Rhythm Rate Rhythm P waves PR QRS QT Treatment Notes:

A V A V

NSR 60-100 60 -100 regular regular normal 120-200 60 - 120 360-440 none

Sinus Node Arrhythmias

S Arrhythmia 60 -100 60 - 100 irregular irregular normal normal normal rate dependant no treatment if asymptomatic; normally occurs
atropine/epi or pacer to with respirations;
maintain HR if symptomatic; may be caused by
dopamine if low BP digoxin toxicity

SB <60 <60 regular regular normal normal normal rate dependant no treatment if asymptomatic;
remove cause; hold or d/c
meds; atropine/epi; dopamine
if low BP ;pacer

ST 100 - 150 100 - 150 regular regular normal normal normal rate dependant no treatment if asymptomatic;
shortens with remove cause ;rate reduction
increased HR meds without knowing cause
not advised; if cause known
and patient symptomatic may
use beta blockers or Ca
channel blockers to decrease
HR

Sinus arrest or may be may be regular with regular with normal except normal if P normal when rate usually none - find underlying
pause <60 <60 pauses pauses no P with present present dependant; cause; d/c med if related;
pause normal when atropine/epi or pacer if
present prolonged

SSS may show: SB, sinus irregular with irregular with variations with varies with normal varies with no treatment if asymptomatic;
arrest , SA block, sinus pauses sinus pauses rhythm rhythm rhythm correct underlying cause;
sinus pause, atrial and abrupt and abrupt changes atropine/epi/pacer
tachycardia with slow rate changes rate changes symptomatic bradycardia;
ventricular response, antiarrhythmics (ß
tachy-brady blockers/digoxin) for
syndrome tachyarrhythmia;
anticoagulants if A fib develops
Rhythm Rate Rhythm P waves PR QRS QT Treatment Notes:
A V A V
Atrial Arrhythmias

PAC variable variable underlying underlying normal except P normal normal rate dependant assess for CHF; monitor may have PAC
wave in PAC closely blocked at AV
may be node resulting in
abnormally P wave but no
shaped and may QRS; P wave
be lost in may also be lost
previous T wave in the T wave;
don't confuse a
non-conducted P
wave with a 2°
Type II block - P
waves are
regular in a 2°
Type II block - if
early it is a
blocked PAC

A flutter 250 - 350 < 180 regular regular or saw tooth pattern unmeasurable normal unable to meds to control rate/convert may present in a
irregular measure; T or synchronized 2:1, 3:1 or 4:1
distorted in cardioversion; block
flutter anticoagulation if A flutter
present for more than 48
hours; ablation

A Fib > 400 60 - 100 irregularly irregularly fibrillatory waves unmeasurable normal unable to control ventricular response:
controlled; irregular irregular measure meds; synchronized
> 100 cardioversion;
uncontrolled anticoagulation; ablation

SVT 150- 250 150 -250 regular regular regular not measureable normal not measurable vagal/CSM; meds;
adenosine; treat cause;
pace termination;
synchronized cardioversion;
ablation
Rhythm Rate Rhythm P waves PR QRS QT Treatment Notes:
A V A V
Junctional Arrhythmias

PJC varies varies regular regular inverted; if before QRS < 120 normal rate dependant eliminate cause; d/c digoxin;
with with except for except for occurs eliminate or d/c caffeine
underlying underlying premature premature before,
rhythm rhythm beats beats during or
after QRS

Junctional/Nodal may/may 40 - 60 regular regular inverted in if before QRS < 120 normal rate dependant correct underlying cause;
not be leads II, III assess electrolytes; atropine
identified and aVf; if symptomatic; r/o digoxin
hidden in toxicity; pace
QRS;
follows QRS

Accelerated may/may 60 - 100 regular regular inverted in if before QRS < 120 normal rate dependant assess electrolytes; r/o
Junctional/Nodal not be Leads II, III digoxin toxicity; correct
identified and aVf; underlying cause; temporary
hidden in pacing if symptomatic
QRS;
follows QRS

