Name That Rhythm!Name That Rhythm!

Sinus Bradycardia (SB)Sinus Bradycardia (SB)• Normal except HR<60

V-pacedV-paced

Spike before the QRS

What’s the Difference Between Heart What’s the Difference Between Heart BlockageBlockage & & BlockBlock??

Electricity blocked from traveling normally =

arrhythmia

Clogged blood vessels = oxygen to the heart

= heart attack

Idioventricular RhythmIdioventricular Rhythm

• Ventricular beats, but…

at a slow rate

Your patient isGoing down the Drain if he stays

In this rhythm very Long!

Pulseless Electrical Activity (PEA)Pulseless Electrical Activity (PEA)• Normal rhythm,

but…

* No Pulse*

Call Code!Gabriel is blowing

his horn!!

Mobitz I: WenkebachMobitz I: Wenkebach• PR interval gradually longer until a QRS is dropped

• Pattern repeats

normal longer longer dropped QRS

Every second beat is a PVC

BigeminyBigeminy

GeminyCricket!

Atrial Fibrillation (Afib)Atrial Fibrillation (Afib)

• Irregular• No definable P waves

unable to count the # of waves

Premature Ventricular Contraction Premature Ventricular Contraction (PVC)(PVC)

•Early ventricular beat

Normal ValuesNormal Values

Heart RateHeart Rate: 60-100 beats per minute

.12-.20 seconds

< .11 secondsQRS IntervalQRS Interval:

PR IntervalPR Interval:

CoupletCouplet

Failure to CaptureFailure to Capture

• Pacer spike is fired, but no beat follows

Mobitz IIMobitz II

• PR interval consistent except some QRS missing

Example PR intervals: .16 – B - .16 – B - .16 - .16 - B

Blocked QRS

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

Junctional RhythmJunctional Rhythm

• No P wave or PR < .12

PausePause

• Period of no electrical activity, then resumes

6 Beats of VT6 Beats of VT

Paroxysmal Atrial Tachycardia (PAT)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

.24 - .24 - .24 - .24 - .24

PR intervals:

Sinus Tachycardia (ST)Sinus Tachycardia (ST)• Normal except HR >100 bpm

Ventricular Tachycardia (VT)Ventricular Tachycardia (VT)

• Ventricular beats (wide QRS’s)

• Rate > 150 bpm

Call Code!

Sinus Arrhythmia (SA)Sinus Arrhythmia (SA)• Normal except irregular

AsystoleAsystole• No electrical activity

Call Code!

My heart may stop if This guy was swimming

With me!!!

TrigeminyTrigeminyEvery 3rd beat is a PVC

3rd Degree AV Block3rd Degree AV Block (3º AVB)(3º AVB)

Example PR intervals: .14 – B - .20 – B – B - .12 – B - .44 - .32 - B

blocked normal blocked blocked short blocked normal blocked

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!

Torsades de Pointes

• A form of VTach which looks like the rhythm strip is twisting

Call CODE!

Steps to Interpret RhythmsSteps to Interpret Rhythms

SINUS

ATRIAL

VENTRICULAR

JUNCTIONAL 3. What is the HEART RATE?

4. What is the PR interval?

5. What is the QRS interval?

1. Are the beats at regular or irregular intervals apart?

2. Do you see P, QRS, T pattern?

A-pacedA-paced

A spike before the P wave site

Mobitz IIMobitz IIPR regular except some QRS are dropped

.12 – B - .12 - .12 – B - .12 – BPR intervals:

QRS

Atrial FlutterAtrial Flutter

• Numerous P waves that you can count

Premature BeatsPremature Beats

PVC

PJC

PAC

Wide QRS

PR<.12

PR=.12-.20

Wenkebach

PR gradually longer until QRS dropped

.12 - .18 - .24 – B - .12 - .18 - .24 – B

PR intervals:

Ventricular Fibrillation (VF)Ventricular Fibrillation (VF)

• Squiggly line

Call CODE!

Failure to SenseFailure 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

enters

exits

QRS exits higher than it starts

ST ElevationST Elevation

Wandering Atrial Pacemaker (WAP)Wandering Atrial Pacemaker (WAP)

• P waves vary in shape (at least 3 different P waves)

3º AVB PR interval varies, but not in Wenkebach pattern

.12 – B - .20 – B – B - .16 - .44 – B - .32

PR intervals:

Premature BeatsPremature Beats

Premature Atrial Contraction (PAC)

Premature Junctional Contraction (PJC)

Premature Ventricular Contraction (PVC)

3 Types

Bundle Branch Blocks (BBB)Bundle Branch Blocks (BBB)

QRS >.11

AV-pacedAV-paced

Spikes before the P wave site & QRS

Premature Premature JunctionalJunctional Contraction (PContraction (PJJC)C)

• Early beat

• No P wave or PR interval is <.12

First Degree AV BlockFirst Degree AV Block(1º AVB)(1º AVB)

• PR interval > .20

Example PR intervals: .28 - .28 - .28 - .28 - .28 - .28

A V//

enters

exits

QRS exits lower than it starts

ST DepressionST Depression

Paroxysmal Supraventricular Tachycardia Paroxysmal Supraventricular Tachycardia (PSVT)(PSVT)

• Sudden rate change >150 bpm

• QRS may look different after rate change

QRS look different in shape

Types of AV BlocksTypes of AV Blocks

•First Degree 1°AVB

•Second Degree

•Third Degree 3°AVB

Wenkebach

Mobitz II

Premature Premature AtrialAtrial Contraction (P Contraction (PAAC)C)

• Early beat

• Normal PR interval

The alarm clockAlways goes off

PREMATURELY!!

TripletTriplet

• VT

• VFib

• Asystole

• Torsades

• PEA

Which rhythms are a CODE Blue?

WAY TO GO!WAY TO GO!You’re catching on!You’re catching on!