NORMAL SINUS RHYTHM

ECG: Rate: 60-100; Rhythm: regular; QRS shape: normal; P:QRS ratio: 1:1
(p always in front of QRS)

SINUS BRDYCARDIA

Sinus node creates an impulse at a slower than normal rate

Causes:
o Athlete, sleep, ICP, MI
o Vagal stimulation vomiting, straining, suctioning, sever pain
o Meds bb, ccb, amiodarone
o The Hs and Ts hypovolemia, hypoxia, hydrogen ion (acidosis),
hypo/hyperkalemia, hypoglycemia, hypothermia; toxins, tamponade,
tension pneumothorax, thrombosis, trauma
Management: IV atropine blocks vagal stimulation; Pacemaker
ECG: Same as those for normal sinus rhythm, except for the Rate: less than
60
SINUS TACHYCARDIA

Sinus node creates an impulse at a faster than normal rate

Causes:
o Stress, blood loss, anemia, shock, hypo/hypervolemia, HF, fever,
exercise, anxiety
o Meds/ stimulants/ illicit drugs catecholamines, aminophylline,
atropine, caffeine, ETOH, nicotine
Management: BB, CCB; catheter ablation, pacemaker if unresponsive to
meds
ECG: Same as those of normal sinus rhythm, except for Rate: greater than
100

ATRIAL FLUTTER

Conduction defect in the atrium causing rapid, regular, atrial rate (250-
400/min)
Because the atrial rate is faster than the AV node can conduct not all
impulses reach the ventricle causing a therapeutic block which helps prevent
ventricular fibrillation.
S/S: SOB, low BP, chest pain
Causes : COPD, valvular disease, open heart surgery
 Management: monitoring, cardioversion, ablation; meds to slow ventricular
response BB, CCB, digitalis
ECG: Rhythm: regular; QRS shape: normal; P:QRS ratio: 2-4:1 (p-waves
have saw tooth appearance)

ATRIAL FIBRILLATION

Uncoordinated atrial electrical activity that causes rapid, disorganized and

uncoordinated twitiching of atrium; atrial rate: 300-600, vent rate: 120-200;
can be transient or persistent
A-fib causes an increased risk of stroke b/c erratic atrial contractions promote
thrombi formation
Due to smaller stroke volume, loss in AV synchrony, and atrial kick (= c/o)
S/S may include: SOB, fatigue, hypotension, CP, Pulm edema, altered LOC,
syncope, palpitations, pulse deficit
Cause: age, heart disease, HF, CAD, HTN, DM, obesity, hyperparathyroidism,
pulm HTN/emboli, heavy ingestion of ETOH (holiday heart), pulmonary or
open heart surgery
Management:
o Self limiting; return to normal sinus rhythm within 24 hrs
o Cardioversion, Amiodarone, BB, CCB, ablation
o Coumadin to prevent thrombi formation
ECG: Rhythm: highly irregular; QRS shape: normal; P:QRS ratio: many:1; no
discernible p-waves

VENTRICULAR TACHYCARDIA
 Abnormal impulses within the ventricles causing the heart to beat more than
160 bpm causing inadequate filling of the ventricles = less systemic
circulation; ventricle rate: 100-200
Causes: MI, CAD, heart disease
Management: Cardioversion, defibrillation if pt is pulse less, implantable
cardioverter defibrillator
ECG: Rate: +100; Rhythm; regular; QRS shape: bizarre, abnormal; p-waves
are very difficult to detect

VENTRICULAR FIBRILLATION

Rapid disorganized ventricular rhythm that causes ineffective quivering of the

ventricles; ventricular rate greater than 300 bpm
V-fib is always characterized the absence of an audible HB, palpable pulse,
and respirations.
Cause: MI, CAD, untreated VT, Heart disease, electrolyte imbalances,
electrical shock
Treatment: Defibrillation, if more than 4 min response CPR then
defibrillation, epinephrine
ECG: No p-waves; rhythm extremely irregular without a specific pattern;
unrecognizable QRS

ASYSTOYLE

No cardiac electrical activity