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26 Cards in this Set

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NORMAL SINUS RHYTHM
RATE: 60 - 100

PR: IS CONSISTANT

WITH A NARROW QRS
Rhythm: Regular
Rate: 60-100
P waves: Normal in configuration and direction; one P wave precedes each QRS complex
PR: Normal (0.12 - 0.20seconds)
QRS: Normal (0.10 seconds or less)
SINUS TACHYCARDIA
RATE: 100 - 160

PR IS CONSISTANT

NARROW QRS
Rhythm: Regular
Rate: 100 – 160
P waves: Normal in configuration and direction; one P wave precedes each QRS complex
PR: Normal (0.12 – 0.20 seconds)
QRS: Normal (0.10 seconds or less
SINUS BRADYCARDIA
RATE: 40 - 60

PR IS CONSISTENT

NARROW QRS
Rhythm: Regular
Rate: 40 – 60
P waves: Normal in configuration and direction; one P wave precedes each QRS complex
PR: Normal (0.12 – 0.20 seconds)
QRS: Normal (0.10 seconds or less)
SINUS ARRHYTHMIA
RHYTHM IS IRREGULAR

PR IS CONSISTENT

NARROW QRS
Rhythm: Irregular
Rate” Normal (60 – 100) or slow (less than 60)
P waves: Normal in configuration and direction; one P wave precedes each QRS complex
PR: Normal (0.12 – 0.20 seconds)
QRS: Normal (0.10 seconds or less)
SINUS ARREST AND SINUS EXIT BLOCK
SINUS ARREST:underlying rhythm does not resume on time after the pause; the length of the pause is not a multiple of the underlying P-P (or R-R) interval

SINUS BLOCK: underlying rhythm resumes on time after the pause, with the length of the pause being a multiple of the underlying P-P (or R-R) interval
PAUSE WITH A FLAT BASLINE

PR ABSENT DURING PAUSE

NARROW QRS
Rhythm: underlying rhythm usually regular; irregular during pause
Rate: Underlying rhythm maybe normal (60-100) or slow (less than 60)
P waves: Sinus P waves present with underlying rhythm; PR absent during pause
PR: Normal duration (0.12-0.20 seconds) with underlying rhythm; PR absent during pause
QRS: Normal (0.10 seconds or less) with underlying rhythm; QRS absent during pause
PREMATURE JUNCTIONAL CONTRACTION

(PJC)
PR is short, inverted, none or after the QRS

QRS is narrow and happens to early
Rhythm: underlying rhythm usually regular; irregular with PJC’s
Rate: rate is that of underlying rhythm
P waves: P wave associated with the PJC will be inverted in Lead II and will occur immediately before QRS, immediately after the QRS, or will be hidden within the QRS complex
PR: short (0.10 seconds or less)
QRS: normal (0.10 seconds or less)
JUNCTIONAL RHYTHM
Rate is 40 - 60

PR is short, inverted, none, or after the QRS

narrow QRS
Rhythm: regular
Rate: 40-60
P waves: inverted in lead II and occurs immediately before the QRS, immediately after the QRS, or is hidden within the QRS complex
PR: short (0.10 seconds or less)
QRS: normal (0.10 seconds or less)
ACCELERATED JUCTIONAL RHYTHM
RATE is 60 - 100

PR is short, inverted,none or after the QRS

narrow QRS
Rhythm: regular
Rate: 60-100
P waves: inverted in Lead II and occurs immediately before the QRS, immediately after the QRS, or hidden within the QRS complex
PR: short 0.10) seconds or less)
QRS: normal (0.10 seconds or less)
PAROXSYMAL JUNCTIONAL TACHYCARDIA

(PJT)
Rate > 100

PR is short,inverted,none or after the QRS

narrow QRS
Rhythm: regular
Rate: over 100 per minute
P waves: inverted in Lead II and occurs immediately before the QRS immediately after the QRS, or hidden within the QRS complex
PR: short (0.10 seconds or less)
QRS: normal (0.10 seconds or less)
WANDERING ATRIAL PACEMAKER

(WAP)
Rhythm is irregular

P waves all look different
Rhythm: Regular or Irregular
Rate: usually normal (60-100) but maybe slower
P waves: vary in size and shape and direction across rhythm strip
PR: may vary slightly depending on the changing pacemaker location
QRS: Normal (0.10 seconds or less)
PREMATURE ATRIAL CONTRACTION

(PAC)
P waves

narrow QRS that happens early
Rhythm: underlying rhythm usually regular, irregular with PAC’s
Rate: heart rate is that of underlying rhythm
P waves: P wave associated with PAC is premature and abnormal in size shape or direction (in lead II P wave is usually upright (often pointed), or it maybe inverted); abnormal P waves often found in preceding T waves, distorting the T wave contour
PR: Normal or Prolonged – usually differs from that of underlying rhythm.
QRS: Normal (0.10 seconds or less)
NONCONDUCTED PAC’s
P waves with no compensating QRS
Rhythm: Underlying rhythm usually regular; irregular with non conducted PAC’s
Rate: heart rate is that of underlying rhythm
P waves: P wave associated with the non conducted PAC is premature, and abnormal in size, shape or direction; often found hidden in preceding T wave contour
PR: absent with nonconductive PAC
QRS: Absent with nonconductive PAC
PAROXYSMAL ATRIAL TACHYCARDIA