Junctional may/may 100 - 150 regular if regular inverted in if before QRS < 120 normal rate dependant correct underlying cause;
Tachycardia not be identified Leads II, III assess electrolytes;
identified and aVf; discontinue digoxin, Ca/β
hidden in blockers slow rate (check dig
QRS; level first); vagal maneuvers;
follows QRS adenosine; synchronized
cardioversion if
compromised; temp. pace to
reset rhythm; ablation
followed by pacemaker
Rhythm Rate Rhythm P waves PR QRS QT Treatment Notes:
A V A V
Ventricular

PVC's varies/occurs variable irregular d/t irregular as per as per as per rate dependant correct underlying cause; may have a
with any premature d/t underlying underlying underlying but prolonged discontinue medications compensated or
rhythm beats premature rhythm; no rhythm; none rhythm; wide with PVC; T that may be causing uncompensated pause;
(underlying beats P with with PVC and bizarre; > has opposite PVC's; correct electrolyte 2 in row = couplet; 3 in a
rhythm regular) (underlying PVC 120 deflection to imbalances; row = triplet/VT; every
rhythm QRS antiarrhythmic if second beat = bigeminy;
regular) warranted every 3 beat = trigeminy;
if late in the cycle it is not
a PVC rather a
ventricular escape beat

Idioventricular absent 20 - 40 not measurable regular absent not measurable > 120 rate dependant pacing; atropine or epi; may be accelerated
NO ANTIARRHYTHMICS idioventricular rhythm:
rate 41 -1 00

Monomorphic not 100 - not measurable usually not not measurable wide and not measurable What is their Goal of
VT measurable 250 regular but associated bizarre; > Care: Stable:
may be with QRS; 120 antiarrhythmic; Unstable:
slightly may be synchronized
irregular buried or cardioversion;
retrograde Pulseless: defibrillate,
code blue, CPR, ACLS

Polymorphic not 150 - not measurable irregular none not measurable cyclically twists not measurable What is their Goal of
VT(Torsades measurable 250 from + to - Care; d/c medications that
de Pointes) lengthen QT; overdrive
pacing; IV MgSO4;
cardioversion; if pulseless
- defibrillation; code blue;
CPR; ACLS

VF absent fibrillating chaotic and not definable absent not measurable not measurable not measurable What is their Goal of may be coarse or fine VF
Care; defibrillate; code
blue; CPR; ACLS

Ventricular may be no if P present absent if present - absent absent absent What is their Goal of
Standstill evident activity may be regular regular or Care; code blue; CPR;
irregular ACLS, assess cause

Asystole absent absent none none absent not measurable not measurable not measurable What is their Goal of
Care; code blue; CPR;
epi/pacemaker; ACLS;
always confirm in 2 leads

PEA as per presenting rhythm What is their Goal of Causes: 5 H's and 5 T's
Care: code blue; CPR;
ACLS: assess cause
Rhythm Rate Rhythm P waves PR QRS QT Treatment Notes:
A V A V
AV Blocks

1˚ HB A and V rates are equal regular regular normal > 200 normal rate observe for progression to
dependant; T more severe block; correct
may appear underlying cause
notched if P
follows closely

2˚ HB Type I Atrial > Ventricular regular irregular normal gradually normal rate dependant mentor for progression;
lengthens review meds; if V rate
until one slow/symptomatic
fails to →atropine / temp. pacing
conduct to
ventricles

2˚ HB Type II 60 - 100 usually regular irregular if block normal; normal or normal; does rate dependant monitor for progression; d/c can rapidly
bradycardia intermittent; 2,3,4 P for prolonged; not always meds that slow conduction; progress to3˚ HB
range: regular if block is each QRS fixed when follow each P if V rate slow/symptomatic
½,⅓,¼ of A constant followed by →temp. pacing
rate QRS

3˚ HB 60 - 100 depends on regular regular not related PR varies: normal width rate dependant d/c meds that ↓ AV
origin of to QRS; A > no relation if conducted conduction; meds to ↑
escape V with P's to QRS from AV conduction; temp. pacing
rhythm that march node/junction;
through widened if
QRS ventricular