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 Normal Sinus Rhythm is the normal regular rhythm of the heart set by the natural pacemaker of the heart called the sinoatrial node. It is located in the wall of the right atrium. Normal cardiac impulses start there and are transmitted to the atria and down to the ventricles. |
1. What is the rate? 60-100 beats per minute 2. What is the rhythm? Atrial rhythm regular Ventricular rhythm regular 3. Is there a P wave before each QRS? Yes 4. Are P waves upright and uniform? Yes 5. What is the length of the PR interval? 0.12-0.20 seconds (3-5 small squares) 6. Do all QRS complexes look alike? What is the length of the QRS complexes? Yes 0.06-0.12 seconds (1 ½ to 3 small squares)
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 Sinus Bradycardia is a regular but unusually slow heart beat (less than 60 bpm). Sinus bradycardia is often seen as a normal variation in athletes, during sleep, or in response to a vagal maneuver. |
1. What is the rate? Less than 60 beats per minute 2. What is the rhythm? Atrial rhythm regular Ventricular rhythm regular 3. Is there a P wave before each QRS? Are P waves upright and uniform? Yes Yes 4. What is the length of the PR interval? 0.12-0.20 seconds (3-5 small squares) 5. Do all QRS complexes look alike? What is the length of the QRS complexes? Yes 0.06-0.12 seconds (1 ½ to 3 small squares)
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 Sinus Tachycardia is a fast heartbeat related to a rapid firing of the sinoatrial (SA) node. The clinical dysrhythmia depends on the underlying cause. It may be normal depending on the patient. |
1. What is the rate? 101-160 beats per minute 2. What is the rhythm? Atrial rhythm regular Ventricular rhythm regular 3. Is there a P wave before each QRS? Are P waves upright and uniform? Yes Yes 4. What is the length of the PR interval? 0.12-0.20 seconds (3-5 small squares) 5. Do all QRS complexes look alike? What is the length of the QRS complexes? Yes 0.06-0.12 seconds (1 ½ to 3 small squares)
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 Sinus Arrhythmia is a normal variation in the beating of your heart. A sinus arrhythmia refers to an irregular or disorganized heart rhythm . ▪ This rate usually increases with inspiration and decreases with expiration. |
1. What is the rate? 60-100 beats per minute 2. What is the rhythm? Irregular (varies more than 0.08 sec) 3. Is there a P wave before each QRS? Are P waves upright and uniform? Yes Yes 4. What is the length of the PR interval? 0.12-0.20 seconds (3-5 small squares) 5. Do all QRS complexes look alike? What is the length of the QRS complexes? Yes 0.06-0.12 seconds (1 ½ to 3 small squares)
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 Sinus Arrest or Pause is defined as the transient absence of sinus P waves that last from 2 seconds to several minutes. |
1. What is the rate? Variable, depending on frequency 2. What is the rhythm? Irregular, when sinus arrest is present 3. Is there a P wave before each QRS? Are P waves upright and uniform? Yes, if QRS is present Yes, if QRS is present 4. What is the length of the PR interval? 0.12-0.20 seconds (3-5 small squares) 5. Do all QRS complexes look alike? What is the length of the QRS complexes? Yes, when present 0.06-0.12 seconds (1 ½ to 3 small squares)
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 Atrial Flutter is a coordinated rapid beating of the atria. Atrial flutter is the second most common tachyarrhymia. |
1. What is the rate? Atrial: 250-400 bpm Ventricular: variable 2. What is the rhythm? Atrial: regular Ventricular: may be irregular 3. Is there a P wave before each QRS? Are P waves upright and uniform? Normal P waves are absent; flutter waves (f waves) (sawtooth pattern) 4. What is the length of the PR interval? Not measurable 5. Do all QRS complexes look alike? What is the length of the QRS complexes? Yes 0.06-0.12 seconds (1 ½ to 3 small squares)
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 Atrial Fibrillation The electrical signal that circles uncoordinated through the muscles of the atria causing them to quiver (sometimes more than 400 times per minute) without contracting. The ventricles do not receive regular impulses and contract out of rhythm, and the heartbeat becomes uncontrolled and irregular. It is the most common arrhythmia, and 85 percent of people who experience it are older than 65 years. |
1. What is the rate? Atrial: 350-400 bpm Ventricular: variable 2. What is the rhythm? Irregularly irregular 3. Is there a P wave before each QRS? Are P waves upright and uniform? Normal P waves are absent; replaced by f waves 4. What is the length of the PR interval? Not discernable 5. Do all QRS complexes look alike? What is the length of the QRS complexes? Yes 0.06-0.12 seconds (1 ½ to 3 small squares)
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 Supraventricular Tachycardia (SVT) ▪ Encompasses all fast (tachy) dysrhythmias in which heart rate is greater than 150 beats per minute (bpm) |
