Cardiac Rhythms and Dysrhythmias
Rhythm and Strip ECG Characteristics Management
Normal sinus rhythm Rate: 60 – 100 bpm
Rhythm: regular
There is one P for every QRS
PR interval: 0.12 – 0.20 seconds
QRS complex: 0.06 – 0.10 seconds
Sinus tachycardia Rate: 101 – 150 bpm
Rhythm: regular
There is one P for every QRS but may
be hidden with T wave due to speed
PR interval: 0.12 – 0.20 seconds
QRS complex: 0.06 – 0.10 seconds
Sinus bradycardia Rate: < 60 bpm
Rhythm: regular
There is one P for every QRS
PR interval: 0.12 – 0.20 seconds
QRS complex: 0.06 – 0.10 seconds
Premature atrial contractions (PAC) Rate: varies
Rhythm: regular with early beats
originating in atria
There is one P for every QRS
PR interval: not measured
QRS complex: 0.06 – 0.10 seconds
Atrial flutter Rate: atrial 240 – 360 bpm, ventricular
rate depends on degree of AV block
Rhythm: regular
P:QRS ratio: 2:1. 4:1, 6:1, or variable
PR interval: not measured
QRS complex: 0.06 – 0.10 seconds
This is a normal heart rhythm so no
treatment is required
This is only treated if client is
symptomatic or is at risk for
myocardial damage
If there is an underlying cause, beta-
blockers or verapamil can be used
This is only treated if client is
symptomatic; administer IV atropine,
isoproterenol, and/or pacemaker may
be used
This usually requires no treatment.
Advise client to reduce alcohol intake,
reduce stress, and stop smoking
This is treated with synchronized
cardioversion; meds to reduce
ventricular response such as beta-
blocker or calcium channel blocker
followed by a class I antidysrhythmic
or amiodarone
Atrial fibrillation
Premature ventricular contractions (PVC)
Ventricular tachycardia
Ventricular fibrillation
First-degree AV block
Rate: 300 – 600 bpm; ventricular 100 –
180 bpm in untreated clients
Rhythm: irregularly regular
P:QRS ratio is variable
PR interval: not measured
QRS complex: 0.06 – 0.10 seconds
Rate: variable
Rhythm: irregular; PVC interrupts
underlying rhythm and followed by a
compensatory pause
No P wave noted before a PVC
PR interval: absent
QRS complex: wide, > 0.12 seconds
Rate: 100 – 250 bpm
Rhythm: regular
No indentifiable P wave
PR interval: not measured
QRS complex: ≥ 0.12 seconds; bizarre
shape
Rate: too rapid to count
Rhythm: grossly irregular
No identifiable P waves
PR interval: none
QRS complex: bizzare, varying in
shape and direction
Rate: 60 – 10 bpm
Rhythm: regular
There in one P for every QRS
PR interval: > 0.20 seconds
QRS complex: 0.06 – 0.10 seconds
This is treated with synchronized
cardioversion; meds to reduce
ventricular response rate such as
metoprolol, diltiazem, or digoxin;
anticoagulant therapy to reduce risk of
clot formation and stroke
This is treated if client is symptomatic;
advise against using stimulants
(caffeine, nicotine); drug therapy
includes, class I and III
antidysrhythmics and possibly addition
of a beta blocker
This is treated if VT is sustained or if
client is symptomatic; treatment
includes IV procainamide, lidocaine.
If unstable, a class III antidysrhythmic
and immediate cardioversion; ablation
surgery or internal defibrillator for
repeated episodes
Immediate defibrillation
No treatment required
Second-degree AV block type 1 (Mobitz 1, Wenckebach)
Second-degree AV block type 2 (Mobitz 2)
Third-degree block (complete heart block)
Rate: 60 – 100 bpm Treatment includes monitoring and
Rhythm: atrial regular, ventricular observation; atropine and isoproterenol
irregular if client is symptomatic (rarely
P:QRS ratio: 1:1 until P wave is progresses to a higher level of block)
blocked w/ no QRS following
PR interval: progressively lengthens in
regular pattern
QRS complex: 0.06 – 0.10 seconds;
sudden absence of QRS complex
Rate: atrial 60 -100 bpm, ventricular < Treatment includes atropine or
60 bpm isoproterenol; pacemaker therapy
Rhythm: atrial regular, ventricular
irregular
P:QRS ration: typically 2:1, may vary
PR interval: constant PR interval for
each conducted QRS
QRS complex: 0.06 – 0.10 seconds
Rate: atrial 60 – 100 bpm; ventricular Immediate pacemaker therapy
15 – 60 bpm
Rhythm: both atrial and ventricular are
regular
Independent rhythm (no relationship
between P and QRS)
PR interval: not measured
QRS complex: