Transcript Name-That-Rhythm

Name That Rhythm!
Dysrhythmia Identification Practice
Be sure to click on slide show icon!
Remember to Use the 5
Steps to Interpret Rhythms
1. Are the beats at regular or irregular intervals apart?
2. Do you see P, QRS, T pattern?
SINUS
3. What is the HEART RATE?
ATRIAL
JUNCTIONAL
4. What is the PR interval?
VENTRICULAR
5. What is the QRS interval?
Sinus Bradycardia (SB)
• Normal except HR<60
V-paced
Spike before the QRS
What’s the Difference Between Heart
Blockage
&
Block?
Clogged blood vessels
= ioxygen to the
heart = heart attack
Electricity blocked from
traveling normally =
arrhythmia
Idioventricular Rhythm
• Ventricular beats, but…
at a slow rate
Pulseless Electrical Activity (PEA)
• Normal rhythm,
but…
* No Pulse*
Call Code!
Mobitz I: Wenkebach
• PR interval gradually longer until a QRS is dropped
• Pattern repeats
normal
longer
longer
dropped QRS
Bigeminy
Every second beat is a PVC
Jiminy Cricket
Atrial Fibrillation (Afib)
• Irregular
• No definable P waves
unable to count the # of waves
The atria are quivering, leaving a wavy line, but since it is above the
Ventricles, you will still see a QRS
Premature Ventricular Contraction
(PVC)
•Early ventricular beat
Normal Values
Heart Rate:
60-100 beats per minute
PR Interval:
.12-.20 seconds
QRS Interval:
< .11 seconds
Couplet
Failure to Capture
• Pacer spike is fired, but no beat follows
Mobitz II
• PR interval consistent except some QRS missing
Blocked QRS
Example PR intervals: .16 – B - .16 – B - .16 - .16 - B
Normal Sinus Rhythm (NSR)
•
•
•
•
Rhythm is normal
Rate normal 60-100
PR normal .12-.20
QRS normal < .11
Junctional Rhythm
• No P wave or PR < .12
Pause
• Period of no electrical activity, then resumes
6 Beats of VT
Paroxysmal Atrial Tachycardia (PAT)
• Sudden rate change > 150 bpm
• QRS shape is similar before & after rate
change, there is a definable p wave
QRS look similar in shape
1 º AVB
PR interval >.20
PR intervals:
.24 - .24 - .24 - .24 - .24
Sinus Tachycardia (ST)
• Normal except HR >100 bpm
If you step on a tack, you
will quickly get off of it!
Ventricular Tachycardia (VT)
• Ventricular beats (wide QRS’s)
• Rate > 150 bpm
Call Code!
Sinus Arrhythmia (SA)
• Normal except irregular
Asystole
• No electrical activity
Wouldn’t your heart stop if you
saw one of these in the water!
Call Code!
Trigeminy
Every 3rd beat is a PVC
Tricycle has 3 wheels
3rd Degree AV Block (3º AVB)
Your patient is a ticking
Time Bomb!
Atria & ventricles act independently
• Regular P waves
• Regular QRS complexes
But…P waves and QRS not working together
• PR interval varies (but not in Wenkebach pattern)
• Harmful -- patient needs a pacemaker soon!
blocked
normal blocked
blocked
short
blocked
normal blocked
Example PR intervals: .14 – B - .20 – B – B - .12 – B - .44 - .32 - B
Torsades de Pointes
• A form of VTach which looks like the
rhythm strip is twisting
Call CODE!
A-paced
A spike before the P wave site
Mobitz II
PR regular except some QRS are dropped
PR intervals:
.12 – B - .12 - .12 – B - .12 – B
Atrial Flutter
• Numerous P waves that you can count
Premature Beats
Identifying Characteristic
PVC
PJC
PAC
Wide Bizarre QRS
PR<.12, or no P wave
PR=.12-.20, nl for
atrial beat
Wenkebach
PR gradually longer until QRS dropped
PR intervals:
.12 - .18 - .24 – B - .12 - .18 - .24 – B
Ventricular Fibrillation (VF)
• Squiggly line
Call CODE!
Failure to Sense
• Heart is beating just fine, but pacemaker fires anyway
• Spikes are not in a consistent place before P or QRS
--seen in many different places
ST Elevation
QRS exits higher than it starts
exits
enters
Wandering Atrial Pacemaker (WAP)
• P waves vary in shape (at least 3 different P waves)
3º AVB
PR interval varies, but not in Wenkebach pattern
PR intervals:
.12 – B - .20 – B – B - .16 - .44 – B - .32
Premature Beats
3 Types
Premature Atrial Contraction (PAC)
Premature Junctional Contraction (PJC)
Premature Ventricular Contraction (PVC)
Bundle Branch Blocks (BBB)
QRS >.11
AV-paced
Spikes before the P wave site & QRS
Premature Junctional Contraction (PJC)
• Early beat
• No P wave or PR interval is <.12
First Degree AV Block
(1º AVB)
• PR interval > .20
A
//
V
Example PR intervals: .28 - .28 - .28 - .28 - .28 - .28
ST Depression
QRS exits lower than it starts
enters
exits
Paroxysmal Supraventricular Tachycardia
(PSVT)
• Sudden rate change >150 bpm, cannot distinguish
whether it is from atrial or junctional area, but you know
that it is not from the ventricles
• QRS looks different before & after rate change
• Cannot see a definable P Wave
QRS look different in shape
Types of AV Blocks
•First Degree
1°AVB
•Second Degree
Wenkebach
Mobitz II
•Third Degree
3°AVB
Premature Atrial Contraction (PAC)
• Early beat
• Normal PR interval
Triplet
Which rhythms are a
CODE Blue?
•
•
•
•
•
•
VT
VFib
Asystole
Torsades
PEA
Sustained Failure to capture
(Patient’s heart may not be beating enough to
sustain life)
WAY TO GO!
You’re catching on!