Name That Rhythm!

Sinus Bradycardia (SB) Normal except HR<60

V-paced Spike before the QRS

What’s the Difference Between Heart Blockage & Block? Electricity blocked from traveling normally = arrhythmia Clogged blood vessels = ioxygen to the heart = heart attack

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) Normal rhythm, but… No Pulse* Gabriel is blowing his horn!! Call Code!

Mobitz I: Wenkebach PR interval gradually longer until a QRS is dropped Pattern repeats normal longer dropped QRS

Every second beat is a PVC Bigeminy Every second beat is a PVC Geminy Cricket!

Atrial Fibrillation (Afib) Irregular No definable P waves unable to count the # of waves

Premature Ventricular Contraction (PVC) Early ventricular beat

Normal Values Heart Rate: 60-100 beats per minute .12-.20 seconds PR Interval: QRS Interval: < .11 seconds

Couplet

Failure to Capture Pacer spike is fired, but no beat follows

Example PR intervals: .16 – B - .16 – B - .16 - .16 - B Mobitz II PR interval consistent except some QRS missing Blocked QRS Example PR intervals: .16 – B - .16 – B - .16 - .16 - B

Normal Sinus Rhythm (NSR) Rhythm is normal Rate normal 60-100 PR normal .12-.20 QRS normal < .11

Junctional Rhythm No P wave or PR < .12

Pause Period of no electrical activity, then resumes

6 Beats of VT

Paroxysmal Atrial Tachycardia (PAT) Sudden rate change > 150 bpm QRS shape is similar before & after rate change QRS look similar in shape

1 º AVB PR interval >.20 PR intervals: .24 - .24 - .24 - .24 - .24

Sinus Tachycardia (ST) Normal except HR >100 bpm

Ventricular Tachycardia (VT) Ventricular beats (wide QRS’s) Rate > 150 bpm Call Code!

Sinus Arrhythmia (SA) Normal except irregular

Asystole No electrical activity Call Code! My heart may stop if This guy was swimming With me!!!

Trigeminy Every 3rd beat is a PVC

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! blocked normal short Example PR intervals: .14 – B - .20 – B – B - .12 – B - .44 - .32 - B

Torsades de Pointes A form of VTach which looks like the rhythm strip is twisting Call CODE!

Steps to Interpret Rhythms 1. Are the beats at regular or irregular intervals apart? 2. Do you see P, QRS, T pattern? SINUS ATRIAL VENTRICULAR JUNCTIONAL 3. What is the HEART RATE? 4. What is the PR interval? 5. What is the QRS interval?

A spike before the P wave site A-paced A spike before the P wave site

PR regular except some QRS are dropped Mobitz II PR regular except some QRS are dropped PR intervals: .12 – B - .12 - .12 – B - .12 – B QRS

Atrial Flutter Numerous P waves that you can count

Premature Beats PVC PJC PAC Wide QRS PR<.12 PR=.12-.20

PR gradually longer until QRS dropped Wenkebach PR gradually longer until QRS dropped PR intervals: .12 - .18 - .24 – B - .12 - .18 - .24 – B

Ventricular Fibrillation (VF) Squiggly line Call CODE!

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

QRS exits higher than it starts ST Elevation QRS exits higher than it starts enters exits

Wandering Atrial Pacemaker (WAP) P waves vary in shape (at least 3 different P waves)

PR interval varies, but not in Wenkebach pattern 3º AVB PR interval varies, but not in Wenkebach pattern PR intervals: .12 – B - .20 – B – B - .16 - .44 – B - .32

Premature Beats 3 Types Premature Atrial Contraction (PAC) Premature Junctional Contraction (PJC) Premature Ventricular Contraction (PVC)

Bundle Branch Blocks (BBB) QRS >.11

Spikes before the P wave site & QRS AV-paced Spikes before the P wave site & QRS

Premature Junctional Contraction (PJC) Early beat No P wave or PR interval is <.12

First Degree AV Block (1º AVB) PR interval > .20 A V // Example PR intervals: .28 - .28 - .28 - .28 - .28 - .28

QRS exits lower than it starts ST Depression QRS exits lower than it starts enters exits

Paroxysmal Supraventricular Tachycardia (PSVT) Sudden rate change >150 bpm QRS may look different after rate change QRS look different in shape

Types of AV Blocks First Degree 1°AVB Second Degree Third Degree 3°AVB Wenkebach Mobitz II

Premature Atrial Contraction (PAC) Early beat Normal PR interval The alarm clock Always goes off PREMATURELY!!

Triplet

Which rhythms are a CODE Blue? VT VFib Asystole Torsades PEA

WAY TO GO! You’re catching on!