This document provides information on various cardiac rhythms by describing their characteristic ECG patterns including rate, rhythm, P wave morphology, P-R interval, QRS duration, and common causes. Key rhythms summarized include:
- Normal sinus rhythm has a rate of 60-100 bpm, upright P waves, P-R interval of 0.12-0.20 seconds, and is caused by normal sinus node function.
- Sinus tachycardia has a rate over 100 bpm but otherwise normal P waves and intervals due to conditions like exercise, medications, fever.
- Atrial fibrillation has irregular ventricular rhythm, unidentifiable P waves, and causes like heart disease and thyroid
This document provides information on various cardiac rhythms by describing their characteristic ECG patterns including rate, rhythm, P wave morphology, P-R interval, QRS duration, and common causes. Key rhythms summarized include:
- Normal sinus rhythm has a rate of 60-100 bpm, upright P waves, P-R interval of 0.12-0.20 seconds, and is caused by normal sinus node function.
- Sinus tachycardia has a rate over 100 bpm but otherwise normal P waves and intervals due to conditions like exercise, medications, fever.
- Atrial fibrillation has irregular ventricular rhythm, unidentifiable P waves, and causes like heart disease and thyroid
This document provides information on various cardiac rhythms by describing their characteristic ECG patterns including rate, rhythm, P wave morphology, P-R interval, QRS duration, and common causes. Key rhythms summarized include:
- Normal sinus rhythm has a rate of 60-100 bpm, upright P waves, P-R interval of 0.12-0.20 seconds, and is caused by normal sinus node function.
- Sinus tachycardia has a rate over 100 bpm but otherwise normal P waves and intervals due to conditions like exercise, medications, fever.
- Atrial fibrillation has irregular ventricular rhythm, unidentifiable P waves, and causes like heart disease and thyroid
This document provides information on various cardiac rhythms by describing their characteristic ECG patterns including rate, rhythm, P wave morphology, P-R interval, QRS duration, and common causes. Key rhythms summarized include:
- Normal sinus rhythm has a rate of 60-100 bpm, upright P waves, P-R interval of 0.12-0.20 seconds, and is caused by normal sinus node function.
- Sinus tachycardia has a rate over 100 bpm but otherwise normal P waves and intervals due to conditions like exercise, medications, fever.
- Atrial fibrillation has irregular ventricular rhythm, unidentifiable P waves, and causes like heart disease and thyroid
> 100 Rhythm: R- R = P waves: Upright, similar P-R: 0.12 -0 .20 second & consistent qRs: 0.04 0.10 second P:qRs: 1P:1qRs
Sinus Tachycardia
Causes: intrinsic sinus node disease increased parasympathetic tone drug effect.
Sinus Bradycardia
Rate: < 60 Rhythm: R- R = P waves: Upright; similar P-R: 0.12 -0 .20 second & consistent qRs: 0.04 0.10 second P:qRs: 1P:1qRs
Rate: 60-100 per minute Rhythm: R- R = P waves: Upright, similar P-R: 0.12 -0 .20 second & consistent qRs: 0.04 0.10 second P:qRs: 1P:1qRs
Normal Sinus Rhythm
(NSR)
Causes: Exercise Hypovolemia Medications Fever Hypoxia Substances Anxiety, Fear Acute MI Fight or Flight Congestive Heart Failure
ECG Characteristics
Rhythm
Example
Ischemic heart disease
Hypoxia Acute MI Digitalis toxicity Mitral or tricuspid disease
Atrial Fibrillation
Causes: ischemic heart disease Hypoxia Acute MI Dig Toxicity Mitral or Tricuspid valve disease Pulmonary embolism
Atrial Flutter
Rate:
Atrial: 400-700 Vent. 160-180/minute Rhythm: Atrial: irregular; Vent.: irregular P waves: No identifiable Ps f waves: may be seen. PRI: unable to measure (No identifiable P) qRs: usually normal
Rate:
Atrial rate 250-350
Vent 150 common Rhythm: Atrial = Regular Vent = Reg. or irreg P waves: Not identifiable F waves: Uniform (sawtooth or picket fence ) PRI: not measurable qRs: 0.04 0.10 second
Rate: usually < 100, dependant On underlying rhythm Rhythm: irregular P waves: Early & upright, different from Sinus PR: 0.12 0.20 second; different from Sinus qRs: 0.04 0.10 second P:qRs = 1:1
Premature Atrial Contractions (PAC)
Causes: normal excessive use of caffeine, tobacco, or alcohol CHF Myocardial ischemia or injury Hypokalemia, Dig toxicity COPD
ECG Characteristics
Rhythm
PAC = i
Example
usually < 100,
dependant on the underlying rhythm Rhythm: irregular P waves: Inverted before or after qRs or not visible PR interval: < 0.12 second when inverted P is before qRs qRs: 0.04 0.10 second P:qRs = 1:1 if Ps are visible
Premature Junctional Contraction (PJC)
Causes: Same as PACs
Rate:
Rate: usually 160-220 Rhythm: Regular P waves: differ in shape from Sinus Ps; usually difficult to identify (rate related) PR Interval: Normal when the Ps can be identified; short if WPW present qRs: usually normal Other: Onset sudden, often initiated by a PAC
Paroxysmal Atrial Tachycardia
Causes: Same as PACs
ECG Characteristics
Rhythm
Example
Same as Sinus, Atrial, and
Junctional Tachycardia, and Atrial Flutter
Causes:
Supraventricular Tachycardia (SVT) An umrella term used when unable to distinguish which rhythm is present.
