1. SCN EKG Review and Strip
Milburn, R.L., & Stech, M

2. Objectives Identify regular and irregular neonatal heart rhythms
Recognize causes of irregular heart rhythms in the neonate
Match irregular heart rhythms with their appropriate medical treatment

3. Overview Basic Neonatal ECG P wave= atrial depolarization
QRS complex= ventricular depolarization
T wave= ventricular repolarization

4. Normal Sinus Rhythm Heart rate 100-180 bpm
Regular, uniform P wave before each QRS complex followed by a T wave
No treatments necessary

5. Sinus Bradycardia Heart rate <100 bpm Slow rate with normal P waves
Caused by:
Hypoxia
Acidosis
Increased intracranial pressure
Increased vagal tone
Abdominal Distention
Hypoglycemia
Hypothermia
Digoxin

6. Sinus Bradycardia Treatments
Treat underlying causes
Administer Oxygen
Resuscitation if appropriate

7. Sinus Tachycardia Heart rate >181 and <220 bpm
Normal P wave that precedes QRS complex
Caused by:
Heart Failure
Fever
Anemia
Pain
Infections
Hypovolemia
Treatment:
Treat underlying cause

8. Atrial Flutter “Saw tooth” flutter waves
P waves may be hidden in QRS complex
Heart rate can reach as high as 500 in neonates
Caused by:
Damage to Sinus Node
Congenital heart disease
Digoxin Toxicity
Idiopathic

9. Atrial Flutter Treatments
If unstable:
Pacing
Electrical cardioversion
If stable:
Digoxin
Propranolol
Amiodarone

10. Atrial Fibrillation “Irregularly irregular”
No two R to R intervals will look the same
Absent P waves
Caused by:
Atrial septal defects
Mitral valve anomalies
Atrial dilatation

11. Atrial Fibrillation Treatments
If unstable:
Electrical cardioversion
If stable:
Digoxin
Propranolol
Due to risk of thrombus, anticoagulant therapy may be started

12. Supraventricular Tachycardia (SVT)
Heart rate >220 bpm
Abnormal P axis
P wave may be seen or hidden
Caused by:
Cardiac defects
Conduction abnormalities
Myocarditis
Systemic infections
Idiopathic

13. SVT Treatments If unstable: If stable: Vagal maneuvers can also treat
Adenosine (0.05 mg/kg)
Amiodarone
If stable:
Propranolol
Digoxin
Vagal maneuvers can also treat
Ice

14. Ventricular Tachycardia
Lethal arrhythmia
Regular rhythm with no P waves
Wide QRS complex
Caused by:
Asphyxia
Cardiac Tumors
Hypoxia
Acidosis
Electrolyte Imbalances
Drug toxicity
Cardiac Anomalies
Conduction Disorders

15. Ventricular Fibrillation
Lethal Arrhythmia
Chaotic rhythm
Rapid and irregular
Caused by:
Hypoxia
Acidosis
Electrolyte Imbalances
Cardiac Anomalies

16. Asystole Lethal Arrhythmia Absence of electrical activity
Rhythm is flat
No P waves or QRS complexes

17. Treatments for Lethal Arrhythmias
Defibrillation for Pulseless rhythms (such as Ventricular Tachycardia and Ventricular Fibrillation)
Cardioversion for rhythms with pulses (such as Ventricular Tachycardia)

18. Abnormal Beats Premature Ventricular Contraction (PVC):
Early with no P wave
Wide QRS complex
T wave inverted
Caused by:
Acidosis
Electrolyte Imbalances
Cardiac Disease
Irritation from invasive lines (such as UVCs)
May be normal in infants up to 2 months of age

19. PVC Treatments Infant should have cardiac work up including: BMP
12 lead EKG
ECHO

20. References
Ambulance Technician Study. (2013). ECG rhythms. Retrieved from
New York-Presbyterian Healthcare System. (2011). Neonatal basic dysrhythmia study guide.