ACLS Rhythms Cheat Sheet

Amanda Hooper
2008-2009
Normal Sinus Rhythm
Arrest Rhythms

Asystole
PEA
Vfib/pulseless Vtach
Agonal Rhythm/Asystole
Pulseless Electrical Activity (PEA)

Note that PEA can look like any rhythm (any organized
electrical activity), but if no pulse it is PEA
Course Ventricular Fibrillation
Fine Ventricular Fibrillation
Non-Arrest Rhythms
• One very important thing that seems like it should be
easy but I always have to remember how to do:
determine the rate…

• Find a QRS complex that is closest to a dark vertical

line. Then count the number of “big boxes” until the
next QRS complex. For each “big box” you pass,
select the next number off the mnemonic "300-150-
100-75-60-50" to estimate the rate.

• Alternatively, you can count the number of big boxes

between two QRS complexes and divide 300 by that
number.
Sinus Tachycardia

Note the rate is > 100 bpm

 Atrial Fibrillation

Note it is “irregularly irregular” and there are

no definite p waves
Atrial flutter

Note the “saw-tooth” pattern

Reentry Supraventricular Tachycardia

This is a regular, narrow

complex tachycardia without P
waves, usually with a sudden
onset and cessation
Monomorphic Ventricular Tachycardia

With ventricular rhythms, QRS is usually wide. V tach is

more organized electrical activity than v fib, but v tach
often deteriorates into v fib so both are very bad!
Polymorphic Ventricular Tachycardia
Torsades de Pointes

A special type of polymorphic Vtach-

Note the “spindling” in the QRS complexes
 Sinus Bradycardia

Note the rate <60 bpm. Could be physiologic or

symptomatic depending on the patient.
1 Degree AV Block
st

Note the increased PR interval

2nd Degree AV Block: Mobitz type I
(Wenckebach)

Note the progressive lengthening of the PR interval

until one P wave (arrow) is not followed by a QRS
2 Degree Block: Mobitz type II
nd

Note the regular PR interval until beats are dropped.

 3rd Degree AV Block

Note the regular P waves and regular ventricular “escape

beats” but no relationship between the P waves and
escape beats.