Rhythm: Absolutely regular
Rate: > 150 per minute P Waves: Not visible (PRI not measurable) qRs: normal 0.04 0.10 sec
Causes: Same as Junctional Escape Same as Paroxysmal Atrial Tachycardia (PAT) Rhythms.
Junctional Tachycardia Rate: 101-200
Causes: healthy athlete at rest related to medicationsBeta Blockers, Calcium Channel Blockers, Dig Toxicity or increased parasympathetic tone Acute Inferior Wall MI Rheumatic Heart Disease Post-Cardiac Surgery Valvular Disease SA Node Disease Hypoxia
40-60 61 100 (accelerated) Rhythm: Regular P waves: Inverted before or after qRs or not visible PR interval: < 0.12 second when inverted P is before qRs qRs: 0.04 0.10 second P:qRs 1:1 if Ps are visible
Dependent upon underlying rhythm Rhythm: R R z P waves: Usually absent, if present, not associated with PVC qRs: 0.12 second or greater; bizarre and notched ST & T: Often opposite in direction to the qRs.
Premature Ventricular Complex (PVC)
R on T = PVC falls on the T
wave of the complex before the PVC
Location
Similar shape = Uniformed
Different shape = Multiformed
Morphology
Every other = Bigeminy
Every third = Trigeminy
Pattern
One on a strip = Rare
One in a row = Isolated Two in a row = Pair, couplet Three in a row = V Tachycardia
Timing
Rate:
ECG Characteristics
Rhythm
PVC
Example
PVC
regularity, chaotic undulating waves P Waves:
qRs:
ST/T Wave: Organized activity:
A group of three PVCs in a row or
more at a rate greater than 100/ minute or more constitutes Ventricular Tachycardia.
Causes: Acute Myocardial Infarction Untreated Ventricular Tachycardia Hypothermia R-on-T PVCs Electrolyte imbalance Electrical shock No Cardiac Output or Pulse
Rhythm:
Ventricular Fibrillation Rate:
Causes: Same as PVCs R on T Phenomenon
> 100 per minute and
usually not > 220 Rhythm: Usually regular P Waves: P waves or if present, not associated with qRs qRs: Wide (t 0.12 sec), bizarre ST/T wave: Opposite direction of qRs
Rate: Ventricular rate = 0 Rhythm: unless Ps are present, then regular or irregular P waves: may be present qRs:
P:qRs
Rate > 40 to 100 = Accelerated
Rate: 20-40 per minute Rhythm: R R = P waves: No P waves associated to qRs qRs: > 0.12 sec, notched, bizarre appearance ST/T : Opposite direction of qRs
Idioventricular Rhythm
Causes: Myocardial Infarction Digitalis toxicity Metabolic imbalances Post resuscitation rhythm
ECG Characteristics
Rhythm
Example
2nd degree AV Block,
Type II
2nd degree AV Block,
Type I
1st degree AV Block
Rhythm
More P waves than qRs
X PRI consistent X qRs normal or wide (bundle branch block) X R - Rz or R R =
X More P waves than qRs
X PRI progressively increases in a cycle until P appears w/o qRs. X Cyclic pattern reoccurs XRRz
X 1P : 1 qRs X Prolonged PRI (> 0.20 sec not > 0.40 sec)
ECG Characteristics
Example
= non-conducted P wave
= non-conducted P wave
3rd degree AV Block
Rhythm X More P waves than qRs X P not r/t qRs (P too close, P too far) X PRI varies greatly X qRs normal or wide XRR=
