Normal Sinus Rhythm

1. Rate: 60100 beats/ minute

2. Rhythm: Regular
3. P Wave: Before every QRS
complex
4. PR Interval: 0.120.20 seconds
5. QRS Complex: under 0.12
seconds

Sinus Bradycardia
1. Rate: Below 60
2. Rhythm: Regular
3. P Wave: Before every QRS
complex
4. PR Interval: 0.120.20 seconds
5. QRS Complex: under 0.12
seconds
Causes
-MI
-Ischemia to conduction system
(R. Coronary artery)
-Vagal stimulation (vomit, suction)
-Exercise
-Sleep
-Medications (digoxin, BB)

Signs + Symptoms
- Dizziness
- SOB
- Chest pain
- Syncope

Treatment
- Atropine ( HR)
- Pacemaker

What do I do if my pts rate drops?

Check apical HR
Is the patient symptomatic?
If no then monitor
If yes, treat

Sinus Tachycardia
1. Rate: Over 100
2. Rhythm: Regular
3. P Wave: Before every QRS
complex
4. PR Interval: 0.12 to 0.20 seconds
5. QRS Complex: over 0.12 seconds

Causes
-Stress / exercise
-Pain
-Fever
-Caffeine
-Compensation
-Medications (albuterol)

Signs + Symptoms
- Dizziness
- SOB
- Chest pain (heart working
harder)
- Palpitations

Treatment
- Digoxin
- Ca+ channel blockers
- Beta blockers ( all 3 HR)
Is my patient symptomatic?
Am I worried about the heart working
harder?
When would I worry about this?

Atrial Fibrillation - WAVY

Origin: Rapid firing of multiple, irritable foci in atria (atrium quivers)
- Results in an ineffective atrial contraction: Decreased cardiac output
- Atrial kick is lost: Blood ejected into the ventricle by the atria
1.
2.
3.
4.
5.

Rate: May be rapid or slow (Atrial rate faster than ventricular rate)
Rhythm: Irregular
P Wave: Absent *Key feature wavy baseline
PR Interval: Absent
QRS Complex: under 0.12

Causes
- Electrolyte disturbances
- Ischemia
- Conduction system
dysfunction
- Structural defect
- Inflammatory disease
- CHF

Signs + Symptoms
- Dizziness
- Palpitations
- SOB
- Chest pain
- Irregular HR
- Low BP

Atrial Flutter SAWTOOTH

Origin: Irritable focus in atria causes rapid depolarization
1.
2.
3.
4.
5.

Rate: Varies
Rhythm: Regular or irregular
P Wave: Absent sawtooth pattern
PR Interval: Absent
QRS Complex: under 0.12

Treatment
- Amiodarone (Cordarone), digoxin, Beta
Blocker
(Depends on rate)
- May need cardioversion
Concern:
- Atria do not contract
- Blood pools thrombus formation
- Life long anticoagulation!!

Causes:
- Electrolyte disturbances
- Ischemia
- Conduction system
dysfunction

Signs + Symptoms:
- Dizziness
- Palpitations
- SOB
- Chest pain
- May have no symptoms
- Low BP

Treatment:
- Amiodarone (Cordarone), digoxin, Beta
Blocker (Depends on rate)
- May need cardioversion

AV HEART BLOCKS impulses blocked going from SA node to AV node

Causes:
Congenital & atherosclerotic heart disease (most common)
Drugs: digitalis, sympatholytic, BB
Hypokalemia

1ST DEGREE AV BLOCK

Rate 60-100
PROLONGED PR
(greater than 0.20 & conduction is delayed in AV
junction)
QRS complex normal
** Client is asymptomatic
had one

may not even know they

only abnormality is the abnormal duration of the

P-R interval

Treatment stop causative drug & monitor pt

2nd DEGREE AV BLOCK WENCKEBACH

(MOBITZ I)
Impulses are not regularly conducted through the AV
junction
Atrial rate faster than ventricular rate
More Ps than QRS complexes
Irregular rhythm
May be transient
Self limiting
QRS complex is normal
Ventricular rate may be normal

Longer, longer, drop

drops
SA node fires
AV node to

it gets harder & harder for the

** S+S: vertigo, weakness, irregular pulse

Treatment: increase HR w/ atropine or temporary
pacemaker

Prolonged PR then QRS

What are they?

What do you usually see?
Prolonged P-R interval or
More Ps than QRS complexes
No relationship between Ps & QRS complexes
1st degree- prolonged PR interval greater than 0.20 seconds
2nd - Type I- Wenkebach- PR continues to prolong until a QRS is dropped

conduct & a beat is dropped

 2nd - Type II- Mobitz- more Ps than QRS complexes, but when there is a PR interval it remains constant
3rd degree- More Ps than QRS complexes- no relationship to one another.
Causes
- Medications
- Ischemia
- MI
- Electrolyte disturbance

Signs & Symptoms

- Depends on ventricular rate
- Dizziness
- SOB
- Chest Pain
- Unconscious

VENTRICULAR ARRHYTHMIAS

Premature Ventricular Contractions (PVC)

Abnormal focus in the ventricle
Stimulates the ventricle directly
Wide bizarre complex
Usually not perfused

Treatment
- Atropine, Isuprel
- Pacemaker

PREMATURE VENTRICULAR CONTRACTIONS (PVC)

Rate - underlying rate may be normal

Rhythm - regular except when the premature beat occurs & then irregular
Bigeminy PVC every other beat

Trigeminy PVC every 3rd beat

P Waves - Underlying rhythm may be normal within the PVC none

PR- interval - underlying rhythm may be normal within the PVC none
QRS complex - underlying rhythm is normal PVC wide & bizarre

Causes
- Ischemia
- Irritability
- Electrolyte disturbances

Signs & Symptoms

- Dizziness
- Palpitations
- SOB
- CP
- May have low B/P

VENTRICULAR TACHYCARDIA

Rate over 150

Rhythm - regular
NO P wave
NO PR interval
QRS complex - wide & bizarre
Single ectopic focus in the ventricle
fires repeatedly
Can occur as a run 3 or more or
Continuously

Treatment
- Amiodarone (Cordarone)
- Lidocaine, (Procainamide)
- Pronestyl

Causes
- Ischemia
- Irritability
- Electrolyte disturbances

Signs & Symptoms

- May or may not have a
pulse
- Dizziness
- Palpitations
- SOB
- CP
- May have low B/P

Treatment- Treat cause

No pulse Immediate defibrillation
Pulse - Cardioversion
- Amiodarone (Cordarone)

Lidocaine, (Procainamide)
Pronestyl

VENTRICULAR FIBRILLATION
NO
NO
NO
NO
NO

Rate
Rhythm
P waves
PR interval
QRS complex
Ineffective quivering of the ventricle
No atrial or ventricular activity
Multiple ectopic foci
No p waves
No QRS complexes
Wavy baseline

Causes
- Electrolyte disturbances
- Cardiac ischemia
- MI
- Untreated VT
- Cardiomyopathy

Signs & Symptoms

- No pulse
- Unconscious

Treatment
- Immediate defibrillation
- CPR followed by medications
Lidocaine, Amiodarone, Magnesium

ASYSTOLE

No identifiable p waves or QRS complexes

No electrical activity
Differs from Pulseless electrical activity (PEA)
ECG activity electrical activity but heart not pumping
no pulse

Causes
- Advanced heart block,
- MI
- Cardiomyopathy

Signs & Symptoms

- No pulse
- Unconscious

Treatment
- CPR
- Pacemaker