|
RHYTHM
|
P WAVE
|
PR INTERVAL
|
QRS RATE & RHYTHM
|
COMMENT
|
| normal sinus |
before each QRS, look alike |
constant regular .12-.20 |
60-100, rate follows atrial <.09 |
SA is pacer |
| sinus arrhythmia |
before each QRS |
constant |
60-100 irregular, phasic variation with or without respiration rate same as AR |
Rate increases with inspiration & decreases with expiration or drugs. Common in young & aged. SA node and lungs both innervated by vagus. |
| sinus bradycardia |
before each QRS |
constant |
less than 60 & regular rate follows atrial |
Not often below 40. Athletes, pain, meds |
| sinus tachycardia |
before each QRS |
constant |
greater than 100 & regular, but may vary a little. Rate follows atrial. |
Seldom above 160. May be higher in children. SNS. |
| atrial premature beat |
premature P, may have abn. configuration |
often different than in sinus cycles |
if conducted, a premature QRS will be present |
Usually no compensatory pause. Palpitations. |
| supraventricular tachycardia |
depends on source -- before, during, after QRS -- upright or inverted. |
may not occur, may be constant or variable |
depends on origin of tachycardia. Often regular |
May have abrupt onset & termination. Carotid pressure may terminate. |
| atrial flutter |
saw tooth baseline, about 300 F waves |
constant or variable |
depends on amount of AV block -- often 75, 100, or 150. Regular QRS or irregular. Usually less than AR |
Carotid pressure may produce temporary slowing & unveil the flutter waves |
| atrial fibrillation |
no atrial contraction or kick, no P |
none |
slow or rapid ventricular response. Always loess than AR |
irregular pulse |
| ventricular premature contraction |
none preceding the premature QRS |
none |
not applicable |
QRS broad. Not preceded by premature P & ususally does not interrupt the atrial |
| ventricular tachycardia |
usually not seen. If present not related to QRS |
variable |
usually 100-200, often slightly irregular |
QRS broad & different |
| ventricular fibrillation |
none |
none |
not well defined QRS complexes |
no palpable pulse & no audible heart tone |
| junctional dysrhythmia |
abnormal in shape & size. May precede, follow, or be buried in QRS |
if present less than 0.10 sec. |
QRS normal unless P is buried in it. Rate is 40-60 per minute |
May need pacemaker for slow rates. |
| 1st degree AV block |
before each QRS. Delayed not really a block |
0.20 or more & constant |
regular |
May be a warning 2nd or 3rd degree block will follow |
| 2nd degree AV block Mobitz 1, Wenckebach |
normal AV node dysfunction |
progressively longer until a P wave is not conducted |
QRS normal with an occasional one dropped. Atrial rate normal & greater than ventricular rate |
May progress to a complete block |
| 2nd degree AV block Mobitz II |
normal P; Purkinje dysfunction |
constant |
atrial/ventricular rate 2:1, 3:1, 4:1. QRS may be normal or widened |
Slow ventricular responses require treatment. Decreased CO |
| 3rd degree AV block Complete heart block |
occurs without relationship to QRS. Atrial is faster |
variable |
usually below 60 & usually regular |
Ectopic nodal or focus. Spells of syncope (Stokes Adams attacks)May be due to ventricular asystole, tachycardia, or fibrillation |
