NURS 370 Med Surg Module 5: ECG Rhythm Recognition

Sinus Rhythm

A sinus rhythm is regular with normal P, Q-R-S, T deflections and intervals. 

Rate = 60-100 at rest.

Sinus Rhythm

What Rhythm is This?

Sinus Bradycardia

Sinus bradycardia is a sinus rhythm with a rate less than 60 per minute in an adult.

Sinus Bradycardia 

What Rhythm is This?

Sinus Tachycardia

Sinus tachycardia is a sinus rhythm with a rate greater than 100 per minute in an adult.

Note that the p waves are still present.

Sinus Tachycardia

What Rhythm is This?

First-Degree Heart Block

Sinus rhythm with 1^st degree heart block is a sinus rhythm with a prolonged PR interval > 0.20 seconds due to a delay in transmission from the atria to the ventricles.

First-Degree Heart Block

What Rhythm is This?

Second-Degree AV Heart Block Mobitz Type I

A 2^nd degree AV block is usually classified as Mobitz Type I (Wenckebach) or Mobitz Type II.  A Mobitz Type I heart block is characterized by progressive lengthening of the PR interval until a QRS complex is dropped.

Second-Degree AV Heart Block Mobitz Type I

What Rhythm is This?

Second-Degree AV Heart Block Mobitz Type II

A Mobitz Type II heart block is characterized by an intermittent dropped QRS that is not in a Mobitz Type I pattern.  The Mobitz Type II block must be evaluated since it is one that can rapidly progress to a complete heart block.

Second-Degree AV Heart Block Mobitz Type II

What Rhythm is This?

Third-Degree AV Heart Block

A 3rd degree heart block (sometimes called a complete heart block) is a rhythm in which there is no relationship between the P and QRS waves.  In this case, the P to P intervals are regular but have no relationship to the QRS complexes on the ECG.

Third-Degree AV Heart Block

What Rhythm is This?

Supraventricular Tachycardia

Supraventricular tachycardia (SVT) is an extremely fast atrial rhythm with narrow QRS complexes when the impulse originates above the bundle branches (above the ventricles).

Supraventricular Tachycardia

What Rhythm is This?

Atrial Fibrillation

Atrial Fibrillation (Afib or AF) is a very common arrhythmia.  This rhythm is characterized by no waves before the QRS complex and a very irregular heart rate.

Atrial Fibrillation

What Rhythm is This?

Atrial Flutter

Atrial flutter is a supraventricular arrhythmia that is characterized by a “saw-toothed” flutter appearance on the ECG that represents multiple P waves for each QRS complex.

Atrial Flutter

What Rhythm is This?

Asystole

Asystole is also commonly known as a “flat line” where there is no electrical activity seen on the cardiac monitor.  Not responsive to electrical defibrillation.

Pulseless Electrical Activity

Can be virtually any organized ECG rhythm in a patient who is unresponsive and lacks a palpable pulse. Thus, one cannot learn a PEA rhythm. It should not be confused, however, with specific pulseless scenarios listed previously.

Ventricular Tachycardia

Ventricular tachycardia (Vtach or VT) is characterized by bizarre widened QRS complexes, no P waves and usually a rate over 100 per minute.  May quickly degenerate to Ventricular fibrillation and death.  VT may be responsive to electrical defibrillation.

Ventricular Tachycardia 

What Rhythm is This?

Ventricular Fibrillation

Ventricular fibrillation (Vfib or VF) is characterized by a chaotic wave pattern and no pulse.  VF may be responsive to electrical defibrillation.

Ventricular Fibrillation

What Rhythm is This?