Cardiac Dysrhythmia Overview to help with ACLS Precourse Examination 2025 Rhythm Strip Samples to help with ACLS Precourse Assessment with Unique Criteria. Heart Block Tricks from Terry

Agonal rhythm/asystole Atrial Fibrillation Atrial Flutter Ventricular Fibrillation Monomorphic Ventricular Tachycardia Normal Sinus Rhythm Polymorphic Ventricular Tachycardia Pulseless Electrical Activity Supraventricular Tachycardia Second-degree atrioventricular block (Mobitz I, Wenckebach) Second-degree atrioventricular block (Mobitz II block) Sinus bradycardia Sinus tachycardia Third-degree atrioventricular block RHYTHM &  ETIOLOGY CRITERIA OVERVIE W UNIQUE CRITERI A SAMPLE STRIPS ***Normal Sinus Rhythm  Normal, None RHY – Regular R – 60-100 P – Upright PRI – 0.12 – 0.20 QRS – 0.04 – 0.10 None, normal rhythm 2 ***Sinus Tachycardia  Exercise  Anxiety  Caffeine  Nicotine  Fever  Shock  CHF  Hypotension  Pain  Hypoxemia  Anterior MI RHY – Regular R – 100 - 160 P – Upright PRI – 0.12 – 0.20 QRS – 0.04 – 0.10 Rate 100 - 160 ***Sinus RHY – Regular Rate below RHYTHM &  ETIOLOGY CRITERIA OVERVIE W UNIQUE CRITERI A SAMPLE STRIPS Bradycardia  Damage SA  Normal sleep athletes  Vagal  Glaucoma  Hypothermia  Inferior MI  Drugs – MS, digoxin, Inderal  IICP R – below 60 P – Upright PRI – 0.12 – 0.20 QRS – 0.04 – 0.10 60 ***PVC/PVD Premature Ventricular Contraction/Depolari zati on  Hypoxia,  Hypotension  anemia  Ischemic hrt dis  Electrolytes AN ECTOPIC BEAT RHY – Irregular R – 60-100 P – Upright PRI – 0.12 – 0.20 QRS– 0.04 – 0.10 SR, early beat has VENT beat (wide & bizarre) 3  M.I.  Myocarditis, pericarditis  CHF  Stress, fatigue, smoking, overeating, caffeine  Hypoglycemia  Sepsis  Cyclic anti- depressants  Acidosis Supraventricular Tachycardia  Not visible sudden start or stop. RHY – Regular R – 160 - 250 P – Upright PRI – 0.12 – 0.20 QRS– 0.04 – 0.10 Rate above 160 - 250 ***Atrial Flutter RHY – Regular or Regular or RHYTHM &  ETIOLOGY CRITERIA OVERVIE W UNIQUE CRITERI A SAMPLE STRIPS  Ischemic heart disease  MI  Dig toxicity  Mitral, Tricuspid valve disease  Stress  PE  Hyperthyroid  Often temp Irregular R– Atrial 250– 400 Vent: 70 - 150 P – none, F’s PRI – none QRS – 0.04 – 0.10 Irregular, no P’s (called F’s) Saw tooth 4 Atrial Fibrillation  Ischemic heart disease  Dig toxicity  CHF  MI  Mitral or Tricuspid valve disease RHY – Irregular R– atrial 350- 600 Vent. – below 100 controlled, above 100 uncontrolled . P – None f’s PRI – none QRS – 0.04– 0.10 Irregular, no P’s (called f’s) ***PEA Pulseless Electrical Activity  Looks like any rhythm that should have a pulse but does not ***2nd degree AV Block Type I – Mobitz I, Wenckeback RHY – Irregular PRI – vary QRS– 0.04 – 0.10 Irregular EXTRA Ps PRI longer & longer, Dropped QRS RHYTHM &  ETIOLOGY CRITERIA OVERVIE W UNIQUE CRITERI A SAMPLE STRIPS ***2nd degree AV Block Type II or Mobitz II RHY – Regular or Irregular PRI – constant QRS – normal or wide Regular or Irregular EXTRA Ps 5 3rd degree AV Block, Complete Heart Block  Same as 1st degree RHY - Regular PRI – vary QRS – usually wide Regular EXTRA Ps PRI varies greatly ***Ventricula r Tachycardia monomorpic  All complexes are the same shape and look the same  Wide complex tachycardia RHY – Regular R – Above 100 P – None PRI –None QRS – Wide, Bizarre R over 100 All Vent beats ***Ventricular Fibrillation  Following V Tach  Acute MI  Electrolyte Imbalance RHY – Chaotic R – None P – None PRI –None QRS – none, fibrillatory line Chaotic wavy line. No pulse. RHYTHM &  ETIOLOGY CRITERIA OVERVIE W UNIQUE CRITERI A SAMPLE STRIPS 6 Torasades de Pointes Polymorphic ventricular tachycardia Best Treated with magnesium RHY – Chaotic waves R – None P – None PRI –None QRS – points twist Chaotic wavy line. No pulse. Points twist ***Agonal  Dying heart  Drugs used in cardiac arrest provide some electrical waves. RHY – Regular R – Slow P – None PRI – None QRS – very very wide Slow wide bizarre stretched out waves. No Pulse ***Asystole  Primary event in cardiac arrest.  Untreated V-tach or V-fib RHY – None unless only Ps R – No Vent rate P – may be present PRI – None QRS – None Straight line or only Ps No Pulse Calculating Heart Rate - note strips on pretest are longer than 6 seconds. Table for Small Box Method To calculate the heart rate, count the number of 0.04 squares (or small boxes) between two QRS complexes (1500 divided by X = HR) Small Boxes from R to R 9 = 168 14 = 107 19 = 79 24 = 63 29 = 52 34 = 44 39 = 38 44 = 34 5 = 300 10 = 150 15 = 100 20 = 75 25 = 60 30 = 50 35 = 43 40 = 37 45 = 33 6 = 250 11 = 136 16 = 94 21= 72 26 =58 31 = 48 36 = 42 41 = 37 46 = 33 7 = 214 12 = 125 17 = 88 22 = 68 27 = 56 32 = 47 37 = 41 42 = 36 47 = 32 8 = 188 13 = 115 18 = 83 23 = 65 28 = 54 33 = 45 38 =40 43 = 35 48 = 31