Rhythms Flashcards
Rhythm- regular (A&V) Rate- 60-99 (A&V) P Waves- present, positive, 1:1 PR- .12-.20 sec QRS- .04-.10 Rx- none
Normal Sinus Rhythm
Rhythm- regular (A&V) Rate- <60 usually 40-60 (A&V) P Wave- present, positive, 1:1 PR- .12-.20 sec QRS- .04-.10 sec Rx- If symptoms- atropine, TCP
Sinus Bradycardia
SB
Rhythm- Regular (A&V) Rate- >99-160 (A&V) P Waves-Present, positive, 1:1 PR- .12-.20 sec QRS- .04-.10 sec Rx- Treat cause (fever, pain, anxiety, hypoxia)
Sinus Tachycardia
ST
Rhythm- Cyclical (irregular but patterned) (varies with respiration) Rate- 60-99(A&V) P Waves- Present, positive, 1:1 PR- .12-.20 sec QRS- .04-.10 sec Rx- none
Sinus Arrhythmia
Seen in presence of another rhythm.
Measure R-R interval to determine length (duration) of pause.
Rx- none, unless symptoms
Sinus Pause
Rhythm- (seen in presence of another rhythm
Rate- come early
P Waves- present, normal or may look different, 1:1
PR- usually .12-.20 sec
QRS- .04-.10 sec Non conducted if not followed by QRS
Rx- generally none unless symptoms
Premature Atrial Complex
PAC
Rhythm- Atrial regular, ventricular regular but can vary
Rate- Atrial 250-400. Ventricular normal, <100 (“controlled”) or fast (“uncontrolled”)
P Waves- Absent flutter (“F”) waves (Sawtooth) (ratio 2:1, 3:1, 4:1, etc.)
PR- none
QRS- .04-.10 sec
Rx- Control rate & convert rhythm Cardioversion (<48 hours) Consider anti-coagulation
Atrial Flutter
AF
Rhythm- Atrial chaotic, erratic ventricular irregular (“irregularly irregular”)
Rate- Atrial >400 Ventricular normal or slow (“controlled”) or fast (“uncontrolled”)
P Waves- Absent fib (“f”) Waves
PR- none
QRS- .04-.10 sec
Rx- Control rate & convert rhythm cardio version (<48 hours) Consider anti-coagulation
Atrial Fibrillation
Afib
Rhythm- regular (A&V)
Rate- 40-60 (A&V)
P Waves- Inverted (before or after QRS) or absent (hidden) or normal with short PRi
PR-
Junctional Rhythm
JR
Rhythm- regular (A&V)
Rate- 61-99 (A&V)
P Waves- Inverted (before or after QRS) or absent (hidden) or normal with a short PRi
PR-
Accelerated Junctional Rhythm
AJR
Rhythm- Regular (A&V)
Rate- >99 (A&V)
P Waves- Inverted (before and after QRS) or absent (hidden) or normal with a short PRi
PR-
Junctional Tachycardia
JT
Rhythm- seen in the presence of another rhythm
Rate- come early
P Waves- inverted (before or after QRS) or absent (hidden) or normal with a short PRi
PR-
Premature Junctional Complex
PJC
Rhythm- seen in the presence of another rhythm
Rate- come late (after pause)
P Waves- Inverted (before or after QRS) or absent (hidden) or normal with a short PRi
PR-
Junctional Escape Beat
JEB
Rhythm- Regular (V) Rate- >100 usually 150-200 P Waves- non discernible PR- none QRS- .04-.10 sec Rx- stable?- vagal &/? Adenosine Unstable- adenosine then cardioversion
Supra ventricular Tachycardia
SVT
Rhythm- regular V only Rate- <40 P Waves- none PR- n/a QRS- >.10 sec Rx- pacing (may try atropine) Back up rhythm - do not eliminate
Idioventricular Rhythm
IVR
Rhythm- regular V only Rate- 40-99 P Waves- none PR- n/a QRS- >.10 sec Rx- none, usually adequate CO
Accelerated Idioventricular Rhythm
AIVR
Rhythm- regular, usually V only Rate- >99-250 P Waves- non discernible PR- n/a QRS- >.10 sec Rx- stable - consider drugs/cardioversion Pulseless- treat like VF
Ventricular Tachycardia
VT
LETHAL
Rhythm- somewhat irregular (spiraling V rhythm) Rate- >99-250 P Waves- not discernible PR- n/a QRS- >.10 sec Rx- Magnesium; check cardiac drug levels Pulseless- treat like VF
Torsades de pointes
LETHAL
Rhythm- chaotic, erratic V only Rate- n/a P Waves- none PR- n/a QRS- n/a Rx- defibrillate once: 120 joules biphasic, 360 joules monophasic; then drugs ACLS
Ventricular Fibrillation
VF
LETHAL
Rhythm- none Rate- none P Waves- none PR- n/a QRS- n/a Rx- check another lead. CPR, pacing, drugs (atropine, epinephrine, vasopressin)
Asystole
LETHAL
Rhythm- Regular, usually A only Rate- 60-99 or <60 A only P Waves- present, normal, QRS absent PR- n/a QRS- n/a Rx- check in another lead. CPR, pacing, drugs (atropine, vasopressin, epi)
Ventricular Standstill
LETHAL
Rhythm- seen in the presence of another rhythm
Rate- come early
P Waves- none
PR- n/a
QRS- >.10 sec
Rx- if symptoms- anti arrhythmia drug (amiodorone, lidocaine)
Premature ventricular Complex
PVC
Rhythm- seen in the presence of another rhythm Rate- come late after a pause P Waves- none PR- n/a QRS- >.10 sec Rx- helper beats - do not eliminate If symptoms, treat slow rate (atropine)
Ventricular Escape Beat
VEB
Rhythm/Rate/P Wave/PR- seen in the presence of another rhythm, must be supraventricular
QRS- >.10 sec
Rx- none, if symptoms treat the underlying rhythm
Bundle Branch Block
BBB
Rhythm- Regular (A&V, except SA) Rate- normal, slow, or fast P Waves- present, positive, 1:1 PR- >.20 sec constant QRS- .04-.10 sec Rx- none
NSR, SB, ST, SA with First Degree Block
Rhythm- Atrial regular, ventricular irregular (grouped beatings)
Rate- 60-99 or <60
P Wave- present, positive, not 1:1, 1 more P than QRS (1 QRS blocked)
PR- progressively lengthens (prolongs) until QRS is blocked (varies)
QRS- .04-.10 or >.10 sec
Rx- if symptoms- TCP, atropine
Second Degree, Type I
Mobitz I, Wenkebach
Rhythm- Atrial regular Ventricular irregular (grouped beatings
OR regular ventricular complexes regularly blocked
Rate- 60-99 or <60
P Waves- present, positive, not 1:1, more P’s than QRS’s (QRS’s “blocked”) (ratio 3:2, 4:3, etc)
PR- .12-.20 or >.20 sec Constant when present (until blocked by the QRS’s)
QRS- .04-.10 or >.10 sec
Rx- if symptoms- TCP, atropine (avoid atropine for wide QRS
Second Degree, Type II
Mobitz II
Rhythm- Regular A&V
Rate- 60-99 or <60 (usually)
P Waves- present, positive, not 1:1, complete A-V dissociation
PR- varies, not constant
QRS- .04-.10 or >.10 sec
Rx- if symptoms-TCP (atropine ONLY if QRS is normal)
Third Degree Block
Complete
