NSR Parameters
Rate? 30 bpm
Regularity? regular
P waves? normal
PR interval? 0.12 s
QRS duration? 0.10 s
Interpretation? Sinus Bradycardia
Rhythm #2
Rate? 70 bpm
Regularity? occasionally irreg.
P waves? 2/7 different contour
PR interval? 0.14 s (except 2/7)
QRS duration? 0.08 s
Interpretation? NSR with Premature Atrial
Contractions
Rhythm #4
Rate? 60 bpm
Regularity? occasionally irreg.
P waves? none for 7th QRS
PR interval? 0.14 s
QRS duration? 0.08 s (7th wide)
Interpretation? Sinus Rhythm with 1 PVC
Rhythm #5
Rate? 70 bpm
Regularity? regular
P waves? flutter waves
PR interval? none
QRS duration? 0.06 s
Interpretation? Atrial Flutter
Rhythm #7
Completely abnormal.
Rhythm #10
Rate? 60 bpm
Regularity? regular
P waves? normal
PR interval? 0.36 s
QRS duration? 0.08 s
Interpretation? 1st Degree AV Block
Rhythm #11
Rate? 50 bpm
Regularity? regularly irregular
P waves? nl, but 4th no QRS
PR interval? lengthens
QRS duration? 0.08 s
Interpretation? 2nd Degree AV Block, Type I
Rhythm #12
Rate? 40 bpm
Regularity? regular
P waves? nl, 2 of 3 no QRS
PR interval? 0.14 s
QRS duration? 0.08 s
Interpretation? 2nd Degree AV Block, Type II
Rhythm #13
Rate? 40 bpm
Regularity? regular
P waves? no relation to QRS
PR interval? none
QRS duration? wide (> 0.12 s)
Interpretation? 3rd Degree AV Block
Ventricular fibrillation
Sinus bradycardia
Normal Sinus Rhythm
Second-degree AV block
(Mobitz Type II)
Sinus tachycardia
Sustained ventricular
tachycardia
First-degree AV block
Atrial flutter with high grade,
variable AV block
Atrial Flutter with multifocal
PVC's
Torsade de Pointes
Rate:70 beats/min.
Rhythm: sinus
P not exceed 3 small seq.
QRS complex: normal
ACLS - KKNGH
ATRIAL FLUTTER 29 July,
2017
30
Rate:> 140 beats/min.
Rhythm: sinus
PR:< 0.20 sec.
QRS complex: normal
SINUS TACHYCARDIA
29 July,
ACLS - KKNGH 31
2017
Rate: wide-ranging ventricular response to atrial rate of 300-400
beats/min.
Rhythm: irregular (classic irregularly irregular)
P waves: Chaotic atrial fibrillatory waves only
Creates disturbed baseline
PR: cannot be measured
QRS: Remains 0.10-0.12 sec unless QRS complex distorted by
fibrillation waves or by conduction defects through ventricles.
29 July,
ACLS - KKNGH 33
2017
Rate: >70 beats/min; usually > 130 bpm
Rhythm: irregular atrial firing
P waves: by definition must have 3 or more P waves that differ in polarity
(up/down).
Shape, and size since the atrial impulse is generated from multiple foci
QRS complex: narrow; 0.10 sec in absense of intraventricular conduction defect.
ACLS - KKNGH
PACs 29 July,
2017
34
Rate: exceeds upper limit of sinus tachycardia (>120
beats/min); seldom <150 beats/min: up to 250 beats/min.
Rhythm: regular
ACLS - KKNGH
JUNCTIONAL RYTHM 29 July,
2017
36
Rhythm: irregular
P waves: is usually obscured by the QRS,ST,or T wave of the PVC s
QRS complex: not normal looking (wider than 0.12 s )
Rate: variable
unifocal or multifocal Beats
ACLS - KKNGH
PVCs 29 July,
37
2017
Rate: ventricular rate> 100 bpm; typically 120 to 250 bpm
Rhythm: only regular ventricular
PR: nonexistent
P waves: seldom seen but present;
QRS complexes: marked variation and inconsistency seen in the QRS complexes
ACLS - KKNGH
V.T. 29 July,
2017
38
Atrial Rate: cannot determine atrial rate
Ventricular rate: 150-250 complexes/min.
Rhythm: only irregular ventricular rhythm
PR: nonexistent
P waves: noneexistent
QRS complexes: display classic spindle-node
ACLS - KKNGH
TORSADES de POINTES 29 July,
2017
39
Rate: <60 beats/min
Rhythm: regular sinus
PR: regular; <0.20 sec.
P waves: size and shape normal;
QRS complex: narrow; sec in absence of intraventricular
conduction defect
Sinus Bradycardia
ACLS - KKNGH
Muscle Tremor Artefact 29 July,
2017
40
Rate: First-degree heart block can be seen with
both sinus bradycardia and sinus tachycardia
Rhythm: sinus, regular, both atria and ventricles
PR: prolonged, >0.20 sec, but does not vary
(fixed)
P waves: size and shape normal
QRS complex: narrow ; 0.10 sec in absence of
intraventricular conduction defect
ACLS - KKNGH
Complete Heart Block 29 July,
2017
44
Idvoventricular Rhythm at 55 bpm -
ACLS - KKNGH Accelerated
29 July,
2017
45
ACLS - KKNGH
Pacemaker Rhythm
29 July,
2017
46
ACLS - KKNGH
ARTEFACT 29 July,
2017
47
THANK YOU
29 July,
ACLS - KKNGH 48
2017