue around the SA node is not carrying the impulse. The
seriousness of this dysrhythmia is related to the frequency and duration of the blocks.
Note that each pause is equal to a multiple of previous P-P intervals.
sinus arrest - answeroccurs when the SA node fails to fire. The resulting pause is often
NOT equal to the multiple of P-P intervals seen in Sinus Exit Block. Instead, often an
escape pacemaker such as the AV junction will assume control of the heart. Again, like
Sinus Exit Block, treatment is related to the frequency and duration of the periods of
sinus arrest.
NSR with PACs - answerRhythm: Irregular with PAC's
Rate: dependent on rhythm
Every P has a QRS and every QRS has a P
PRI: .12 - .20, may differ from underlying rhythm
QRS: dependent on rhythm
SVT - answerRhythm: Regular
, Rate: 150-250 bpm
PRI: Dependent on location of "circuit"
QRS: Normal, if accessory pathway used - prolonged (>.12) with delta wave (WPW)
A fib - answerMost common cardiac arrhythmia.
May occur with hypertension, ischemia, mitral valve and pericardial disease, MI, aging.
Increased risk for developing atrial thrombus and systemic embolism. Treatment
includes anticoagulation, drugs to slow ventricular conduction (rate control) and/or
chemical or d/c cardioversion.
Rhythm: irregularly irregular
Rate: slow or fast
No identifiable P's
QRS usually narrow but may be wide with conduction defect
A flutter - answerCharacterized by "saw tooth" atrial activity
Conduction ratio to the ventricles 2:1 - 8:1. ( usually 2:1-4:1)
Caused by a reentrant circuit located in the right atrium.
May occur in COPD, hypoxia, intrinsic cardiac disease, valve disease, pericarditis or
post operatively.
If >150 bpm, may seriously compromise cardiac output.
Treatment is rate control, cardioversion, surgical or catheter ablation.
Rate: atrial rate 250-400 (generally 300bpm)
A paced - answerresults from the electronic pacing of an atrium. Note the vertical spike
before the P wave. An electronic pacemaker lead repeatedly generates a small but
sufficient current to begin depolarization of the atria...and the resulting P wave.
1st degree AV block - answerresults from a prolonged transmission of the electrical
impulse through the AV junction (AV node and the Bundle of His). The significant finding
of this rhythm is a prolonged PR interval of more than .20 seconds. The underlying
rhythm should be identified and named prior to claiming a first degree AV block. For
example, this rhythm is a normal sinus rhythm WITH a first degree AV block.
2nd degree AVB type 1 - answerresults from a cyclical and progressive conduction
delay through the AV junction. The ECG presents with a cyclical lengthening of the PR
interval followed by a dropped QRS - a P wave not partnered with a QRS. The QRS
complexes yield an irregular rhythm. Second degree AV block Type I may be caused by
enhanced vagal tone, myocardial ischemia or the effects of drugs such as calcium-
channel blockers, digitalis and beta-blockers.
2nd degree AVB type 2 - answerypically caused by an intermittent block (interrupted
supraventricular impulse) below the AV node. One or more QRS complexes are
dropped with PR intervals that do not change (fixed PR interval). This irregular rhythm
requires close monitoring: 1) low cardiac output is likely when multiple dropped QRS
complexes occur; and 2) this rhythm can progress to complete heart block (third degree
AVB).
