Basic Rhythm Recognition

You can narrow down most rhythms to within 3 possibilites based on rate (fast, slow, normal), regularity (regular, irregular), and width (narrow, wide).

Fast Normal Slow Regular Sinus Tach SVT A flutter (regular conduction) VT (with pulse) Normal Sinus Accelerated Junctional A flutter Sinus Brady Complete block Ventricular/Junctional escape Irregular A fib with RVR A flutter (variable conduction) Multifocal atrial tachycardia Sinus Arrhythmia Afib/flutter Sinus with PVC/PACs Wandering atrial pacemaker Afib/flutter SVR 2nd degree blocks

Evaluate p waves -Are they present? -How do they relate to the QRS? -Are they all the same?

Multifocal Atrial Tachycardia: Irregularly irregular with rate above 100 and 3 or more different p wave morphologies

Atrial fibrilation with rapid ventricular response: Tachycardic and irregularly irregular. Variable R-R interval. P waves largly absent.

Evaluate the QRS complex Is is wide or narrow? Wide QRS can be a ventricular rhythm Any of these rhythms can be aberrantly conducted (bundle branch block)

3rd degree AV block (complete heart block) with ventricular escape vs aberrantly conducted junctional escape rhythm.

2nd degree AV block type 1 (Wenkiebach or Mobitz 1): Variable PR interval that prolongs with each beat leading to non conducting P wave

Nonsustained Ventricular Tachycardia terminating with sinus tachycardia with frequent aberrantly conducted PACs vs PVCs

Atrial flutter with variable conduction and slow ventricular response