lOMoARcPSD|7259008

V&A rate V&A rhythm QRS shape P wave PR P:QRS Common Causes Interventions/
and interval ratio Medications
duration
Normal Sinus 60 – 100 Regular Normal Normal; 0.12 – 0.20 1:1 N/A N/A
Rhythm bpm in front of secs
QRS

Sinus < 60 bpm Regular Normal Normal; 0.12 – 0.20 1:1 Well-conditioned P: pacing
Bradycardia in front of secs athletes, Vagal A: atropine
QRS stimulation, decreased E: epinephrine
metabolic rate, heart D: dopamine
disease, Amiodarone,
Beta blockers, Ca
channel blockers,
Digoxin

Sinus Node
Dysrhythmias Sinus > 100 but < Regular Normal Normal; 0.12 – 0.20 1:1 Stress, acute blood loss, Hemodynamic
Tachycardia 150 bpm in front of secs anemia, shock, hyper & instability 
QRS hypovolemia, heart cardioversion;
failure, pain, fever, if narrow QRS 
exercise, anxiety, Beta blockers & Ca
caffeine, nicotine, channel blockers;
amphetamines, cocaine, if wide QRS 
E pills, POTS adenosine *only if
QRS is monomorphic
& regular rhythm

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 lOMoARcPSD|7259008

V&A rate V&A rhythm QRS shape P wave PR P:QRS Common Causes Interventions/
and interval ratio Medications
duration
1st Degree AV Depends Depends on Normal or In front of > 0.20 secs 1:1 Occurs when all atrial Initial Tx is IV bolus
Block on under- under-lying abnormal QRS impulses are conducted of atropine
lying rhythm through the AV node into
rhythm the ventricles at a rate If pt doesn't respond
slower than normal to atropine 
transcutaneous
2nd Degree AV Depends Regular PP Normal or In front of PR interval 3:2, Occurs when there is a pacing is indicated
Block Type on under- interval if abnormal QRS becomes 4:3, repeating pattern in
1(Mobitz 1 or lying normal sinus longer w/ 5:4, which all but one of a If pt doesn't have a
Wenchkebach) rhythm; rhythm; goes each ECG and so series of atrial impulses pulse, Tx is the same
V rate < A from longest complex forth are conducted through as ventricular
rate RR interval until no P the AV node into the asystole.
and gradually wave ventricles
shortens until visible; Pacemaker may be
next long RR becomes indicated
Conduction interval irregular
Abnormalities 2nd Degree AV Depends Regular PP Abnormal In front of Constant 2:1, Occurs when only some Tx is directed
Block Type 2 on under- same as above; but can be QRS for those P 3:1, of the atrial impulses are toward increasing
(Mobitz 2) lying RR interval is normal waves just 4:1, conducted through the the HR to maintain
rhythm; usually before QRS 5:1, AV node into the normal CO.
V rate < A regular or complex and so ventricles
rate irregular forth If pt is stable and
depending on no symptoms, no
P:QRS ratio treatment.
3rd Degree AV Depends Regular PP & Depends on Depends Very P waves Occurs when no atrial
Block on escape RR intervals, escape on under- irregular > QRS impulse is conducted
rhythm but PP interval rhythm lying complex through the AV node into
and does not equal rhythm the ventricle
underlying RR interval
atrial
rhythm;
V rate < A
rate

V&A rate V&A rhythm QRS shape P wave PR P:QRS Common Causes Interventions/

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 lOMoARcPSD|7259008

and interval ratio Medications

duration
Premature Atrial Depends Irregular Normal, Early & 0.12 – 0.20 1:1 Increased If in frequent, no
Contraction on under- abnormal or different secs catecholamine levels, Tx needed.
(PAC), lying absent P wave heart disease,
Supraventricular rhythm or caffeine, alcohol, If frequent (more
Tachycardia hidden nicotine, stretched than 6/min)  treat
(SVT) in T atrial myocardium, underlying cause.
wave anxiety, hypokalemia,
atrial injury, Consider using vagal
ischemia, infarction maneuvers,
synchronized
cardioversion,
Adenosine, Beta
Blockers, Calcium
Channel Blockers

Atrial A rate: Highly Normal or No dis- Cannot Many:1 Unknown cause Vagal maneuvers,
Fibrillation 300 – 600 irregular abnormal cernible measure synchronized
Atrial
bpm; P waves Risk Factors: cardioversion, Beta
Dysrhythmias
V rate: increased age, male, Blockers, Calcium
120 – 200 high BMI, Channel Blockers;
bpm systolic BP  160 if HF present:
mmHG, Amiodarone, Digoxin
PR interval  160
milliseconds, HTN,
grade 3 or higher
heart murmur, HF &
heart diseases

Atrial Flutter A rate: Atrial rhythm Normal, Saw- Cannot 2:1, Occurs in pts w/
250 – 400 is regular; abnormal or toothed determine 3:1, COPD, pulmonary
bpm; ventricular absent shaped 4:1 HTN, valvular disease
V rate: rhythm is & thyrotoxicosis
75 – 150 regular or
bpm irregular due
to change in
AV conduction

V&A rate V&A rhythm QRS shape P wave PR P:QRS Common Causes Interventions/

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 lOMoARcPSD|7259008

and interval ratio Medications

duration
Premature Depends Irregular due 0.12 secs or Depends If P wave is 0:1, Caffeine, nicotine, If frequent &
Ventricular on the to early QRS longer on in front of 1:1 alcohol, cardiac persistent:
Contraction under-  shorter RR timing of QRS; ischemia, infarction, Amiodarone or
(PVC) lying interval PVC interval is increased workload, Sotalol
rhythm < 0.12 secs. digitalis toxicity,
*Couplets, hypoxia, acidosis,
Bigeminy, hypokalemia,
Trigeminy mechanical irritation
of myocardium with
catheters/wires

Ventricular V rate: Regular 0.12 secs or Very Very Difficult to Electrolyte Synchronized
Tachycardia 100 – 200 more difficult irregular determine disturbances, hypoxia, cardioversion,
(V Tach w/ bpm; to detect mechanical irritation defibrillation for
pulse) A rate of myocardium w/ Polymorphic V tach,
depends on catheters/wires Amiodarone or
*3 or more PVCs under- Lidocaine,
Ventricular in a row lying Procainamide,
Dysrhythmias **Monomorphic rhythm Sotalol
or Polymorphic
Ventricular Cardiac Arrest: CPR & immediate
Tachycardia immediate defibrillation,
(Pulseless V interventions needed Epinephrine (IV
Tach) to prevent irreversible push), Amiodarone
brain death or Lidocaine
*3 or more PVCs
in a row
Ventricular > 300 bpm Extremely Irregular; CAD  #1, V Tach, CPR & immediate
Fibrillation irregular, w/ undulating cardiomyopathy, Defib, Epinephrine
(V Fib) out specific waves w/ out valvular heart (IV push),
pattern recognizable disease, several Amiodarone or
QRS proarrhythmic meds, Lidocaine
complexes acid-base &
electrolyte abnorms,
electrical shock,
hypoxia
Asystole Cardiac Arrest  CPR (No defib), confirm asystole in more than one lead, Epinephrine, Identify and treat reversible causes
Normal EKG Waves

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***includes P wave, QRS complex, T wave, possible U wave

***PR interval, ST segment & QT interval
 Each small box represents 0.04 sec. or 1 mm
 5 small boxes = 0.20 secs or 5 mm
Measurements:
 PR interval = beginning of P wave to the beginning of QRS complex
o Represents time needed for sinus node stimulation, atrial depolarization and conduction through the AV node before ventricular depolarization
o Normal = 0.12 – 0.20 secs in duration
 ST segment = end of QRS complex to beginning of T wave
o Above or below isometric line  cardiac ischemia
 QRS complex = beginning of Q wave to the end of the S wave
 QT interval = beginning of the Q wave to the end of the T wave
o Represents total time for ventricular depolarization and repolarization
o Normal = 0.32 – 0.40 secs in duration if HR is between 65 – 95 BPM
 TP interval = end of the T wave to the beginning of the next P wave
 PP interval = beginning of one P wave to the beginning of the next P wave
o Determines atrial rate and rhythm
 RR interval = measures QRS complex to the next QRS complex
o Determines ventricular rate and rhythm
Waves, Complexes and Intervals:
 P wave = electrical impulse starting in the SA node and spreading through the atria; represents atrial depolarization
o Normal = 2.5 mm tall & 0.11 secs or < in duration
 QRS complex = ventricular depolarization
o Normal = < 0.12 secs in duration
o If < 5 mm tall  small qrs is used
o If > 5 mm tall  large QRS is used
 Q wave = 1st negative deflection after the P wave; normally < 0.04 secs
 R wave = first positive deflection after P wave
 S wave = 1st negative deflection after the R wave
 T wave = ventricular repolarization; when cells regain a (-) charge
o Both atrial & ventricular repolarization occur at the same time
o Tall T wave occurs in patients with HYPERkalemia
 U wave = repolarization of the Purkinje fibers
o Occurs in patients with HYPOkalemia, HTN or heart disease

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