{ASLO CALLED SVT}
Rate is > 140 no visible P waves

narrow QRS
RHYTHM: regular
Rate: Atrial 140-250
Ventricular 140-250
P waves: abnormal (often pointed); usually hidden in preceding T waves
PR: not measurable
QRS: normal (0.10 seconds or less)
ATRIAL FLUTTER
sawtooth waves

narrow QRS

put down conduction rate
2:1 3:1 4:1
Rhythm: regular or irregular (depends on AV conduction Ratios)
Rate: Atrial 250-400
Ventricular: varies with number of impulses conducted through AV node’ will be less than Atrial rate
P waves: V- shaped wave forms with sawtooth appearance called flutter waves
PR: not measurable
QRS: Normal (0.10 seconds or less)
ATRIAL FIBRILLATION
RHYTHM IRREGULAR-IRREGULAR

WIDE QRS
Rhythm: Grossly irregular (unless the ventricular rate is very rapid, in which case the rhythm becomes more regular)
Rate: Atrial rate: 400 or more – not measurable on surface ecg
Ventricular rate: varies with number of impulses conducted through AV node ventricles
P waves: Irregular wavy deflections called fibrillatory waves (f waves)
PR: not measurable
QRS: normal (0.10seconds or less)
BUNDLE BRANCH BLOCK
QRS > .12
Rhythm: Regular
Rate: Rate is that of
Underlying rhythm (usually sinus)
P waves: Sinus
Pr: Normal (0.12 – 0.20 seconds)
QRS: Wide (0.12 seconds or greater)
PREMATURE VENTRICULAR CONTRACTIONS

(PVCs)
happens to soon

wide QRS

it can be monophasic ^^, or multifocal ^v
Rhythm: underlying rhythm usually
regular;
Irregular with PVC
Rate: rate is that of underlying rhythm
P waves: none associated with the
Underlying rhythm can occasionally be
seen before the PVC or after the PVC
in the ST segment or T wave
PR: not measurable
QRS: Premature, wide (0.12 seconds or
greater), and abnormal (differ from the
QRS complexes of the underlying
rhythm)
VENTRICULAR TACHYCARDIA

(V TACH)
RATE IS >100

WIDE QRS
Rhythm: regular
Rate: 140 - 250
P waves: No P waves are associated
with ventricular tachycardia. How-
ever, the SA node continues to beat
independently and sinus P waves may
occasionally be seen between the
QRS complexes. Usually the P waves
Are hidden in the QRS.
PR: not measurable
QRS: wide (0.12 seconds or greater)
VENTRICULAR FIBRILLATION

(V FIB)
RHYTHM IS CHAOTIC

wode QRS
Rhythm: Chaotic; irregular deflections
Rate: 0 (P waves and QRS complexes
are absent)
P waves: Absent; deflections seen are
Chaotic, irregular undulations that
vary in size, shape, and height;
deflections may be small (described
as “coarse”)
PR: not measurable
QRS: Absent
IDIOVENTRICULAR RHYTHM
(VENTRICULAR ESCAPE RHYTHM)
RATE is 40 - 60

wide QRS
Rhythm: usually regular
Rate: 30 –40 (sometimes slower)
P waves: absent
PR: not measurable
QRS: wide (0.12 seconds or greater)
ACCELERATED IDIOVENTRICULAR RHYTHM
(ACC IVR)
rate >40-<100

wide QRS
Rhythm: usually regular
Rate:50 –100
P waves: absent
PR: not measurable
QRS: wide (0.12 seconds or greater)
VENTRICULAR STANDSTILL
(VENTRICULAR ASYSTOLE)
P waves with no compensating QRS or flatline
Rhythm: 0 (no QRS complexes are
Present)
Rate: 0 (no QRS complexes are
Present)
P waves: ECG tracing will show either
P waves without QRS complexes or a
straight line.
PR: not measurable
QRS: absent
FIRST-DEGREE AV BLOCK:
PR >.20
Rhythm: Regular
Rate: Heart rate is that of underlying rhythm (usually sinus); both atrial and ventricular rates will be the same
P waves: Sinus; one P wave to each QRS
PR: Prolonged (greater than 0.20 seconds); remains constant
QRS: Normal (0.10 seconds or less)
SECOND-DEGREE AV BLOCK (MOBITZ I)
(WENCKEBACH)
PR lengthening and dropped beat
Rhythm: Atrial: regular
Ventricular: irregular
Rate: Atrial: Rate is that of underlying rhythm (usually sinus)
P waves: Sinus
PR: PR varies> PR progressively lengthens until a P wave occurs without a QRS. A pause follows the dropped QRS.
QRS: Normal (0.10 seconds or less)
SECOND-DEGREE AV BLOCK (MOBITZ II)
PR consistent with too many P waves
Rhythm: Atrial: regular
Ventricular: will be regular unless the AV conduction ratio varies
Rate: Atrial: Rate is that of underlying rhythm (usually sinus)
Ventricular: Rate will depend on number of impulses conducted through AV nove--will be less than the atrial rate
P waves: Sinus; two or three P waves (sometimes more) before each QRS
PR: Maybe normal or prolonged; remains constant
QRS: Normal (if block located in bundle of His)
Wide (if block located in bundle branches)
THIRD- DEGREE AV BLOCK
(COMPLETE HEART BLOCK)
Variable PR

QRS march out,P waves march out and can be hidden in the QRS and T waves
Rhythm: Atrial: Regular
Ventricular: Regular
Rate: Atrial: Rate is that of underlying rhythm (usually sinus)
Ventricular: Rate is between 40 and 60 if paced by AV node.
Rate is between 30 and 40 if paced by ventricles
P waves: Sinus P waves—no constant relationship between P waves and QRS. (P waves can be seen marching through QRS complexes and T waves.)
PR: Varies greatly
QRS: Normal (if block located at level of AV node or bundle of His)
Wide (if block located at level of bundle branches)