1. What is the rate? Atrial: 150-250 bpm Ventricular: 150-250 bpm 2. What is the rhythm? Regular 3. Is there a P wave before each QRS? Are P waves upright and uniform? Usually not discernable, especially at the high rate range (becomes hidden in the QRS) 4. What is the length of the PR interval? Usually not discernable 5. Do all QRS complexes look alike? What is the length of the QRS complexes? Yes 0.06-0.12 seconds (1 ½ to 3 small squares)
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 Premature Atrial Contractions (PAC’s) ▪ A PAC is not a rhythm, it is an ectopic beat that originates from the atria. ▪ Normal beat, but just occurs early! |
1. What is the rate? Usually regular but depends on the underlying rhythm 2. What is the rhythm? Irregular as a result of the PAC 3. Is there a P wave before each QRS? Are P waves upright and uniform? Usually upright but premature and abnormal shape 4. What is the length of the PR interval? 0.12-0.20 seconds (3-5 small boxes) 5. Do all QRS complexes look alike? What is the length of the QRS complexes? Yes 0.06-0.12 seconds (1 ½ to 3 small squares)
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 Premature Ventricular Contractions ▪ A PVC is not a rhythm, but an ectopic beat that arises from an irritable site in the ventricles. ▪ PVCs appear in many different patterns and shapes, but are always wide and bizarre compared to a “normal” beat |
1. What is the rate? Atrial: usually normal Ventricular: usually normal Depends on underlying rhythm 2. What is the rhythm? Depends on underlying rhythm; Irregular during PVC’s 3. Is there a P wave before each QRS? Are P waves upright and uniform? Absent with PVC’s 4. What is the length of the PR interval? Not measureable during PVC’s 5. Do all QRS complexes look alike? What is the length of the QRS complexes? Varies Wide and bizarre (>0.12 sec), occurs earlier than expected
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 Idioventricular Rhythm is also termed ventricular escape rhythm. It is considered a last-ditch effort of the ventricles to try to prevent cardiac standstill. ▪ The SA node and AV node have failed ▪ Rate usually between 20 to 40 beats per minute (bpm) ▪ Cardiac output is compromised!! |
1. What is the rate? Ventricular: 20-40 bpm 2. What is the rhythm? Usually regular 3. Is there a P wave before each QRS? Are P waves upright and uniform? Absent 4. What is the length of the PR interval? Not measureable 5. Do all QRS complexes look alike? What is the length of the QRS complexes? Wide and bizarre (>0.12 sec), with T wave deflection
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 Accelerated Idioventricular Rhythm is last-ditch effort of the ventricles to try to prevent cardiac standstill. • The SA node and AV node have failed • Rate usually between 40 to 100 beats per minute (bpm) • Cardiac output is compromised |
1. What is the rate? Ventricular: 41-100 bpm 2. What is the rhythm? Usually regular 3. Is there a P wave before each QRS? Are P waves upright and uniform? Absent 4. What is the length of the PR interval? Not measureable 5. Do all QRS complexes look alike? What is the length of the QRS complexes? Wide and bizarre (>0.12 sec), with T wave deflection
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 Agonal rhythm is when the Idioventricular rhythm is 20 beats or less per minute. Frequently is seen as the last-ordered semblance of a heart rhythm when resuscitation efforts are unsuccessful. |
1. What is the rate? Ventricular: <20 bpm VERY SLOW!! 2. What is the rhythm? Usually regular 3. Is there a P wave before each QRS? Are P waves upright and uniform? Absent 4. What is the length of the PR interval? Not measureable 5. Do all QRS complexes look alike? What is the length of the QRS complexes? Wide and bizarre (>0.12 sec), with T wave deflection
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 Ventricular Tachycardia almost always occurs in diseased hearts. ▪ Rhythm in which three or more PVCs arise in sequence at a rate greater than 100 beats per minute. ▪ V-tach can occur in short bursts lasting less than 30 seconds, causing few or no symptoms. ▪ Sustained v-tach lasts for more than 30 seconds and requires immediate treatment to prevent death. ▪ V-tach can quickly deteriorate into ventricular fibrillation. |
1. What is the rate? 101-250 bpm 2. What is the rhythm? Atrial rhythm not distinguishable Ventricular rhythm usually regular 3. Is there a P wave before each QRS? Are P waves upright and uniform? No 4. What is the length of the PR interval? Not measureable 5. Do all QRS complexes look alike? What is the length of the QRS complexes? Wide and bizarre (>0.12 sec)
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 Ventricular Fibrillation ♥ V-Fib (coarse and fine) ♥ Occurs as a result of multiple weak ectopic foci in the ventricles ♥ No coordinated atrial or ventricular contraction ♥ Electrical impulses initiated by multiple ventricular sites; impulses are not transmitted through normal conduction pathway |
1. What is the rate? Not discernible 2. What is the rhythm? Rapid, unorganized, not discernable 3. Is there a P wave before each QRS? Are P waves upright and uniform? No 4. What is the length of the PR interval? None 5. Do all QRS complexes look alike? What is the length of the QRS complexes? None
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