Name That Rhythm!

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Name That Rhythm!
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Sinus Bradycardia (SB)

• Normal except HRlt60

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V-paced
Spike before the QRS
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Whats the Difference Between Heart Blockage
Block?
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Idioventricular Rhythm

• Ventricular beats, but
• at a slow rate

Your patient is Going down the Drain if he stays
In this rhythm very Long!
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Pulseless Electrical Activity (PEA)

• Normal rhythm, but
• No Pulse

Gabriel is blowing his horn!!
Call Code!
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Mobitz I Wenkebach

• PR interval gradually longer until a QRS is
  dropped
• Pattern repeats

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Bigeminy

• Every second beat is a PVC

Geminy Cricket!
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Atrial Fibrillation (Afib)

• Irregular
• No definable P waves
• unable to count the of waves

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Premature Ventricular Contraction (PVC)

• Early ventricular beat

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Normal Values

• Heart Rate

60-100 beats per minute
.12-.20 seconds
PR Interval
lt .11 seconds
QRS Interval
12

• Couplet

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Failure to Capture

• Pacer spike is fired, but no beat follows

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Mobitz II

• PR interval consistent except some QRS missing

Example PR intervals .16 B - .16 B - .16 -
.16 - B
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Normal Sinus Rhythm (NSR)

• Rhythm is normal
• Rate normal 60-100
• PR normal .12-.20
• QRS normal lt .11

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Junctional Rhythm

• No P wave or PR lt .12

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Pause

• Period of no electrical activity, then resumes

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6 Beats of VT
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Paroxysmal Atrial Tachycardia (PAT)

• Sudden rate change gt 150 bpm
• QRS shape is similar before after rate change

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• 1 º AVB
• PR interval gt.20

PR intervals
.24 - .24 - .24 - .24 - .24
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Sinus Tachycardia (ST)

• Normal except HR gt100 bpm

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Ventricular Tachycardia (VT)

• Ventricular beats (wide QRSs)
• Rate gt 150 bpm

Call Code!
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Sinus Arrhythmia (SA)

• Normal except irregular

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Asystole

• No electrical activity

Call Code!
My heart may stop if This guy was swimming With
me!!!
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Trigeminy
Every 3rd beat is a PVC
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3rd Degree AV Block (3º AVB)

• Atria ventricles act independently
• Regular P waves
• Regular QRS complexes
• ButP waves and QRS not working together
• PR interval varies (but not in Wenkebach pattern)
• Harmful -- patient needs a pacemaker soon!

Example PR intervals .14 B - .20 B B -
.12 B - .44 - .32 - B
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Torsades de Pointes

• A form of VTach which looks like the rhythm strip
  is twisting

Call CODE!
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Steps to Interpret Rhythms

• 1. Are the beats at regular or irregular
  intervals apart?
• 2. Do you see P, QRS, T pattern?

• 3. What is the HEART RATE?
• 4. What is the PR interval?
• 5. What is the QRS interval?

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A-paced
A spike before the P wave site
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• Mobitz II
• PR regular except some QRS are dropped

PR intervals
.12 B - .12 - .12 B - .12 B
QRS
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Atrial Flutter

• Numerous P waves that you can count

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Premature Beats

• PVC
• PJC
• PAC

Wide QRS
PRlt.12
PR.12-.20
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• Wenkebach
• PR gradually longer until QRS dropped

PR intervals
.12 - .18 - .24 B - .12 - .18 - .24 B
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Ventricular Fibrillation (VF)

• Squiggly line

Call CODE!
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Failure to Sense

• Heart is beating just fine, but pacemaker fires
  anyway
• Spikes are not in a consistent place before P or
  QRS --seen in many different places

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ST Elevation
QRS exits higher than it starts
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Wandering Atrial Pacemaker (WAP)

• P waves vary in shape (at least 3 different P
  waves)

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• 3º AVB
• PR interval varies, but not in Wenkebach pattern

PR intervals
.12 B - .20 B B - .16 - .44 B - .32
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Premature Beats
3 Types
Premature Atrial Contraction (PAC) Premature
Junctional Contraction (PJC) Premature
Ventricular Contraction (PVC)
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Bundle Branch Blocks (BBB)
QRS gt.11
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AV-paced
Spikes before the P wave site QRS
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Premature Junctional Contraction (PJC)

• Early beat
• No P wave or PR interval is lt.12

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First Degree AV Block(1º AVB)

• PR interval gt .20

Example PR intervals .28 - .28 - .28 - .28 -
.28 - .28
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ST Depression
QRS exits lower than it starts
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Paroxysmal Supraventricular Tachycardia (PSVT)

• Sudden rate change gt150 bpm
• QRS may look different after rate change

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Types of AV Blocks
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Premature Atrial Contraction (PAC)

• Early beat
• Normal PR interval

The alarm clock Always goes off PREMATURELY!!
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Triplet
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Which rhythms are a CODE Blue?

• VT
• VFib
• Asystole
• Torsades
• PEA

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WAY TO GO!Youre catching on!