Ateneo De Zamboanga University

College of Nursing
Week III Related Learning Experience Asynchronous Activity
Medical ward

Name: Altar, Catherine Sienna B. Clinical Instructor: Darwin I. Halbi

Date: August 27, 2020 Thursday

I. Describe and give an illustration of an ECG tracing on the following arrythmias/ dysrhythmias,
according to:
•Rate •PR intervals (secs.)
•Rhythm •QRS (secs)
•P wave,

A. Normal Sinus Rhythm

- A normal resting heart rate for adults ranges from 60 to 100 beats per minute. Generally, a lower heart rate at rest
implies more efficient heart function and better cardiovascular fitness. For example, a well-trained athlete might
have a normal resting heart rate closer to 40 beats per minute.

Heart Rate Rhythm P wave PR Interval (secs) QRS (secs.)

Before each QRS,
60 to 100 Regular .12 -.20 <.12
Identical

1. Sinus Bradycardia
- Sinus bradycardia is a slow, regular heartbeat. It happens when your heart's pacemaker, the sinus node,
generates heartbeats less than 60 times in a minute. For some people, such as healthy young adults and
athletes, sinus bradycardia can be normal and a sign of cardiovascular health.

Heart Rate Rhythm P wave PR Interval (secs) QRS (secs.)

resting heart rate of
60 beats per minute
or less
normal upright P
wave in lead II (sinus
P wave) preceding
Regular every QRS complex Normal (0.16 second). Normal (0.16 second).
with a ventricular
rate of less than 60
beats per minute

2. Sinus Tachycardia
- Sinus tachycardia is recognized on an ECG with a normal upright P wave in lead II preceding every QRS
complex, indicating that the pacemaker is coming from the sinus node and not elsewhere in the atria, with an
atrial rate of greater than 100 beats per minute.

Heart Rate Rhythm P wave PR Interval (secs) QRS (secs.)

an elevated sinus normal
rhythm characterized upright P
greater than 100 by an increase in the wave in lead II
2:1 block ≥120 ms
beats/min (bpm) rate of electrical preceding
impulses arising from every QRS
the sinoatrial node complex

3. Atrial Flutter
- Atrial flutter occurs when a “reentrant” circuit is present, causing a repeated loop of electrical activity to
depolarize the atrium at a rate of about 250 to 350 beats per minute; remember the atrial rate in atrial
fibrillation is 400 to 600 bpm.

Wk3/ECG
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 Heart Rate Rhythm P wave PR Interval (secs) QRS (secs.)
110 bpm (Atrial rate is
Flutter waves, F waves are consistent,
210. Typical 0.12 sec (normal
Regular (can be irregular) or F waves, are 2 for every QRS (2:1 or
“sawtooth” pattern of range = 0.04-0.12)
present 3:1 is typical)
atrial flutter.)

4. Atrial Fibrillation
- Atrial fibrillation is an irregular and often rapid heart rate that can increase your risk of strokes, heart failure
and other heart-related complications.

Heart Rate Rhythm P wave PR Interval (secs) QRS (secs.)

90 bpm (atrial rate is Not 0.08 seconds
very fast and chaotic, Irregular discernible. None (Normal range =
and cannot be counted) Chaotic. 0.04-0.12)

5. Premature Ventricular Contraction PVC

- Premature ventricular contractions (PVCs) are extra heartbeats that begin in one of your heart's two lower
pumping chambers (ventricles). These extra beats disrupt your regular heart rhythm, sometimes causing you
to feel a fluttering or a skipped beat in your chest.

Heart Rate Rhythm P wave PR Interval (secs) QRS (secs.)

Wide and bizarre.
Preceding P wave The QRS of a PVC
Underlying rate is absent; No P will be at least 0.12
Irregular N/A
may vary wave preceding the seconds and is
PVC usually 0.14 second
or greater.

6. Ventricular Tachycardia
- Ventricular tachycardia (VT) is a fast, abnormal heart rate. It starts in your heart's lower chambers, called
the ventricles. VT is defined as 3 or more heartbeats in a row, at a rate of more than 100 beats a minute.

Heart Rate Rhythm P wave PR Interval (secs) QRS (secs.)

May be present or
absent. If present,
< 0.12 seconds at
> 100 bpm Regular they have no set None
100-250bpm
relationship to the
QRS complex

7. Ventricular Fibrillation
- is a heart rhythm problem that occurs when the heart beats with rapid, erratic electrical impulse. This causes
pumping chambers in your heart (the ventricles) to quiver uselessly, instead of pumping blood.

Heart Rate Rhythm P wave PR Interval (secs) QRS (secs.)

0 Chaotic Absent Absent Absent

8. First Degree Block

- First-degree atrioventricular (AV) block is defined as a PR interval of greater than 0.20 seconds on
electrocardiography (ECG) without disruption of atrial to ventricular conduction (figure). It is generally
asymptomatic and without significant complications.

