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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

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
slide8

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
slide20
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

slide30
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

slide33
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
slide36

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)
slide38
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

slide44

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

First Degree 1°AVB

  • Second Degree
  • Third Degree 3°AVB

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!!

slide49

Which rhythms are a CODE Blue?

  • VT
  • VFib
  • Asystole
  • Torsades
  • PEA
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