Rhythm Analysis

Question 1

Rhythms are often named according to what?

Answer 1

the source of the electrical activity in the heart or the structure where the problem is occurring.

Question 2

What will dictate the heart rate?

Answer 2

the fastest electricity in the heart (regardless of location or source)

Question 3

Pacemaker rhythms are identified by what?

Answer 3

the presence of a conspicuous vertical mark known as a “spike”.

Question 4

If the spike precedes the P wave, it is referred to what?

Answer 4

as an Atrial Pacemaker rhythm.

Question 5

If the spike precedes the ventricular depolarization, it is referred to as what?

Answer 5

a Ventricular Pacemaker rhythm.

Question 6

If there is a spike prior to the P wave and the ventricular depolarization, it is referred to as what?

Answer 6

an AV (atrioventricular sequential) Pacemaker rhythm.

Question 7

QRS complexes in Ventricular and Atrioventricular Pacemaker rhythms will look like what?

Answer 7

• have a wide, bizarre appearance (just like ventricular rhythms)
• and typically measure 0.12 seconds or greater.

Question 8

Are pacemakers always on ?

Answer 8

Many pacemakers also are programmed to “sense” the inherent electrical activity occurring within the heart, so the device only turns on when needed and does not compete with the patients own natural electrical activity.

Question 9

A variety of problems can occur when is comes to pacemakers. Name them. (3)

Answer 9

• The wire may not embed in the endocardium or pull out post-procedure
• the device may oversense or undersense
• or fail to capture.

Question 10

How to check if rhythm is regular ?

Answer 10

• When analyzing the tracing you will first check R wave to R wave across the strip.
• If the intervals vary by 1 ½ small boxes or less the rhythm is considered regular.

Question 11

Describe 1500 technique to calculate heart rate

Answer 11

• Starting at the beginning of the tracing through the end, measure from one R wave to the next R wave (ventricular assessment), then P wave to P wave (atrial assessment), then count the number of small boxes between each and divide that number into 1500.
• Most accurate heart rate when analyzing regular heart rhythms.
• You may include ½ of a small box i.e. 37.5/1500 = 40 bpm (don’t forget to round up or down if a portion of a beat is included in the answer).

Question 12

What is an irregular rhythms

Answer 12

If the rhythm varies by two small boxes or more, the rhythm is considered “irregular”.

Question 13

The heart rate determination technique used for irregular rhythms is what?

Answer 13

the “six-second technique”.
Simply count the number of complete cardiac complexes in six seconds and multiply by ten.

Question 15

The P wave in lead II in a normal heart is typically how ?

Answer 15

rounded and upright in appearance.

Question 16

P waves may come in a variety of morphologies. Name them. (8)

Answer 16

• rounded and upright
• peaked
• flattened
• notched
• biphasic (second complex, pictured)
• inverted
• buried
• absent

Question 17

PR interval measurement is from what to what ?

Answer 17

from the beginning of the P wave to the beginning of the QRS complex.

Question 18

The normal range for PR interval is what ?

Answer 18

0.12 – 0.20 seconds (3 to 5 small boxes)

Question 19

The QRS represents what ?

Answer 19

ventricular depolarization

Question 20

The normal duration of the QRS complex measures what ?

Answer 20

from: 0.06 – 0.10 second