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Basic Arrhythmia Course Exam: 10 October 2008
Eina Jane & Co. © 2008 Last Updated: 06 October 2008Walraven, G. (2006).
Basic arrhythmias
. Upper Saddle River, New Jersey: Brady Prentice Hall/Health.
Sinus P before QRS, then TMorphing P; hidden, lost in TInverted P; before, during/hidden, after QRS
Normal Sinus Rhythm
 
 
Regular 60‐100 bpm
 
P Wave: normal upright 
 
PRI: 0.12‐0.20s
 
QRS: <0.12s
Wandering Pacemaker
 
Slightly irregular 60‐100 bpm
 
P Wave: morphology changes, difficult to see, change every complex
 
PRI: 0.12‐0.20s, changes every comple
 
QRS: <0.12s
Premature Junctional Contraction
 
 
Underlying rhythm and rate
 
P Waves: inverted; before, during, afterQRS
 
PRI: measured before QRS, <0.12s
 
QRS: <0.12s
Sinus Bradycardia
 
 
Regular <60 bpm
 
P Wave: normal upright 
 
PRI: 0.12‐0.20s
 
QRS: <0.12s
Premature Atrial Contraction
 
 
Regular underlying except for PAC,60‐100 bpm, just one beat 
 
P Wave: flattened, notched, lost in Twave
 
PRI: 0.12‐0.20s, >0.20s
 
QRS: <0.12s
Junctional Escape Rhythm
 
 
Regular 40‐60 bpm
 
P Waves: inverted; before, during, afterQRS
 
PRI: measured before QRS, <0.12s
 
QRS: <0.12s
Sinus Tachycardia
 
 
Regular >100 bpm
 
P Wave: normal upright 
 
PRI: 0.12‐0.20s
 
QRS: <0.12s
 Atrial Tachycardia
 
 
Regular 150‐250 bpm
 
P Wave: different, lost in T wave
 
PRI: 0.12‐0.20s
 
QRS: <0.12s
 Accelerated Junctional Rhythm
 
 
Regular 60‐100 bpm
 
P Waves: inverted; before, during, afterQRS
 
PRI: measured before QRS, <0.12s
 
QRS: <0.12s
Sinus Arrhythmia
 
 
Irregular 60‐100 bpm
 
P Wave: normal upright 
 
PRI: 0.12‐0.20s
 
QRS: <0.12s
 Atrial Flutter
 
 
Regular; atrial rate 250‐350 bpm
 
P Wave: sawtooth
 
PRI: unable to determine
 
QRS: <0.12s
Junctional Tachycardia
 
 
Regular 100‐180 bpm
 
P Waves: inverted; before, during, afterQRS
 
PRI: measured before QRS, <0.12s
 
QRS: <0.12s
 Atrial Fibrillation
 
 
Grossly irregular >350 bpm <100:controlled vs. >100: uncontrolled
 
P Wave: fibrillatory
 
PRI: unable to measure
 
QRS: <0.12s
Supraventricular Tachycardia
 
 
Regular rapid arrhythmia
 
P Waves: invisible
 
PRI: unable to measure
 
QRS: narrow
Paroxysmal Atrial Tachycardia
 
 
Random atrial tachycardia that breaks to normal
Paroxysmal SupraventricularTachycardia
 
 
Normal then sudden random SVT burst 
 
Obscure regular rhythm
 
No P, rates vary
 
Basic Arrhythmia Course Exam: 10 October 2008
Eina Jane & Co. © 2008 Last Updated: 06 October 2008Walraven, G. (2006).
Basic arrhythmias
. Upper Saddle River, New Jersey: Brady Prentice Hall/Health.
P=P, P>QRS, QRS narrow/wide,functioning impulse withgatekeeper
P, wide/bizarre QRS1° Heart Block 
 
 
Delay
true block; “toll” inAV junction
 
Underlying rhythm/rate
 
P Wave: normal upright,followed by QRS
 
PRI: ≥0.20s; constant acrossstrip; prolonged PRI
 
QRS: <0.12s
 AV Block Algorithm
Does PRI change?
NO YES/ \
Are QRS missing? Is R‐R regular?/ \
NO NO
1°HB 2°HB T1Wenckebach
YES YES
2°HB T2 3° Complete HBClassical Mobitz II 
Premature Ventricular Contraction
 
 
Underlying rhythm, rate; disrupted byectopic beat 
 
P Wave: not preceded by P; dissociatedP may be seen near PVC
 
PRI: focus in ventricles
none
 
QRS: wide and bizarre; ≥0.12s, T wavein opposite direction from R wave
2° HB Type 1: Wenckebach(Mobitz I)
 
2 consecutive long PRI thendrop in QRS after P
 
Irregular, slightly lower thannormal rate (vary)
 
P Waves: normal, upright;not always followed by QRS
 
QRS: >0.12s
Ventricular Tachycardia
 
 
Regular, slightly irregular, 150‐250bpm; >250 moves to flutter; usually<150
 
P Wave: not preceded by P; dissociatedP may be seen near PVC
 
PRI: focus in ventricles
none
 
QRS: wide and bizarre; ≥0.12s, T wavein opposite direction from R wave
2° HB Type II: Classical (MobitzII)
 
Intermittent block,
 pattern; count # of blocks
 
R‐R regular/irregular; P‐Pregular; bradycardia rate: ½to 1/3 slower than normaldepending on block 
 
PRI: constantly paired withQRS; can be >0.20s
 
QRS: <0.12s
3° HB: Complete Heart Block 
 
Atria & ventricle dissociation,
communication
 
Regular
 
P Waves: normal upright, P>QRS,superimposed QRS
 
PRI: may not exist 
 
Junctional Rate: 40‐60 narrow QRS(<0.12s)
 
Vetricular Rate: 20‐40, wider QRS(≥0.12s)
Ventricular Fibrillation
 
Chaotic with no discernable waves orcomplexes
 
Irregular compared to regular V‐tach
 
Cannot determine rate
 
Coarse vs. fine
 
Treatment 
o
 
Defibrillate
o
 
Epinephrine
o
 
Atropine or amiodarone
o
 
Defibrillate
o
 
Vasopressin
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