Wk3/ECG
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Heart Rate Rhythm P wave PR Interval (secs) QRS (secs.)
0.24 sec (normal range =
Regular (can be slightly 0.04 sec (normal range
90 bpm Normal 0.12-0.20), one P wave
irregular) = 0.04 – 0.12)
for each QRS

9. Second Degree Block

- Second-degree atrioventricular (AV) block, or second-degree heart block, is a disorder characterized by
disturbance, delay, or interruption of atrial impulse conduction to the ventricles through
the atrioventricular node (AVN) and bundle of His. Electrocardiographically, some P waves are not followed
by a QRS complex

Heart Rate Rhythm P wave PR Interval (secs) QRS (secs.)

Ventricular rhythm is Normal; Some are 0.04sec (can be
60 bpm (typically Constant for p-waves
irregular; Atrial rhythm not followed by longer than normal
bradycardic) followed by a QRS
is regular QRS complexes range = 0.04 – 0.12)

10. Third Degree Block

- Third-degree atrioventricular block (AV block) is a medical condition in which the nerve impulse generated
in the sinoatrial node (SA node) in the atrium of the heart cannot propagate to the ventricles. Because the
impulse is blocked, an accessory pacemaker in the lower chambers will typically activate the ventricles.
- Clinical Significance: A third degree block is an absence of conduction between the atria and the ventricles.
There is a complete electrical block between the two and they pace the heart independent of each other.

Heart Rate Rhythm P wave PR Interval (secs) QRS (secs.)

Normal; Some are
Ventricular rhythm is 0.16 sec (normal
60 bpm (typically hard to see and Varies; disassociated
regular; Atrial rhythm range is = 0.04-
bradycardic) buried in QRS from QRS
is regular 0.12)
complexes

11. Asystole
- Asystole is the absence of ventricular contractions in the context of a lethal heart arrhythmia (in contrast to an
induced asystole on a cooled patient on a heart-lung machine and general anesthesia during surgery
necessitating stopping the heart). Asystole is cardiac arrest with no electrical activity. Treat with high quality
CPR and 1mg Epinephrine1:10,000 given every 3-5 minutes.

Heart Rate Rhythm P wave PR Interval (secs) QRS (secs.)

None None Absent Absent Absent

I. Give an ECG Tracing and illustration reading of a patient with excitation in Electrolytes Disturbance:
1. HYPOKALEMIA
2. HYPERKALEMIA
3. HYPERCALCEMIA
4. HYPOCALCEMIA

1. HYPOKALEMIA
- Hypokalemia is a metabolic imbalance characterized by extremely low potassium levels in the blood. It is a
symptom of another disease or condition, or a side effect of diuretic drugs. 
- If you have hypokalemia, that means you have low levels of potassium in your blood. Potassium is a mineral
your body needs to work normally. It helps muscles to move, cells to get the nutrients they need, and nerves
to send their signals. It is especially important for cells in your heart.

Wk3/ECG
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 2. HYPERKALEMIA
- Hyperkalemia is the medical term that describes a potassium level in your blood that's higher than normal.
Potassium is a chemical that is critical to the function of nerve and muscle cells, including those in your heart.

3. HYPERCALCEMIA
- Hypercalcemia is a condition in which the calcium level in your blood is above normal. Too much calcium in
your blood can weaken your bones, create kidney stones, and interfere with how your heart and brain
work. Hypercalcemia is usually a result of overactive parathyroid glands.
- The most common ECG findings of hypercalcemia are a short QT interval (Ref. 1) secondary to a shortened
ST segment. (Source 3) There may also be a widened or flattened T wave; however,
significant hypercalcemia can cause ECG changes that mimic an acute myocardial infarction.

4. HYPOCALCEMIA
- Hypocalcemia is a condition in which there are lower-than-average levels of calcium in the liquid part of the
blood, or the plasma. Calcium has many important roles in your body: Calcium is key to the conduction of
electricity in your body.
Wk3/ECG
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 - The ECG hallmark of hypocalcemia remains the prolongation of the QTc interval because of lengthening of
the ST segment, which is directly proportional to the degree of hypocalcemia or, as otherwise stated,
inversely proportional to the serum calcium level.

REFERENCES:
 https://www.healio.com/cardiology/learn-the-heart/ecg-review/ecg-topic-reviews-and-criteria/sinus-tachycardia-
review#:~:text=Sinus%20tachycardia%20is%20recognized%20on,than%20100%20beats%20per%20minute.
 https://www.thecardiologyadvisor.com/home/decision-support-in-medicine/cardiology/differential-diagnosis-of-
wide-qrs-complex-tachycardias/
 https://www.cedars-sinai.org/health-library/diseases-and-conditions/s/sinus-bradycardia.html
 https://www.nurseslearning.com/courses/nrp/nrp1619/section%202/p01.html
 https://www.proacls.com/wiki/ekg-rhythms/atrial-fibrillation/
 https://www.healio.com/cardiology/learn-the-heart/ecg-review/ecg-topic-reviews-and-criteria/premature-
ventricular-contractions-review
 https://www.mayoclinic.org/diseases-conditions/atrial-fibrillation/symptoms-causes/syc-20350624
 https://rarediseases.org/rare-diseases/hypokalemia/
 https://www.grepmed.com/images/3295/hypokalemia-cardiology-clinical-uwaves-ekg-ecg
 https://www.openanesthesia.org/aba_calcium_-_ecg_changes/#:~:text=Hypercalcemia%3A%20The%20most
%20common%20ECG,mimic%20an%20acute%20myocardial%20infarction.

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