Rhythm and Strip
Normal sinus rhythm
Cardiac Rhythms and Dysrhythmias
ECG Characteristics
Rate: 60 100 bpm
Rhythm: regular
Management
This is a normal heart rhythm so no
treatment is required
There is one P for every QRS
PR interval: 0.12 0.20 seconds
Sinus tachycardia
Sinus bradycardia
QRS complex: 0.06 0.10 seconds
Rate: 101 150 bpm
This is only treated if client is
Rhythm: regular
symptomatic or is at risk for
There is one P for every QRS but may
myocardial damage
be hidden with T wave due to speed
If there is an underlying cause, beta-
PR interval: 0.12 0.20 seconds
blockers or verapamil can be used
QRS complex: 0.06 0.10 seconds
Rate: < 60 bpm
This is only treated if client is
Rhythm: regular
symptomatic; administer IV atropine,
There is one P for every QRS
isoproterenol, and/or pacemaker may
PR interval: 0.12 0.20 seconds
be used
QRS complex: 0.06 0.10 seconds
Premature atrial contractions (PAC)
Rate: varies
This usually requires no treatment.
Rhythm: regular with early beats
Advise client to reduce alcohol intake,
originating in atria
reduce stress, and stop smoking
There is one P for every QRS
PR interval: not measured
Atrial flutter
QRS complex: 0.06 0.10 seconds
Rate: atrial 240 360 bpm, ventricular
This is treated with synchronized
rate depends on degree of AV block
cardioversion; meds to reduce
Rhythm: regular
ventricular response such as beta-
P:QRS ratio: 2:1. 4:1, 6:1, or variable
blocker or calcium channel blocker
PR interval: not measured
followed by a class I antidysrhythmic
QRS complex: 0.06 0.10 seconds
or amiodarone
Atrial fibrillation
Premature ventricular contractions (PVC)
Rate: 300 600 bpm; ventricular 100
This is treated with synchronized
180 bpm in untreated clients
cardioversion; meds to reduce
Rhythm: irregularly regular
ventricular response rate such as
P:QRS ratio is variable
metoprolol, diltiazem, or digoxin;
PR interval: not measured
anticoagulant therapy to reduce risk of
QRS complex: 0.06 0.10 seconds
Rate: variable
clot formation and stroke
This is treated if client is symptomatic;
Rhythm: irregular; PVC interrupts
advise against using stimulants
underlying rhythm and followed by a
(caffeine, nicotine); drug therapy
compensatory pause
includes, class I and III
No P wave noted before a PVC
antidysrhythmics and possibly addition
PR interval: absent
of a beta blocker
QRS complex: wide, > 0.12 seconds
Ventricular tachycardia
Rate: 100 250 bpm
This is treated if VT is sustained or if
Rhythm: regular
client is symptomatic; treatment
No indentifiable P wave
includes IV procainamide, lidocaine.
PR interval: not measured
If unstable, a class III antidysrhythmic
QRS complex: 0.12 seconds; bizarre
and immediate cardioversion; ablation
shape
surgery or internal defibrillator for
repeated episodes
Ventricular fibrillation
Rate: too rapid to count
Immediate defibrillation
Rhythm: grossly irregular
No identifiable P waves
PR interval: none
QRS complex: bizzare, varying in
shape and direction
First-degree AV block
Rate: 60 10 bpm
Rhythm: regular
There in one P for every QRS
PR interval: > 0.20 seconds
QRS complex: 0.06 0.10 seconds
No treatment required
Second-degree AV block type 1 (Mobitz 1, Wenckebach)
Rate: 60 100 bpm
Treatment includes monitoring and
Rhythm: atrial regular, ventricular
observation; atropine and isoproterenol
irregular
if client is symptomatic (rarely
P:QRS ratio: 1:1 until P wave is
progresses to a higher level of block)
blocked w/ no QRS following
PR interval: progressively lengthens in
regular pattern
QRS complex: 0.06 0.10 seconds;
Second-degree AV block type 2 (Mobitz 2)
sudden absence of QRS complex
Rate: atrial 60 -100 bpm, ventricular <
Treatment includes atropine or
60 bpm
isoproterenol; pacemaker therapy
Rhythm: atrial regular, ventricular
irregular
P:QRS ration: typically 2:1, may vary
PR interval: constant PR interval for
each conducted QRS
Third-degree block (complete heart block)
QRS complex: 0.06 0.10 seconds
Rate: atrial 60 100 bpm; ventricular
15 60 bpm
Rhythm: both atrial and ventricular are
Immediate pacemaker therapy
regular
Independent rhythm (no relationship
between P and QRS)
PR interval: not measured
QRS complex:
