Rhythm ECG Characteristics Example

Normal Sinus Rhythm Rate: 60-100 per minute

Rhythm: R- R =
(NSR)
P waves: Upright, similar
P-R: 0.12 -0 .20 second
& consistent
qRs: 0.04 – 0.10 second
P:qRs: 1P:1qRs

Sinus Tachycardia Rate: > 100

Causes: Rhythm: R- R =
‰ Exercise
P waves: Upright, similar
‰ Hypovolemia
P-R: 0.12 -0 .20 second
‰ Medications
& consistent
‰ Fever qRs: 0.04 – 0.10 second
‰ Hypoxia P:qRs: 1P:1qRs
‰ Substances
‰ Anxiety, Fear
‰ Acute MI
‰ Fight or Flight
‰ Congestive Heart Failure

Sinus Bradycardia Rate: < 60

Causes: Rhythm: R- R =
‰ intrinsic sinus node
P waves: Upright; similar
disease P-R: 0.12 -0 .20 second
‰ increased
& consistent
parasympathetic tone qRs: 0.04 – 0.10 second
‰ drug effect. P:qRs: 1P:1qRs
Rhythm ECG Characteristics Example

Premature Atrial Rate: usually < 100,

dependant
Contractions (PAC) i i i
On underlying rhythm
Causes:
Rhythm: irregular
‰ normal
P waves: Early & upright,
‰ excessive use of caffeine,
different from Sinus
tobacco, or alcohol
PR: 0.12 – 0.20 second;
‰ CHF PAC = i
different from Sinus
‰ Myocardial ischemia or
qRs: 0.04 – 0.10 second
injury
P:qRs = 1:1
‰ Hypokalemia, Dig
toxicity
‰ COPD

Atrial Flutter Rate: Atrial rate 250-350

Causes: Vent 150 common
‰ ischemic heart disease
Rhythm: Atrial = Regular
‰ Hypoxia
Vent = Reg. or irreg
‰ Acute MI
P waves: Not identifiable
‰ Dig Toxicity
F waves: Uniform (sawtooth
‰ Mitral or Tricuspid valve
or picket fence )
disease PRI: not measurable
‰ Pulmonary embolism qRs: 0.04 – 0.10 second

Atrial Fibrillation Rate: Atrial: 400-700

‰ Ischemic heart disease
‰ Hypoxia
‰ Acute MI
‰ Digitalis toxicity
‰ Mitral or tricuspid
disease
Vent. 160-180/minute
Rhythm: Atrial: irregular;
Vent.: irregular
P waves: No identifiable Ps
f waves: may be seen.
PRI: unable to measure
(No identifiable P)
qRs: usually normal
Rhythm ECG Characteristics Example

Paroxysmal Atrial Rate: usually 160-220

Rhythm: Regular
Tachycardia
P waves: differ in shape from
Causes:
Sinus Ps; usually difficult
‰ Same as PACs
to identify (rate related)
PR Interval: Normal when the Ps
can be identified;
short if WPW present
qRs: usually normal
Other: Onset sudden, often
initiated by a PAC

Premature Junctional Rate: usually < 100,

dependant on the
Contraction (PJC)
underlying rhythm
Causes:
Rhythm: irregular
‰ Same as PACs
P waves: Inverted before or after
qRs or not visible
PR interval: < 0.12 second when
inverted P is before
qRs
qRs: 0.04 – 0.10 second
P:qRs = 1:1 if Ps are visible
Rhythm ECG Characteristics Example

Junctional escape Rate: 40-60

61 – 100 (accelerated)
Rhythm
Rhythm: Regular
Causes:
P waves: Inverted before or after
‰healthy athlete at rest
qRs or not visible
‰related to medications-
PR interval: < 0.12 second when
Beta Blockers, Calcium
inverted P is before
Channel Blockers, Dig
qRs
Toxicity
qRs: 0.04 – 0.10 second
‰or increased
P:qRs 1:1 if Ps are visible
parasympathetic tone
‰Acute Inferior Wall MI
‰Rheumatic Heart Disease
‰Post-Cardiac Surgery
‰Valvular Disease
‰SA Node Disease
‰Hypoxia

Junctional Tachycardia Rate: 101-200

Causes:
‰Same as Paroxysmal Same as Junctional Escape
Atrial Tachycardia (PAT) Rhythms.

