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Relias Dysrhythmia Basic A

Normal sinus rhythm Regular Rate: 60- 100 P Wave: Present, upright PR Interval: 0.12-0.20 sec QRS: <0.12 sec Sinus Bradycardia Regular Rate: < P Wave: Present, upright PR Interval: 0.12-0.20 sec QRS: <0.12 sec Sinus Tachycardia Regular Rate: 100- 150 P Wave: Present, upright PR Interval: 0.12-0.20 sec QRS: <0.12 sec Premature Atrial Contraction IRREGULAR Rate: depends on underlying rhythm P wave: Present or hidden in T wave PR Interval: 0.12-0.20 sec QRS: <0.12 sec Atrial Fibrillation

IRREGULAR

Atrial rate: UNMEASURABLE Ventricular rate: variable P wave: unable to see PR Interval: N/A QRS: <0.12 sec A fib RVR IRREGULAR Ventricular rate: 100- 175 P wave: unable to see PR Interval: N/A QRS <0.12 sec Atrial Flutter Usually REGULAR can be irregular Atrial rate: 250- 350 Ventricular rate: variable BUT < atrial rate P Wave: Flutter PR Interval: N/A QRS: <0.12 sec Supraventricular Tachycardia Regular Rate: 150- 350 P wave: Hidden in QRS or T wave PR: unable to determine QRS: <0.12 sec Junctional Rhythm Regular Rate: 40- 60 P Wave: ABSENT or INVERTED

PR Interval: None or <0. QRS: <0.12 sec Accelerated Junctional Rhythm Regular Rate: 60- 100 P Wave: NONE or INVERTED PR Interval: None or <0. QRS: <0.12 sec Junctional Tachycardia Regular Rate: > P Wave: NONE or INVERTED PR Interval: None or <0. QRS: <0.12 sec Premature Ventricular Contraction IRREGULAR Rate: refer to underlying rhythm P Wave: NONE PR Interval: N/A QRS: WIDE and BIZARRE , >0.12 sec Ventricular Tachycardia Regular Rate: > P Wave: NONE PR Interval: N/A QRS: WIDE and BIZARRE, >0.12 sec

Ventricular Fibrillation Chaotic Coarse: big waves Fine: small waves Rate: unmeasurable P Wave: NONE PR Interval: N/A QRS: N/A Idioventricular Regular Rate: 20- 50 P wave: NONE PR Interval: N/A QRS: WIDE, >0.12 sec Accelerated Idoventricular Rhythm Regular Rate: 50- 100 P wave: NONE PR Interval: N/A QRS: WIDE, >0.12 sec 1st Degree AV Block Regular Rate: 60- 100 P Wave: Present, upright PR interval: >0.20 sec CONSISTENTLY LONG QRS: <0.12 sec Husband stays late till 9 consistently

2nd Degree AV Block Type I Mobitz, Wenckebach IRREGULAR Rate: 60- 100 P wave: Present, upright PR Interval: Progressively longer until drop (PR interval longer and longer until drop) QRS: <0.12 sec Husband stays late till 9, then 11, then 1, then doesn't come home at all 2nd Degree AV Block Type II Irregular or regular Rate: < P wave: Present, upright PR Interval: PR interval consistently LONGER like type 1 but then a QRS will drop QRS: <0.12 sec Husband stays late till 9 consistently, then wife goes out and doesn't come home 3rd Degree AV Block Atrials and ventricles don't communicate Rate: regular atrial P wave: Present, upright No relationship between P waves and QRS PR Interval: VARIABLE QRS: variable P-P ad R-R consistent but NO correlation Husband and wife live separate lives and don't communicate SA Node

1st 60 - 100 AV Node 2nd 40 - 60 Bundle of His 3rd 40 - 45 Right and Left Bundle Branches 4th 40 - 45 Purkinje Fibers 5th 20 - 50 1 Small Box 0.04 sec 1 Big Box 0.20 sec Junctional Rhythms SA Node DID NOT FIRE AV Node fired NO P WAVE bc SA node didn't fire Narrow QRS P Wave Amplitude 0.5-2.5 mm Will be shorter than T wave Shows firing of SA node QRS 0.06-0.10 sec SHOULD BE <0.12 sec Wide QRS: delay in ventricular contraction, delay of conduction through bundle branches or purkinje fibers BUNDLE BRANCH BLOCK or BLOCK IN PURKINJE FIBERS (idioventricular) Calculate Regular Rate 1500/ # boxes R-R Calculate Irregular Rate

of Rs in 6 sec strip X 10

Unifocal PVCs Only 1 shape PVC Bigeminy PVC occurs every OTHER beat Trigeminy

PVC occurs every THIRD beat Couplet 2 PVCs together Triplet 3 PVCs together Multifocal Multiple shapes Monomorphic V Tach Same Shapes V Tach Polymorphic V Tach Different Shapes V tach Coarse V Fib Chopy but not as high as polymorphic V tach Fine V Fib Fine and fibrillatory Idioventricular Rhythms Only purkinje fibers firing WIDE QRS always Atrially Paced Spike comes before P Ventricularly Paced Spike comes before QRS and QRS will be wide AV Paced Spike before P and before QR Failure to Capture Spikes with no QRS

Failure to Sense Spikes happen regardless of QRS on their own How to determine the rhythm Regular or irregular? Rate? P before every QRS? QRS for every P? QRS wide or narrow? QT Interval 0.34-0. P Wave 0.06-0.12 sec PR Interval 0.12-0.20 sec SA Node Firing Rhythms Fires normally @ 60- 100

• SR 60- 100
• SB <
• ST 100- 150
• SVT 150- 350 AV Node Firing, SA Node Failed Rhythms Fires normally @ 40- 60
• Junctional rhythm 40- 60
• Accelerated junctional rhythm 60- 100
• Junctional tachycardia 100- 150 Only Purkinje Fibers Firing Rhythms (Everything else has failed) Fires normally @ 20- 50
• Idioventricular 20- 50
• Accelerated idioventricular 50- 100