Rhythm and Strip Normal sinus rhythm

Cardiac Rhythms and Dysrhythmias ECG Characteristics Rate: 60 100 bpm Rhythm: regular There is one P for every QRS PR interval: 0.12 0.20 seconds QRS complex: 0.06 0.10 seconds Rate: 101 150 bpm Rhythm: regular There is one P for every QRS but may be hidden with T wave due to speed PR interval: 0.12 0.20 seconds QRS complex: 0.06 0.10 seconds Rate: < 60 bpm Rhythm: regular There is one P for every QRS PR interval: 0.12 0.20 seconds QRS complex: 0.06 0.10 seconds Rate: varies Rhythm: regular with early beats originating in atria There is one P for every QRS PR interval: not measured QRS complex: 0.06 0.10 seconds Rate: atrial 240 360 bpm, ventricular rate depends on degree of AV block Rhythm: regular P:QRS ratio: 2:1. 4:1, 6:1, or variable PR interval: not measured QRS complex: 0.06 0.10 seconds

Management This is a normal heart rhythm so no treatment is required

Sinus tachycardia

This is only treated if client is symptomatic or is at risk for myocardial damage If there is an underlying cause, betablockers or verapamil can be used This is only treated if client is symptomatic; administer IV atropine, isoproterenol, and/or pacemaker may be used

Sinus bradycardia

Premature atrial contractions (PAC)

This usually requires no treatment. Advise client to reduce alcohol intake, reduce stress, and stop smoking

Atrial flutter

This is treated with synchronized cardioversion; meds to reduce ventricular response such as betablocker or calcium channel blocker followed by a class I antidysrhythmic or amiodarone

Atrial fibrillation

Rate: 300 600 bpm; ventricular 100 180 bpm in untreated clients Rhythm: irregularly regular P:QRS ratio is variable PR interval: not measured QRS complex: 0.06 0.10 seconds Rate: variable Rhythm: irregular; PVC interrupts underlying rhythm and followed by a compensatory pause No P wave noted before a PVC PR interval: absent QRS complex: wide, > 0.12 seconds Rate: 100 250 bpm Rhythm: regular No indentifiable P wave PR interval: not measured QRS complex: 0.12 seconds; bizarre shape Rate: too rapid to count Rhythm: grossly irregular No identifiable P waves PR interval: none QRS complex: bizzare, varying in shape and direction Rate: 60 10 bpm Rhythm: regular There in one P for every QRS PR interval: > 0.20 seconds QRS complex: 0.06 0.10 seconds

This is treated with synchronized cardioversion; meds to reduce ventricular response rate such as metoprolol, diltiazem, or digoxin; anticoagulant therapy to reduce risk of clot formation and stroke This is treated if client is symptomatic; advise against using stimulants (caffeine, nicotine); drug therapy includes, class I and III antidysrhythmics and possibly addition of a beta blocker This is treated if VT is sustained or if client is symptomatic; treatment includes IV procainamide, lidocaine. If unstable, a class III antidysrhythmic and immediate cardioversion; ablation surgery or internal defibrillator for repeated episodes Immediate defibrillation

Premature ventricular contractions (PVC)

Ventricular tachycardia

Ventricular fibrillation

First-degree AV block

No treatment required

Second-degree AV block type 1 (Mobitz 1, Wenckebach)

Second-degree AV block type 2 (Mobitz 2)

Third-degree block (complete heart block)

Rate: 60 100 bpm Rhythm: atrial regular, ventricular irregular P:QRS ratio: 1:1 until P wave is blocked w/ no QRS following PR interval: progressively lengthens in regular pattern QRS complex: 0.06 0.10 seconds; sudden absence of QRS complex Rate: atrial 60 -100 bpm, ventricular < 60 bpm Rhythm: atrial regular, ventricular irregular P:QRS ration: typically 2:1, may vary PR interval: constant PR interval for each conducted QRS QRS complex: 0.06 0.10 seconds Rate: atrial 60 100 bpm; ventricular 15 60 bpm Rhythm: both atrial and ventricular are regular Independent rhythm (no relationship between P and QRS) PR interval: not measured QRS complex:

Treatment includes monitoring and observation; atropine and isoproterenol if client is symptomatic (rarely progresses to a higher level of block)

Treatment includes atropine or isoproterenol; pacemaker therapy

Immediate pacemaker therapy