normal sinus rhythm (NSR) Criteria: (PR, QRS, QT, Rhythm: reg or irreg)
1 P-wave for Every QRS, REGULAR rhythm
PR: 0.12-0.20
QRS: 0.06-0.10 BBB = > 0.12
QT: 0.36-0.44
BPM: 60-100
Sinus Bradycardia Cr
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normal sinus rhythm (NSR) Criteria: (PR, QRS, QT, Rhythm: reg or irreg)
1 P-wave for Every QRS, REGULAR rhythm
PR: 0.12-0.20
QRS: 0.06-0.10 BBB = > 0.12
QT: 0.36-0.44
BPM: 60-100
Sinus Bradycardia Criteria: (PR, QRS, QT, Rhythm: reg/irreg)
PR: 0.12-0.20
QRS: 0.06-0.10
QT: 0.36-0.44
BPM: < 60 (Reg. rate)
Tx: Atropine 0.5mg, Pace, Dopamine 2-10 mcg/kg/min, Epie 2-10 mcg/min
Sinus Tachycardia Criteria: (PR, QRS, QT, Rhythm: reg/irreg)
PR: 0.12-0.20
QRS: 0.06-0.10
QT: 0.36-0.44
BPM: 100-150 (Reg. rate, P wave may merge with T-wave)
Cause: fear, anxiety, hypoxia, sepsis, hypovolemia, infection
Sinus Arrhythmia Criteria: (PR, QRS, QT, Rhythm: reg/irreg)
PR: 0.12-0.20
QRS: 0.06-0.10
QT: 0.36-0.44
BPM: HR increase w/ inspiration, HR decrease w/expiration
P-P interval lengthen and shorten with respirations
Irreg Rhythm
NO TX
Sinus Pause Criteria: (PR, QRS, QT, Rhythm)
PR: 0.12-0.20
QRS: 0.06-0.10
QT: 0.36-0.44
Irregular rhythm
Short Pause: no TX; Long/Freq. Pause & symptomatic = TX like Sinus Brady
Premature Atrial Contraction (PAC)
Heart Rate: Depends on underlying rhythm
Regularity: Interrupts the regularity of underlying rhythm
P-Wave: can be flattened, notched, or unusual. May be hidden within the T wave
PRI: measures between .12-.20 seconds and can be prolonged; can be different from other complexes
QRS: <.12 seconds
TX: none, check Lytes, precursor for A-Fib/Flutter
Atrial Fibrillation (A-Fib) (PR, QRS, QT, RHYTHM, TX)
PR: Can't Measure NO P WAVE
QRS: 0.06-0.10
QT: May/May Not be Measurable
Rhythm: IRREGULARLY IRREGULAR
Rate: Atrial >400 BPM
Tx: Diltiazem (Cardizem), Amiodarone, Beta Blocker (Lopressor), Digoxin, Anti-Coag (Heparin), Cardiovert
Atrial Flutter (PR, QRS, QT, RHYTHM, TX)
PR: Can't Measure NO P WAVE
QRS: 0.06-0.10
QT: Can't Measure
Rhythm: Ventricular Rate = Reg. Atrial = Irreg
Atrial Rate 250-400 Ventricular: count QRS
"Saw Tooth/Flutter Waves" Tx: Same as A-Fib
paroxysmal atrial tachycardia (PAT) (PR, QRS, QT, RHYTHM, TX)
an episode that begins and ends abruptly during which there are very rapid and regular heartbeats that
originate in the atrium
PR: 0.12-0.20
QRS: 0.06-0.10
QT: 0.36-0.44
Atrial Rate: 150-250 Reg
Vent Rate: 150-250
Tx: Adenosine, Diltiazem, vagal, Cardiovert
Premature Junctional Contraction (PJC) (PR, QRS, QT, RHYTHM, TX)
Rate: Normal or accelerated 60-100
P wave: Inverted Before/After QRS, Absent
PR: 0.12-0.20
QRS: normal 0.06-0.10
QT: 0.36-0.44
Conduction: normal
rhythm: irregular: PICs occur early in cycle of baseline rhythm
NO TX: check E-Lytes
-an ectopic pacemaker in the AV Junction produces PJC's
Junctional Rhythm (PR, QRS, QT, RHYTHM, TX)
Rate: Atrial 40-60, Ven. 40-60, Regular
P-Wave: Inverted, Before/After QRS, Absent
PR: <0.12 (May not be able to if Absent) (May be <0.12 if before QRS)
QRS: 0.06-0.10
QT: 0.36-0.44
Tx: If symptomatic Atropine, Pacemaker
Accelerated Junctional Rhythm (PR, QRS, QT, RHYTHM, TX)
Rhythm: Regular regular rhythm
Rate 60-100
P-waves = inverted or occur before during or after QRS, PRI measured if p before QRS <0.12
PR: <0.12 (May not be able to if absent/ may be <0.12 if before QRS)
QRS: 0.06-0.10
QT: 0.36-0.44
Tx: None
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Junctional Tachycardia (PR, QTS, QT, RHYTHM, TX)
Rate: 100 to 180bpm
Regularity: regular
P-wave: inverted, absent, or occur after the QRS-complex
PR-interval: short or absent (<0.12)
QRS: 0.06-0.10
QT: 0.36-0.44
Tx: Vagal, Adenosine, Amiodarone, Cardiovert
Supraventricular Tachycardia (SVT) (PR, QTS, QT, RHYTHM, TX)
NO P-Waves d/t rapid vent. rate
Rate: >150 bpm
Regularity: Regular
PR: Unable to determine
QRS: 0.06-0.10 (Narrow Fast QRS)
QT: 0.36-0.44
Tx: Vagal, Adenosine (6mg, 12mg push), Beta Blocker/CA Channel Blocker, Cardiovert
premature ventricular contraction (PVC) (PR, QRS, QT, RHYTHM, TX)
NO P-Waves; Early Premature Beat
PR: unable to determine
QRS: >0.12 (Wide)
T-Wave - opposite direction of QRS
Patterns: Couplets, bigeminy, trigeminy, quadrigeminy
Unifocal/Multifocal
Compensatory Pause: distance btw complex before and after PVC twice distance of one R-R interval
Tx: E-Lytes, Amiodarone, Lidocaine
Unifocal PVCs
PVCs have the same shape
Same Direction
Multifocal PVCs
PVC Arise from different foci and appear different in shape from each other.
