NORMAL SINUS RHYTHM
R-R regular; rate of 60-100
P-P regular; rate of 60-100
P before & every QRS
PR: 0.12-0.20 seconds
QRS: 0.04-0.12
SINUS BRADYCARDIA
R-R regular; rate of <60
P-P regular; rate of <60
P before & for every QRS
PR: 0.12-0.20 seconds
QRS: 0.04-0.12
SINUS TACHYCARDIA
R-R regular; rate of 101-160
P-P regular; rate 101-160
P before & for every QRS
PR: 0.12-0.20 seconds
QRS: 0.04-0.12
SINUS ARRHYTHMIA
R-R irregular & is influenced by respiration @ rate of 60-100
P-P irregular & is influenced by respiration @ rate of 60-100
P before & for every QRS
PR: 0.12-0.20 seconds
QRS: 0.04-0.12 Rate speeds up with inspiration & slows with expiration
SINUS EXIT BLOCK
R-R irregular
P-P irregular
P before & for every QRS
PR: 0.12-0.20 seconds
QRS: 0.04-0.12
Missing P/QRS/T complexes
Rhythm continues on time
SINUS ARREST
R-R irregular
P-P irregular
P before & for every QRS
PR: 0.12-0.20 seconds
QRS: 0.04-0.12 Missing P/QRS/T complexes
Rhythm continues "off-time"
PREMATURE JUNCTIONAL CONTRACTION
R-R irregular because of early beat; regular underlying rhythm
P-P irregular because of early beat; regular underlying rhythm
P before & for every QRS of underlying rhythm
PR: 0.12-0.20 seconds of underlying rhythm
QRS: 0.04-0.12 seconds of underlying rhythm
Early junctional beat & P-wave will be inverted if seen @ all
Will not reset rest of rhythm
JUNCTIONAL ESCAPE RHYTHM
R-R regular; rate of 40-60
P-P regular; rate of 40-60 P-wave inverted, may come before, during or after QRS
PR: not measureable or short
JUNCTIONAL TACHYCARDIA
R-R regular; rate >100
P-P regular; rate >100 (may or may not have visible P @ fast rate) P-wave inverted, may come before, during or after QRS
If P-wave is with T-wave, it will not peak the T-wave
PREMATURE ATRIAL CONTRACTION
R-R irregular because of early beat; regular underlying rhythm
P-P irregular because of early beat; regular underlying rhythm
P before & for every QRS of underlying rhythm
PR: 0.12-0.20 seconds of underlying rhythm
QRS: 0.04-0.12 seconds of underlying rhythm
Early atrial beat will have P-wave, but may have different morphology
& PR will differ from PR of underlying rhythm.
Early P-wave may be hidden in preceding T-wave.
MULTIFOCAL/WONDERING PACEMAKER
R-R may be a little irregular due to different foci in atria conduction
P-P may be a little irregular due to different foci in atria conduction
P before & for every QRS of underlying rhythm Different shaped P-waves due to changes in conduction foci
PR: usually within 0.12-0.20 seconds
QRS: 0.04-0.12 seconds
ATRIAL TACHYCARDIA/PAT
R-R regular; rate of 161-250
P-P regular; rate of 161-250
P before & for every QRS
PR: 0.12-0.20 seconds
QRS: 0.04-0.12 seconds Can come in runs or bursts
ATRIAL FLUTTER
R-R can be either regular or irregular
P-P regular, at a very fast rate
More P-waves than QRS Saw tooth shaped P-waves
ATRIAL FIBRILLATION
R-R irregular, may be rapid rate
P-P indiscernible, atria fibrillation "Irregularly irregular"
FIRST DEGREE HEART BLOCK
R-R regular; rate of 60-100
P-P regular; rate of 60-100
P before & every QRS
PR: >0.20 seconds & may be constant measurement from beat to beat
QRS: 0.04-0.12
MOBITZ TYPE I SECOND DEGREE HEART BLOCK/WENCKEBACH
R-R irregular, rate may be brady
P-P regular, rate may be brady
More P-waves than QRS
P-wave for every QRS
PR: measurement varies; progressively lengthens
QRS: 0.04-0.12 seconds
Missing QRS complexes after some P-waves
SECOND DEGREE HEART BLOCK/MOBITZ II
R-R may be regular or irregular
P-P regular
P-wave for every QRS, but not a QRS for every P-wave More P-waves than QRS
PR: is constant measurement from beat to beat
QRS: 0.04-0.12 seconds
THIRD DEGREE HEART BLOCK/AV DISSOCIATION/COMPLETE HEART BLOCK
R-R regular, usually @ inherent rate of ventricles(20-40)
P-P regular, usually @ inherent rate of atria(60-100) No relationship between P & QRS
PR: always varies
More P-waves than QRS
QRS is usually wider then normal
PREMATURE VENTRICULAR CONTRACTION
R-R irregular because of early beat; regular underlying rhythm
P-P irregular because of early beat; regular underlying rhythm
P before & for every QRS of underlying rhythm
PR: 0.12-0.20 seconds of underlying rhythm
QRS: 0.04-0.12 seconds of underlying rhythm
Early beat will not have P-wave & will be wide & bizarre
Compensatory pause after early beat, underlying rhythm will not continue "on time"
VENTRICULAR TACHYCARDIA
R-R usually regular & rapid
No P-waves
QRS is wide
IDIOVENTRICULAR/VENTRICULAR ESCAPE
R-R regular @ inherent rate of ventricles (usually 20-40)
No P-waves
QRS is wide
VENTRICULAR FIBRILLATION
Irregular & chaotic
No discernable P-waves or QRS complexes
AGONAL
Rate: usually <20
Wide, possible rounded QRS complexes
No P-waves
