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Name That Rhythm!. Sinus Bradycardia (SB). Normal except HR<60. V-paced. Spike before the QRS. Clogged blood vessels = i oxygen to the heart = heart attack. Electricity blocked from traveling normally = arrhythmia.

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Sinus bradycardia sb
Sinus Bradycardia (SB)

  • Normal except HR<60


V paced
V-paced

Spike before the QRS


What s the difference between heart blockage block

Clogged blood vessels = ioxygen to the heart = heart attack

Electricity blocked from traveling normally = arrhythmia

What’s the Difference Between Heart Blockage & Block?


Idioventricular rhythm
Idioventricular Rhythm

  • Ventricular beats, but…

    at a slow rate

Your patient is

Going down the

Drain if he stays

In this rhythm very

Long!


Pulseless electrical activity pea
Pulseless Electrical Activity (PEA)

  • Normal rhythm, but…

  • No Pulse*

Gabriel is blowing his horn!!

Call Code!


Mobitz i wenkebach

normal

longer

longer

dropped QRS

Mobitz I: Wenkebach

  • PR interval gradually longer until a QRS is dropped

  • Pattern repeats


Bigeminy

  • Every second beat is a PVC

Geminy

Cricket!


Atrial fibrillation afib
Atrial Fibrillation (Afib)

  • Irregular

  • No definable P waves

    unable to count the # of waves



Normal values
Normal Values

Heart Rate:

60-100 beats per minute

.12-.20 seconds

PR Interval:

QRS Interval:

< .11 seconds



Failure to capture
Failure to Capture

  • Pacer spike is fired, but no beat follows


Mobitz ii

Blocked QRS

Mobitz II

  • PR interval consistent except some QRS missing

Example PR intervals: .16 – B - .16 – B - .16 - .16 - B


Normal sinus rhythm nsr
Normal Sinus Rhythm (NSR)

  • Rhythm is normal

  • Rate normal 60-100

  • PR normal .12-.20

  • QRS normal < .11


Junctional rhythm
Junctional Rhythm

  • No P wave or PR < .12


Pause
Pause

  • Period of no electrical activity, then resumes



Paroxysmal atrial tachycardia pat

QRS look similar in shape

Paroxysmal Atrial Tachycardia (PAT)

  • Sudden rate change > 150 bpm

  • QRS shape is similar before & after rate change


1 º AVB

PR interval >.20

PR intervals:

.24 - .24 - .24 - .24 - .24


Sinus tachycardia st
Sinus Tachycardia (ST)

  • Normal except HR >100 bpm


Ventricular tachycardia vt
Ventricular Tachycardia (VT)

  • Ventricular beats (wide QRS’s)

  • Rate > 150 bpm

Call Code!


Sinus arrhythmia sa
Sinus Arrhythmia (SA)

  • Normal except irregular


Asystole
Asystole

  • No electrical activity

Call Code!

My heart may stop if

This guy was swimming

With me!!!


Trigeminy
Trigeminy

Every 3rd beat is a PVC


3rd degree av block 3 avb

normal

normal

blocked

blocked

blocked

blocked

blocked

short

3rd Degree AV Block(3º AVB)

Atria & ventricles act independently

  • Regular P waves

  • Regular QRS complexes

    But…P 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


Torsades de pointes
Torsades de Pointes

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

Call CODE!


Steps to interpret rhythms

SINUS

ATRIAL

JUNCTIONAL

VENTRICULAR

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?


A paced
A-paced

A spike before the P wave site


Mobitz II

PR regular except some QRS are dropped

PR intervals:

.12 – B - .12 - .12 – B - .12 – B

QRS


Atrial flutter
Atrial Flutter

  • Numerous P waves that you can count


Premature beats
Premature Beats

PVC

PJC

PAC

Wide QRS

PR<.12

PR=.12-.20


Wenkebach

PR gradually longer until QRS dropped

PR intervals:

.12 - .18 - .24 – B - .12 - .18 - .24 – B


Ventricular fibrillation vf
Ventricular Fibrillation (VF)

  • Squiggly line

Call CODE!


Failure to sense
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


exits

enters

ST Elevation

QRS exits higher than it starts


Wandering atrial pacemaker wap
Wandering Atrial Pacemaker (WAP)

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


3º AVB

PR interval varies, but not in Wenkebach pattern

PR intervals:

.12 – B - .20 – B – B - .16 - .44 – B - .32


Premature beats1
Premature Beats

3 Types

Premature AtrialContraction (PAC)

Premature JunctionalContraction (PJC)

Premature Ventricular Contraction (PVC)



Av paced
AV-paced

Spikes before the P wave site & QRS


Premature junctional contraction p j c
Premature JunctionalContraction (PJC)

  • Early beat

  • No P wave or PR interval is <.12


First degree av block 1 avb

//

A

V

First Degree AV Block(1º AVB)

  • PR interval > .20

Example PR intervals: .28 - .28 - .28 - .28 - .28 - .28


enters

exits

ST Depression

QRS exits lower than it starts


Paroxysmal supraventricular tachycardia psvt

QRS look different in shape

Paroxysmal Supraventricular Tachycardia (PSVT)

  • Sudden rate change >150 bpm

  • QRS may look different after rate change


Types of av blocks

Wenkebach

Mobitz II

Types of AV Blocks


Premature atrial contraction p a c
Premature Atrial Contraction (PAC)

  • Early beat

  • Normal PR interval

The alarm clock

Always goes off

PREMATURELY!!



Which rhythms are a CODE Blue?

  • VT

  • VFib

  • Asystole

  • Torsades

  • PEA


Way to go you re catching on
WAY TO GO!You’re catching on!


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