Different Direction
Couplet PVC
Two PVC's occurring together without any pause in between
Bigeminy PVC
every other beat is a PVC
Trigeminy PVCs
every third beat is a PVC
Quadrigeminy PVC
every fourth complex is a PVC
Ventricular tachycardia (V-tach)
No P-Waves
Rhythm: Regular to slightly irregular
Rate: Ventricular 150-300
PR: Unable to Determine
QRS: >0.12 (Wide)**
QT: Unable to Determine
*Check Pulse Immediately*
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V-tach with a pulse
Amiodarone 150mg Bolus
if cont. synchronized Cardiovert
Check E-Lytes
v-tach w/out pulse
Shock ASAP
* CPR 2 min
-IV/IO access
Shockable?
-shock
* CPR 2min (change compressor)
-epinephrine 1mg 1:10,000 Q3-5min
-consider advanced airway, capnography
Shockable?
-shock
* CPR 2 min (change compressor)
-amiodarone 300mg bolus
-H's n T's (Hypoxia, Hypovolemia.. / Toxins, Thrombosis:coronary)
Shockable?
-shock
* CPR 2min (change compressor)
-epinephrine 1mg 1:10,000 Q3-5min
Shockable?
-shock
* CPR 2 min (change compressor)
-amiodarone 150mg
Torsades de pointes (TdP)
type of polymorphic VT associated with a prolonged QT interval; the QRS changes in shape, amplitude,
and width and appears to twist around the isoelectric line, resembling a spindle
PR: Unable to determine
Rate: >150-300
QRS: >0.12
QT: Prolonged > 0.44
Tx: IV Magnesium Sulfate
unresponsive & Pulseless = CPR, DEFIB
Ventricular fibrillation (V-fib)
Rhythm: Erratic, Chaotic, Irregular
P-Wave: Absent
Rate: Too Rapid to Count
PR: Unable to Assess
QRS: Unable to Assess
QT: Unable to Assess
Tx: CPR, DEFIBRILLATION, EPINEPHRINE, AMIODARONE
Idioventricular Rhythm (IVR)
Rate: 20-40
Rhythm: regular
P-Wave: Absent
QRS wide and bizarre in shape > 0.12
escape or usurpation
Tx: Pacemaker, Atropine, Epinephrine
Agonal rhythm
A cardiac dysrhythmia seen just before the heart stops altogether; essentially asystole with occasional
QRS complexes that are not associated with cardiac output.
P-Waves: None
PR: Unable to assess
QRS: >0.12
QT: Unable to assess
Tx: None; seen at end of cardiac arrest; referred to as dying Heart Pattern
CPR, Epie
Asystole
No Electrical Activity; No Contraction; No CO/Pulse "Flatline"
Rhythm: None
Rate: None
P-Waves: Maybe a few
PR: None
QRS: None
QT: None
Tx: CPR, EPINEPHRINE
*NO DEFIBRILLATE*
Pulseless Electrical Activity (PEA)
condition in which electrical activity is present on an electrocardiogram, but there is not an adequate
pulse or blood pressure
Rhythm on Monitor; NO Pulse;No CO
Tx: Same as Asystole; CPR, EPINEPHRINE
Different Heart Blocks
First Degree
Second Degree Type I
Second Degree Type II
Third Degree or Complete Heart Block (CHB)
Heart Block Poem Mneumonic
-If the R is far from the P then you have a FIRST DEGREE
PR >0.20
-Longer, longer, longer drop then you have a Wenkebach (SECOND DEGREE TYPE I)
P-Wave dropped progressively
-if some Ps don't get through then you have a Mobitz II (SECOND DEGREE TYPE II)
PR CONSTANT; More P than QRS 2:1, 3:1, 4:1
-If Ps and Qs don't agree then you have a third degree
More P than QRS and don't occur in constant manner
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First Degree AV Heart Block
PR interval is longer than 0.20 sec
-can be caused by CCB or beta-blockers, sometimes in athletes, diseased AV node
Not a rhythm NSR with first degree heart block**
Rhythm: Regular
Rate: Variable
PR >0.20
QRS: 0.06-0.10 if >0.12 = BBB
QT: 0.36-0.44
Tx: None
Second Degree Type I AVB/ Wenckebach/Mobitz I
Progressive Delay of impulse until one is blocked
PR GETS PROGRESSIVELY LONGER
Rhythm: Atrial = Regular Ventricular = Irregular
Rate: 60-100 Atrial rate faster than Ventricular
PR: 0.12 but gets progressively longer until QRS complex dropped
QRS: 0.06-0.10
QT: 0.36-0.44
Tx: If symptomatic = atropine, temporary pacing
Second Degree Type 2 AV Block/ Mobitz II
Rhythm: Atrial Always Regular; Ventricular Regular or Irregular depends on conduction ratio (2:1,3:1,4:1)
Rate: Atrial (60-100) faster than Ventricular (<60)
P-Waves: more P-Waves than QRS
PR: 0.12-0.20 (may be prolonged)
QRS: 0.06-0.10
QT: 0.36-0.44
Tx: Pace, Atropine, Dopamine, Epinephrine
