A.

SINUS RHYTHM DISTURBANCES

1. Sinus tachycardia
Fast rates
P waves may merge with preceding T
waves
Rate: >100 bpm

2. Sinus Bradycardia
Rate: <60 bpm

3. Sinus arrhythmia
Rhythm: irregular

4. Sinus arrest/ pause
PQRST will be missing
5. Sick sinus syndrome
Combination of sinus node
dysrhythmias
Tachy-brady
Brady-tachy

B. ATRIAL ARRHYTHMIAS
1. Premature atrial contraction (PAC)
P is at opposite polarity
P will not be seen because it is lost in
the preceding T wave
P-R interval may be shorter than
normal

2. Atrial tachycardia
Rate: 160-250 bpm
P may be hidden in the previous T
wave
TYPES:
a. Paroxysmal atrial tachycardia
Four or more consecutive PACs
Rate:150-250 bpm
P waves may not be seen
b. Multifocal atrial tachycardia
Tachycardia with beat-to-beat
variation of the p wave
morphology

3. Atrial flutter
Saw-toothed F waves
Atrial Rate: 250-400 bpm
Ventricular rate: 150, 100, 75
Two for one flutter: atrial rate of 300
and ventricular arte of 150
4. Atrial fibrillation
Atrial Rate: >400 bpm
Ventricular rate: 110-180 bpm
Ventricular rhythm: irregular
C. JUNCTIONAL RHYTHMS

1. Junctional rhythm
Rate: 40-60 bpm
P wave is absent or inverted
2. Accelerated Junctional rhythm
Rate: 60-100 bpm
P wave is absent or inverted

3. Junctional Tachycardia
Rate: >100 bpm

D. ATRIOVENTRICULAR HEART BLOCKS
1. First degree heart block
Prolonged PR: >.2 secs
Constant



2. Second degree heart block
a. Mobitz type 1
Progressive lengthening of the PR
interval until a beat is dropped
Dropped beat is seen as a P wave
and not followed by QRS complex
b. Mobitz type 2
No warning before a beat is
dropped
PR interval remain constant
before the dropped beat
3. Third degree heart block / complete heart
block
P waves occur at a faster rate than
ventricular rate
QRS: <60 bpm
P waves bear no relationship to the
QRS
PR intervals: variable
QRS complex: normal/ abnormal
width
E. VENTRICULAR ARRHYTHMIAS

1. Premature ventricular contractions
P wave is not seen before a PVC
Aberrant in appearance
QRS: abnormally wide
T wave and QRS complex are at
opposite directions

a. Unifocal one PVC
b. Multifocal 2 or more PVC
c. Couplet 2 PVC in a row
d. Triplet 3 PVC in a row
e. Bigeminy
Every other normal beats
f. Trigemini
Every other two normal beats
g. Quadrigeminy
Every other three normal beats

2. Ventricular tachycardia
4 or more PVC: bursts and
paroxysmal
Rate: >100 bpm
3. Ventricular fibrillation
Coarse and fine rhythms
4. Idioventricular rhythm
Wide, bizarre QRS complex
Absent P wave
Rate: 20-40 bpm
Rhythm: regular
5. Accelerated idioventricular rhythm
Rate: 40-100 bpm
F. ASYSTOLE
Flat line