Rhythm and Strip

Normal sinus rhythm

Cardiac Rhythms and Dysrhythmias

ECG Characteristics
Rate: 60 100 bpm
Rhythm: regular
There is one P for every QRS
PR interval: 0.12 0.20 seconds
QRS complex: 0.06 0.10 seconds

Management
This is a normal heart rhythm so no
treatment is required

Sinus tachycardia

Rate: 101 150 bpm

Rhythm: regular
There is one P for every QRS but may
be hidden with T wave due to speed
PR interval: 0.12 0.20 seconds
QRS complex: 0.06 0.10 seconds

This is only treated if client is

symptomatic or is at risk for
myocardial damage
If there is an underlying cause, betablockers or verapamil can be used

Sinus bradycardia

Rate: < 60 bpm

Rhythm: regular
There is one P for every QRS
PR interval: 0.12 0.20 seconds
QRS complex: 0.06 0.10 seconds

This is only treated if client is

symptomatic; administer IV atropine,
isoproterenol, and/or pacemaker may
be used

Premature atrial contractions (PAC)

Rate: varies
Rhythm: regular with early beats
originating in atria
There is one P for every QRS
PR interval: not measured
QRS complex: 0.06 0.10 seconds
Rate: atrial 240 360 bpm, ventricular
rate depends on degree of AV block
Rhythm: regular
P:QRS ratio: 2:1. 4:1, 6:1, or variable
PR interval: not measured
QRS complex: 0.06 0.10 seconds

This usually requires no treatment.

Advise client to reduce alcohol intake,
reduce stress, and stop smoking

Atrial flutter

This is treated with synchronized

cardioversion; meds to reduce
ventricular response such as betablocker or calcium channel blocker
followed by a class I antidysrhythmic
or amiodarone

Atrial fibrillation

Rate: 300 600 bpm; ventricular 100

180 bpm in untreated clients
Rhythm: irregularly regular
P:QRS ratio is variable
PR interval: not measured
QRS complex: 0.06 0.10 seconds

This is treated with synchronized

cardioversion; meds to reduce
ventricular response rate such as
metoprolol, diltiazem, or digoxin;
anticoagulant therapy to reduce risk of
clot formation and stroke

Premature ventricular contractions (PVC)

Rate: variable
Rhythm: irregular; PVC interrupts
underlying rhythm and followed by a
compensatory pause
No P wave noted before a PVC
PR interval: absent
QRS complex: wide, > 0.12 seconds
Rate: 100 250 bpm
Rhythm: regular
No indentifiable P wave
PR interval: not measured
QRS complex: 0.12 seconds; bizarre
shape

This is treated if client is symptomatic;

advise against using stimulants
(caffeine, nicotine); drug therapy
includes, class I and III
antidysrhythmics and possibly addition
of a beta blocker

Ventricular tachycardia

Ventricular fibrillation

Rate: too rapid to count

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

This is treated if VT is sustained or if

client is symptomatic; treatment
includes IV procainamide, lidocaine.
If unstable, a class III antidysrhythmic
and immediate cardioversion; ablation
surgery or internal defibrillator for
repeated episodes
Immediate defibrillation

No treatment required

Second-degree AV block type 1 (Mobitz 1, Wenckebach)

Second-degree AV block type 2 (Mobitz 2)

Third-degree block (complete heart block)

Rate: 60 100 bpm

Rhythm: atrial regular, ventricular
irregular
P:QRS ratio: 1:1 until P wave is
blocked w/ no QRS following
PR interval: progressively lengthens in
regular pattern
QRS complex: 0.06 0.10 seconds;
sudden absence of QRS complex
Rate: atrial 60 -100 bpm, ventricular <
60 bpm
Rhythm: atrial regular, ventricular
irregular
P:QRS ration: typically 2:1, may vary
PR interval: constant PR interval for
each conducted QRS
QRS complex: 0.06 0.10 seconds
Rate: atrial 60 100 bpm; ventricular
15 60 bpm
Rhythm: both atrial and ventricular are
regular
Independent rhythm (no relationship
between P and QRS)
PR interval: not measured
QRS complex:

Treatment includes monitoring and

observation; atropine and isoproterenol
if client is symptomatic (rarely
progresses to a higher level of block)

Treatment includes atropine or

isoproterenol; pacemaker therapy

Immediate pacemaker therapy