![]() What is the length of the PR interval? Not measureable during PVCs.Is there a P wave before each QRS? Are P waves upright and uniform? Absent with PVCs.What is the rhythm? Depends on underlying rhythm irregular during PVCs.What is the rate? Atrial: usually normal ventricular: usually normal, depends on underlying rhythm.Treatment: Address underlying causes if possible. If PVCs begin to occur more frequently (> 20-40% of all beats), they may progress to the more dangerous rhythms described later. Stress and the use of stimulants make these worse. Many people have these occasionally, and they don't require treatment in an otherwise healthy heart. PVCs are the most common ventricular dysrhythmia. Premature ventricular contractions (PVCs) are ectopic extra beats. Ventricular rhythms display QRS complexes that are wide (greater than or equal to 0.12 seconds) and abnormal in appearance. P waves are absent because there is no atrial activity or depolarization. When the SA node and the AV junctional tissues fail to generate an impulse, the ventricles assume the role of pacing the heart. What is the length of the PR interval? 0.12-0.20 seconds (3-5 small boxes).Is there a P wave before each QRS? Are P waves upright and uniform? Usually upright, but premature and abnormal shape.What is the rhythm? Irregular as a result of the PAC.What is the rate? Usually regular, but depends on the underlying rhythm.If symptomatic, look for underlying causes and reduce heart rate if elevated. Treatment: None required if asymptomatic. Premature Atrial Complexes (PACs) (rate varies irregular rhythm) What is the length of the PR interval? Usually not discernable.Is there a P wave before each QRS? Are P waves upright and uniform? Usually not discernable, especially at the high rates (becomes hidden in the QRS).What is the rate? Atrial: 150-250 bpm ventricular: 150-250 bpm.Treatment: Vagal maneuvers or adenosine if stable electrical cardioversion if unstable. Supraventricular Tachycardia (> 150 bpm, regular rhythm) What is the length of the PR interval? Not discernable.Is there a P wave before each QRS? Are P waves upright and uniform? Normal P waves are absent.What is the rhythm? Irregularly irregular.What is the rate? Atrial: 350-400 bpm ventricular: variable.Treatment: Rate control (slow ventricular rate to 80-100 beats/minute) with digoxin, beta-adrenergic blockers, or calcium channel blockers (diltiazem) What is the length of the PR interval? Not measurableĪtrial Fibrillation (rate varies always irregular).Is there a P wave before each QRS? Are P waves upright and uniform? Normal P waves are absent flutter waves (f waves) (sawtooth pattern) are present.What is the rhythm? Atrial: regular ventricular: may be irregular.What is the rate? Atrial: 250-400 bpm ventricular: variable.Treatment: Cardioversion = treatment of choice antiarrhythmics (procainamide) to convert the flutter diltiazem, verapamil, digitalis, or a beta blocker (metroprolol) to slow the ventricular rate heparin to reduce incidence of thrombus formation. The four most common atrial arrhythmias are described here.Ītrial Flutter (rate varies usually regular saw-toothed) Atrial tissues or internodal pathways may initiate an impulse instead. Do all QRS complexes look alike? What is the length of the QRS complexes? Yes 0.06-0.12 seconds (1½ to 3 small squares)Ītrial rhythms occur when the sinoatrial (SA) node fails to generate an impulse.What is the length of the PR interval? 0.12-0.20 seconds (3-5 small squares).Is there a P wave before each QRS? Are P waves upright and uniform? Yes Yes.What is the rhythm? Irregular (varies more than 0.08 sec).What is the rate? 60-100 beats per minute.Treatment: Sinus arrhythmia typically is asymptomatic and does not require treatment but may be reduced by avoiding caffeine and other stimulants.įive steps to identify this heart rhythm: Tachycardia with wide QRS complexes - consider anti-arrhythmics, such as procainamide, amiodarone, or sotalol. Treatment: Tachycardia with narrow QRS complexes - consider vagal maneuvers, adenosine, beta blocker (metoprolol), calcium channel blocker (diltiazem), or synchronized cardioversion. ![]() Sinus rhythms have five common variations.
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