Supraventricular Rhythm: Absolutely regular

Tachycardia (SVT) Rate: > 150 per minute
P Waves: Not visible
An umrella term used
(PRI not measurable)
when unable to qRs: normal 0.04 – 0.10 sec
distinguish which
rhythm is present.
Causes:
Same as Sinus, Atrial, and
Junctional Tachycardia, and Atrial
Flutter
Rhythm ECG Characteristics Example

Premature Ventricular Rate: Dependent upon

underlying rhythm
Complex (PVC)
Rhythm: R – R z
Causes:
P waves: Usually absent, if
‰ Gastric overload PVC
present, not associated PVC
‰ Stress
with PVC
‰ Caffeine, Alcohol,
Nicotine qRs: 0.12 second or greater;
‰ Heart Disease
bizarre and notched
‰ Acid-Base Imbalance
ST & T: Often opposite in
‰ Electrolyte Imbalance
direction to the qRs.
‰ Cyclic Antidepressants Timing
‰ Hypoxia One on a strip = Rare
‰ Acidosis One in a row = Isolated
‰ Acute MI Two in a row = Pair, couplet
Three in a row = V Tachycardia
Pattern
Every other = Bigeminy
Every third = Trigeminy
Morphology
Similar shape = Uniformed
Different shape = Multiformed
Location
R – on – T = PVC falls on the T
wave of the complex before the
PVC
Rhythm ECG Characteristics Example

Ventricular Rate: > 100 per minute and

usually not > 220
Tachycardia
Rhythm: Usually regular
Causes:
‰ Same as PVCs
P Waves: ‡ P waves or if
present, not
‰ R on T Phenomenon
associated with qRs
qRs: Wide (t 0.12 sec),
bizarre
ST/T wave: Opposite direction
of qRs

A group of three PVCs in a row or

more at a rate greater than 100/
minute or more constitutes
Ventricular Tachycardia.

Ventricular Fibrillation Rate: ‡

Causes: Rhythm: ‡ regularity,
‰ Acute Myocardial chaotic undulating
Infarction waves
‰ Untreated Ventricular P Waves: ‡
Tachycardia qRs: ‡
‰ Hypothermia ST/T Wave: ‡
‰ R-on-T PVCs Organized activity: ‡
‰ Electrolyte imbalance
‰ Electrical shock No Cardiac Output or Pulse
Rhythm ECG Characteristics Example

Idioventricular Rate: 20-40 per minute

Rhythm: R – R =
Rhythm
P waves: No P waves associated
Causes:
to qRs
‰ Myocardial Infarction
qRs: > 0.12 sec, notched,
‰ Digitalis toxicity
bizarre appearance
‰ Metabolic imbalances
ST/T : Opposite direction of qRs
‰ Post resuscitation rhythm

Rate > 40 to 100 = Accelerated

Asystole Rate: Ventricular rate = 0

Causes: Rhythm: ‡ unless Ps are present,
‰ Extensive myocardial then regular or irregular
damage  P waves: may be present
‰ Acute respiratory failure qRs: ‡
‰ Ischemia or Infarction P:qRs ‡
‰ Traumatic cardiac arrest
‰ Ventricular aneurysm
‰ Countershock
‰ Hypoxia, Hypothermia
‰ Hyperkalemia,
Hypokalemia
‰ Preexisting acidosis
‰ Drug overdose
Rhythm ECG Characteristics Example

1st degree AV Block X 1P : 1 qRs

X Prolonged PRI
(> 0.20 sec not > 0.40 sec)

2nd degree AV Block, X More P waves than qRs

X PRI progressively increases
Type I in a cycle until P appears
w/o qRs.
X Cyclic pattern reoccurs
XR–Rz = non-conducted P wave

2nd degree AV Block, More P waves than qRs

X PRI consistent
Type II X qRs normal or wide (bundle
branch block)
X R - Rz or R – R =

= non-conducted P wave
Rhythm ECG Characteristics Example

3rd degree AV Block X More P waves than qRs

X P not r/t qRs
(P too close, P too far)
X PRI varies greatly
X qRs normal or wide
XR–R=
= non-conducted P wave