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: