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P wave NORMAL SINUS RHYTHM ATRIAL ARRHYTHMIAS Sinus Tachycardia Sinus Bradycardia Sinus Arrhythmia Sinus Pauses Paroxysmal

Tachycardia Present Present, but P wave of abnormal beat rises from different location None (fibrillatory wave present) None (has saw tooth appearance) Present Present Present Present

QRS complex Present

PR interval 0.12 – 0.20

QRS interval 0.04 – 0.11

P-QRS ratio 1:1

Rate 60 – 100

Rhythm Regular

Present Present Present

0.12 – 0.20 0.12 – 0.20 0.12 – 0.20

0.04 – 0.11 0.04 – 0.11 0.04 – 0.11

1:1 1:1 1:1 1:1

>90 < 40 60 – 100 60 – 100 150 - 250

Regular Regular Irregular Irregular Regular during paroxysms Irregular, P-P and R-R intervals different Irregularly irregular Regular or irregular depending on degree of block

-- Absent during pauses -Present 0.12 – 0.20 0.12 – 0.20 (may vary in abnormal beats) Not measurable Not measurable 0.04 – 0.11

1:1

Premature Atrial Contraction

Present

0.04 – 0.11

1:1

60 – 100 Ventricular Rate highly variable 250-400 Ventricular rate depends on the degree of block

Atrial Fibrillation Atrial Flutter

Present Present

0.04 – 0.11 0.04 – 0.11

Not applicable Variable (2:1, 3:1, 4:1, etc)

JUNCTIONAL ARRHYTHMIAS Present but premature and abnormal, can appear before, after or hidden in the QRS, and can be inverted Same as PJC Same as PJC Same as PJC Usually normal but can occur in Sinus tachycardia or bradycardia 40 – 60 60 – 100 > 100

Premature Junctional Contraction (PJC)

Present

< 0.12

0.04 – 0.11

< 1:1 if hidden; 1:1 if inverted P wave < 1:1 if hidden; 1:1 if inverted P wave < 1:1 if hidden; 1:1 if inverted P wave < 1:1 if hidden; 1:1 if inverted P wave

Irregular

Junctional (Nodal) Rhythm Accelerated Junctional Rhythm Junctional (Nodal) Tachycardia

Present Present Present

< 0.12 < 0.12 < 0.12

0.04 – 0.11 0.04 – 0.11 0.04 – 0.11

Regular Regular Regular

ATRIOVENTRICULAR BLOCKS 1st Degree AV Block 2 Degree AV Block Type I (Wenkebach)
nd

Present Present Normal sinus P but some are not followed by a QRS Present Normal sinus P but some are not followed by a QRS, or > 2 p waves before a QRS complex Present Normal sinus P but some are not followed by a QRS, or > 2 p waves before a QRS complex

Present Present

> 0.20 Progressively lengthening Constant PR interval before dropped QRS’ maybe normal or prolonged PR interval

0.04 – 0.11

> 1:1

Usually normal Usually slow to normal

Regular

0.04 – 0.11

> 1:1

Irregular

2nd Degree AV Block Type II

Present

0.04 – 0.11

> 1:1

Usually slow to normal

Irregular

3 Degree AV Block

rd

Present

Highly Variable

< 0.12 if in high conducting system (Bundle of His); > 0.12 if in low conduction system (bundle branches)

> 1:1

Ventricular rate <40 – 60 if block is high in the conduction system; > 40 if lower

Regular P – R and P – R interval but not the same rate

VENTRICULAR ARRHYTHMIAS Occurs earlier than expected and appears widened and bizarre compared to sinus originated beats Occurs earlier than expected and appears widened and bizarre compared to sinus originated beats QRS complex have different morphology Occurs earlier than expected and appears widened and bizarre

Unifocal Premature Ventricular Contraction (PVC)

Not present with abnormal beats

None

> 0.11 – 0.12

< 1:1

Usually 60 – 100 but can occur slower or faster

Irregular

Multifocal PVC

Not present with abnormal beats

None

> 0.11 – 0.12

< 1:1

Usually 60 – 100 but can occur slower or faster

Irregular

Ventricular Bigeminy

Not present with abnormal beats

None

> 0.11 – 0.12

< 1:1

Usually 60 – 100 but can occur slower or faster

Irregular

Ventricular Trigeminy

Not present with abnormal beats

Ventricular Couplets

Not present with abnormal beats

Ventricular Rhythm Accelerated Ventricular Rhythm Runs of Ventricular Tachycardia Sustained Ventricular Tachycardia

Not Present Not Present Not Present Not Present

Ventricular Fibrillation

Not Present

compared to sinus originated beats Every other beat is abnormal Occurs earlier than expected and appears widened and bizarre compared to sinus originated beats Every third beat is abnormal Occurs earlier than expected and appears widened and bizarre compared to sinus originated beats Ventricular beats are paired, may be multifocal Widened and Bizarre Widened and Bizarre Widened and Bizarre Widened and Bizarre None Chaotic and disorganized with variable size and morphology

None

> 0.11 – 0.12

< 1:1

Usually 60 – 100 but can occur slower or faster

Irregular

None

> 0.11 – 0.12

< 1:1

Usually 60 – 100 but can occur slower or faster

Irregular

None None None None

> 0.11 – 0.12 > 0.11 – 0.12 > 0.11 – 0.12 > 0.11 – 0.12

< 1:1 < 1:1 < 1:1 < 1:1

> 40 40 - 100 100 – 250 during the run 100 – 250

Regular Regular Regular Regular

None

Not measurable

None

Not measurable

Chaotic