1. Name That Rhythm!

2. Sinus Bradycardia (SB)
Normal except HR<60

3. V-paced
Spike before the QRS

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

5. Idioventricular Rhythm
Ventricular beats, but…
at a slow rate
Your patient is
Going down the
Drain if he stays
In this rhythm very
Long!

6. Pulseless Electrical Activity (PEA)
Normal rhythm, but…
No Pulse*
Gabriel is blowing his horn!!
Call Code!

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

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

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

10. Premature Ventricular Contraction (PVC)
Early ventricular beat

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

12. Couplet

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

14. 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 – B B

15. Normal Sinus Rhythm (NSR)
Rhythm is normal
Rate normal
PR normal
QRS normal < .11

16. Junctional Rhythm
No P wave or PR < .12

17. Pause
Period of no electrical activity, then resumes

18. 6 Beats of VT

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

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

21. Sinus Tachycardia (ST)
Normal except HR >100 bpm

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

23. Sinus Arrhythmia (SA)
Normal except irregular

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

25. Trigeminy
Every 3rd beat is a PVC

26. 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 – B – B – B B

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

28. 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?

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

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

31. Atrial Flutter
Numerous P waves that you can count

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

33. PR gradually longer until QRS dropped
Wenkebach
PR gradually longer until QRS dropped
PR intervals:
– B – B

34. Ventricular Fibrillation (VF)
Squiggly line
Call CODE!

35. 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

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

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

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

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

40. Bundle Branch Blocks (BBB)
QRS >.11

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

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

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

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

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

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

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

48. Triplet

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

50. WAY TO GO! You’re catching on!