SINUS RHYTHMS Sinus rhythm Sinus bradycardia Sinus tachycardia Sinus arrhythmia Sinoatrial block or sinus exit block

RATE 60-100 bpm Less than 60 bpm 100-160 bpm Usually 60-100 bpm but may be faster or slower

RHYTHM Atrial: regular Ventricular: regular Irregular R-R intervals which shortens during inspiration and lengthens during exhalation Irregular the pause is the same as the distance between two other P-P intervals (an exact multiple of) Irregular the pause is of undetermined length (more than one PQRST complex is omitted) - Not the same distance as the other P-P intervals
SUPRAVENTRICULAR TACHYCARDIA 150-250 BPM

P WAVES

PR INTERVAL

QRS

Sinus arrest

Usually normal but varies because of the pause

Uniform in appearance, upright, normal shape, one preceding each QRS complex

0.12 - 0.20 seconds

0.10 seconds or less

ATRIAL RHYTHMS

RATE

PREMATURE ATRIAL COMPLEX Usually normal but depends on the underlying rhythm

MULTIFOCAL ATRIAL RHYTHM 60-100; If the rate is greater than 100 bpm, the rhythm is termed mutlifocal atrial tachycardia Atrial irregular Ventricular irregular At least 3 different P morphologies are required to make a diagnosis Variable

ATRIAL FLUTTER Atrial rate: 250-350 bpm Ventricular rate: variable but usually does not exceed > 180 bpm Atrial: regular Ventricular: regular or irregular No identifiable P waves, saw-toothed flutter waves

ATRIAL FIBRILLATION Atrial rate: usually greater than 350-400 bpm Ventricular response: slow(SVR), moderate(MVR), rapid(RVR) Ventricular rhythm usually very irregular No identifiable P waves, fibrillatory waves present

RHYTHM

Essentially regular with premature beats Premature and may differ from sinus P waves - May be flattened, notched, pointed or lost 0.12 - 0.20 seconds if the pacemaker site is near the SA node Longer if nearer the AV junction 0.10 seconds or less

regular Premature and may differ from sinus P waves - May be flattened, notched, pointed, biphasic or lost (>200) Usually not measurable because P wave is difficult to distinguish 0.10 seconds or less unless with intraventricular conduction delay

P WAVES

Not measurable

Not measurable

PR INTERVAL

QRS

0.10 seconds or less unless with intraventricular conduction defects

0.10 seconds or less unless with intraventricular conduction defects or if flutter waves are buried in the QRS complex

0.10 seconds or less unless with intraventricular conduction defects