Dysrhythmia identification

What is sinus rhythm?

an EKG reading indication the heart’s electrical system is functioning normally and at a normal pace

What is sinus bradycardia?

Sinus rhythm but below the normal heart rate range (less than 60)

What is sinus tachycardia?

Like sinus rhythm but at an above normal pace (100-160BPM)

How do you recognize normal sinus rhythm?

• Must have a P-wave, QRS complex, and a T-wave

• PR interval must be .12-.2 seconds

• No wide, early, or differently looking complexes

What is the difference between sinus rhythm/bradycardia/tachycardia?

• Sinus Rhythm has a rate of 60-100BPM

• Sinus Brady has a rate of less than 60

• Sinus tach has a rate of 100-160

How can Junctional Rhythm be identified?

• Incomplete complexes: P-wave missing

• HR is 40-60BPM

  • may be 60-100BPM if accelerated

How can premature atrial contractions be identified?

• complexes are complete but there are occasional early p-waves

  • early Ps can occur at different rate and they look different than normal P-waves

• HR 60-100BPM

How can Premature ventricular complexes be identified?

• Underlying rhythm may have complete complexes

• PVCs are early, wide, and different looking to normal PVCs

  • also no P-waves prior to PVCs

• HR depends on underlying rhythm

How can atrial fibrillation be identified?

• Complexes incomplete: QRS WNL but w/F-waves instead of P-waves

  • F-waves are constant and may be course or fine

  • Irregular RR intervals

• AR 350-600bpm

• VR 100-160bpm

how can atrial flutter be identified?

• Incomplete complexes

  • F wave (sawtooth wave) constant, QRS intermittent

• AR 240-360BPM

• VR depends on ratio, typically 60-100BPM

How can Supraventricular tachycardia be identified?

• Complete complexes but P waves may be buried

  • QRS and T-wave WNL

• Fast rate from above the ventricles

  • 160-250BPM

How can First degree AV block be identified?

• Complexes complete

  • All intervals except PR are WNL

  • PR interval >.2 seconds

• 60-100BPM

How can Mobitz I be identified?

• Most complexes complete

• Progressive lengthening of the PR interval until a QRS drops

• 60-100BPM

How can Mobitz II be identified?

• Complexes complete sometimes

  • PR is constant and normal

  • Some P-waves are missing QRS

  • Variation in RR

• 30-100BPM

How to identify a 2:1 AV block?

• Complete complexes every other P-wave

How to identify complete heart block?

• Incomplete complexes

  • No relationship between atrial and ventricular depolarization

  • QRS’s can be wide or narrow

• AR 60-100BPM

• VR 20-40BPM

How to identify Monomorphic Ventricular Tachycardia?

• Incomplete complexes

  • Only wide, tall, and bizarre QRS complexes visible

  • >.12 seconds

  • Complexes uniform

• 100-250BPM

How to identify torsades de pointes (polymorphic ventricular tachycardia)?

• Incomplete complexes

  • Only wide, tall, and bizarre QRS complexes visible

  • >.12 seconds

  • Complexes vary in size “twisting of the points”

• 100-250BPM

How to identify ventricular fibrillation?

• Incomplete complexes

  • All waves are F-waves

• Looks like a squiggly line

How to identify wolff-parkinson-white patterns?

• Complete complexes

  • PR interval shortened at <.12sec

  • Delta wave (slurred upstroke of the QRS)

  • T-wave changes (directed opposite the delta wave and QRS complex)

• Delta wave can be + or -

How to identify preexcited atrial fibrillation?

• Bizarre and differently looking QRS complexes with irregular R-R intervals

• Slurred initial upstroke - delta waves

• Occasional sinus rhythm peaking through

• Very fast HR: 100-300BPM

How to identify paced rhythms?

• Pacing will only come through when heart is not doing its job

• Pacemaker spikes will appear when the pacemaker has activated

How to identify pulseless electrical activity?

• Complexes complete

  • Looks like a normal sinus rhythm but there is no mechanical response to the electrical activity

    • Pt has no pulse