Interpretation of Arrhythmias

HOME Who am I? Interesting Articles Helpful Hints & Links Publication Guidelines Advertising Info Contacting Me Visit me at work at Lehigh Valley Wellness Center		by Louise Diehl-Oplinger, RN, MSN, ND, CCRN, ACNS-BC, NP-C Nurse Practitioner - Owner Doctor of Naturopathy Lehigh Valley Wellness Center Here are some guidelines to help you with EKG rhythm interpretation. Steps to interpretation: Calculate heart rate (ventricular) * Multiply # of R waves in strip 6 second strip by 10 3 second strip by 20 Divide the # of large squares between two R waves into 300 (less accurate) Rhythm (ventricular) ** Measure the interval between 2 R waves Regular vs. Irregular ( > 3 tiny blocks or 0.12 seconds) Do not estimate. Use an EKG caliber or paper. Examine P wave Present, upright, all look the same Measure PR interval Beginning of P to beginning of QRS complex Should be the same Normal 0.12 to 0.20 seconds Measure QRS duration Beginning of Q to end of S Normal is < 0.12 seconds Examine ST segment (should be iso-electric) Examine T wave (upright, flat, inverted, spiked) * If P wave occurs before every QRS, atrial rate will be the same as ventricular. ** If P wave occurs in the same place before every QRS, atrial rhythm will be the same as ventricular. Basic Characteristics of Cardiac Rhythms Dysrhythmia Rate Rhythm P-R Interval QRS Interval Comments Sinus Rhythms Normal Sinus 60-100 Regular 0.12-0.20 sec <0.12 sec   Sinus Bradycardia <60 Regular 0.12-0.20 <0.12 sec   Sinus Tachycardia 100-160 Regular 0.12-0.20 sec <0.12 sec   Sinus Arrythmia 60-100 Irregular 0.12-0.20 sec <0.12 sec Rhythm varies with respiration Sinus Pause/Arrest Depends on pauses Usually regular with pauses 0.12-0.20 sec <0.12 sec   Atrial RhythmsPAC Depends on underlying rhythm Interrupts underlying rhythm 0.12-0.20 sec <0.12 sec Regularity depends on underlying rhythm and number of PAC’s Atrial TachycardiaSVT 150-250 Regular 0.12-0.20 sec <0.12 sec P waves may be hidden in previous T due to rapid rate Atrial Flutter V rate varies A rate 250-350 Irregular Variable <0.12 sec “Sawtooth” pattern F waves Atrial Fibrillation Controlled AF <100 Uncontrolled AF >100 Irregular Nonmeasureable <0.12 sec   Wandering Pacemaker 60-100 Irregular <0.20 sec <0.12 sec Morphology of P wave changes Heart Blocks 1st AV block 60-100 Usually regular >0.20 sec <0.12 sec P:QRS ratio 1:1 2nd Degree Mobitz 1, Wenkebach V < A Atrial regular Ventricular irregular Progressively longer until one QRS dropped <0.12 sec P:QRS ratio 1:1 2nd Degree Mobitz II Remains Constant Atrial regular, Vent regular or irregular variable   More P’s than QRS’s 3rd Degree Block Complete 40-60 Junct 20-40 Vent p-p regular r-r regular Nonmeasurable   More P’s than QRS’s Junctional Rhythms PAC Depends on underlying rhythm Interrupts underlying rhythm     For all junctional rhythms P waves are inverted. The can be hidden, precede or fall after the QRS Junctional Escape 40-60 Regular <0.12 sec if present <0.12 sec   Accelerated Junctional 60-100 Regular <0.12 sec if present <0.12 sec   Junctional Tachycardia 100-180 Regular <0.12 sec if present <0.12 sec   Ventricular Rhythms PVC Depends on underlying rhythm Interrupts underlying rhythm No PR interval >0.12 sec wide and bizarre   Ventricular Tachycardia 150-250 Regular No PR interval >0.12 sec wide and bizarre   Ventricular Fibrillation No cardiac output Irregular No PR interval No QRS Chaotic Idioventricular <20-40 Regular No PR interval >0.12 sec bizarre Slows as heart dies Ventricular Asystole None None None None No electrical activity Reference: ECG Interpretation Made Incredibly Easy. Springhouse Corporation, Springhouse, PA, 1997

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