Rhythm Rules

Normal Sinus Rhythm: RULES

Everything WNL.

Sinus Brady: RULES

Everything WNL,

less than 60bpm.

Sinus Tach: RULES

Everything WNL,

+100bpm

Sinus Arrhythmia: RULES

Everything WNL,

but irregular rhythm.

Sinus Block: RULES

Misses one or more beats, comes back in cadence

Sinus Pause: RULES

Misses one beat, comes back out of cadence.

Sinus Arrest: RULES

more than one dropped beat, does not come back in cadence. (sinus pause for more than one beat)

Supraventricular Tachycardia (SVT): RULES

+100BPM

NO P WAVE or INVERTED P WAVE

Narrow QRS

Paroxysmal Supraverticular Tachycardia (PSVT): RULES

you can see SVT start, and it stops on its own.

Atrial Flutter: RULES

Sawtooth P Wave (F Wave)

Atrial Fibrillation: RULES

NO P WAVES!!!

Totally Irregular Rhythm

Atrial Fibrillation RVR: RULES

150+

Atrial Fibrillation SVR: RULES

-60bpm

Wandering Atrial Pacemaker: RULES

Rhythm: Slightly Irregular

P Wave: 3 different morphs

PRI: Fvcky (longer/shorter)

Premature Atrial Contractons (PAC): RULES

Premature beat (won't be in cadence or rhythm)

Upright P wave

Narrow QRS

Counts into rate.

Multifocal Atrial Tachycardia (MAT): RULES

+100 BPM

3 P Wave Morphs

Totally Irregular Rhythm

Wolff Parkinson White Syndrome (WPW): RULES

Delta Wave.

(lateral hump into R instead of a Q)

Premature Junctional Contraction (PJC): RULES

No P wave, or Inverted P wave before or after QRS.

Short PRI.

May or may not come back in cadence.

Junctional Escape Rhythm: RULES

40-60BPM!!!

No P Wave, or Inverted P wave before or after QRS.

Short PRI.

Junctional Bradycardia: RULES

LESS THAN 40BPM!!!

No P Wave, or Inverted P wave before or after QRS.

Short PRI.

Accelerated Junctional: RULES

61-100BPM!!!!

No P Wave, or Inverted P wave before or after QRS.

Short PRI.

Junctional Tachycardia: RULES

101+BPM!!!!!

No P Wave, or Inverted P wave before or after QRS.

Short PRI.

First Degree AV Block: RULES

Long PRI, but consistent, unchanging.

If the R is far from the P, ____________________!

Second Degree Heart Block "Mobits I" or "Wenckeback"

RULES

Progressively longer PRI,

Dropped QRS.

Longer, longer, longer, _____________!

Second Degree Type II Heart Block "Mobits II"

RULES

Normal P Waves, but some are missing a QRS.

QRS usually BRADY.

If some Ps don't get through, _____________!

Third Degree AVB "Complete Heart Block": RULES

P WAVES have NO relationship to QRS.

QRS usually BRADY!

If Ps and Qs don't agree, __________________________!!

Idoventricular Rhythm (IVR): RULES

15-40bpm

NO PWAVE

QRS: Wide, greater than 0.12s

Accelerated Idoventricular Rhythm (AVIR): RULES

41-100bpm

NO PWAVE

QRS: Wide, greater than 0.12s

Agonal Rhythm: RULES

Less than 15bpm

Irregular Rhythm

NO P WAVES

Wide QRS, greater than 0.12s.

Premature Ventricular Contractions (PVC): RULES

Early beat.

Wide QRS.

DOES NOT COUNT INTO RATE

COMPENSATORY PAUSE PVC: RULES

PVC creates a dropped beat, but does not throw of cadence.

NON-COMPENSATORY PVC: RULES

PVC creates a dropped beat, then rhythm does not come back in cadence.

INTERPOLATED PVC: RULES

Rhythm stays consistent, PVC does not effect rhythm.

Early beat, within consistent rhythm.

UNIFOCAL PVC's:

PVC's w same morphology.

MULTIFOCAL PVC's:

More than one PCV, w different morphs.

COUPLET PVC's:

TWO back to back PVC's.

TRIPLET PVC's:

THREE back to back PVC's.

BIGEMINAL PVC's:

PVC's every SECOND beat.

TRIGEMINAL PVC's:

PVC every THIRD beat.

QUADGEMINAL PVC's:

PVC every FOURTH beat.

Malignant PVC's:

More than 6 PVC's per minute.

R on T phenomenon.

Couplets, Triplets or runs of V-Tach.

Multifocal. Associated chest pain.

Ventricular Tachycardia (V-Tach): RULES

101-250+bpm

Usually regular, can be slightly irregular.

P WAVES: If present, do not associate w QRS. (Fusion Beat)

QRS: Greater than 0.12s.

Torsades de Pointes (TdP): RULES

100-250+bpm

Irregular

P WAVE: If present, do not associate w the QRS.

QRS: Greater than 0.12s, Changes in morphology & size.

Ventricular Fibrillation (V-Fib): RULES

Chaotic firing of numerous sites in the ventricles.

WONKYYYYY.

Asystole: RULES

NADA, FLAT LINE, U DED

Atrial Paced Rhythm: RULES

Spike BEFORE the P wave.

Ventricular Paced Rhythm: RULES

Spike, NO P wave, WIDE QRS.

A/V Sequential Pacing: RULES

Spike, P WAVE, spike WIDE QRS

Fail to Pace/Capture: RULES

Pacemaker spike, NO PWAVE or QRS.

Runaway Pacemaker: RULES

Pacemaker spike, QRS, but stupid fast.