Campugan, Jay M.

BSN-3B

Cardiac Dysrhythmias

Rhythm: Sinus bradycardia ECG tracing

Mechanism: Sinus bradycardia occurs when the

heart's natural pacemaker, the sinus node, fires
electrical signals at a slower rate than usual. This
reduced firing rate results in a slower heart rate,
typically below 60 beats per minute in adults. It can be
caused by various factors, including a decrease in
sympathetic nervous system activity, increased
parasympathetic nervous system activity, certain
medications, or underlying medical conditions. The
mechanism behind sinus bradycardia depends on the
specific cause, but it often involves a disruption in the
normal balance of the autonomic nervous system's
control over heart rate.

Origin: : Sinoatrial Node

Characteristics:
Rate: <60 bpm
Rhythm: Regular
ECG:
- P wave: Present; normal in amplitude and vector;
constant morphology preceding every QRS complex
- P:QRS ratio: 1:1
- PR interval: Normal to slightly prolonged
- QRS width: Normal to slightly prolonged

Rhythm: Sinus tachycardia ECG tracing

Mechanism: Sinus tachycardia occurs when the heart's

natural pacemaker, the sinus node, fires electrical
signals at a faster rate than usual. This increased firing
rate results in a faster heart rate, typically above 100
beats per minute in adults. The mechanism behind
sinus tachycardia is often an appropriate response to
physiological needs, such as increased oxygen demand
during exercise, stress, fever, or other factors. The
sympathetic nervous system plays a role in speeding up
the heart rate in response to these demands, releasing
adrenaline and norepinephrine, which stimulate the
heart. In some cases, medical conditions, medications,
or other factors can also trigger sinus tachycardia.

Origin: Sinoatrial Node

Characteristics:
Rate: >100 bpm
Rhythm: Regular
ECG:
- P wave: Present; Normal upright; constant
morphology preceding every QRS complex
- P:QRS ratio: 1:1
- PR interval: Normal to slightly shortened
- QRS width: Normal to slightly shortened

Rhythm: Sinus arrhythmia ECG tracing

Mechanism: Sinus arrhythmia is a variation in the

normal heart rhythm characterized by irregular spacing
between heartbeats. The mechanism behind sinus
arrhythmia is related to changes in the autonomic
nervous system's influence on the heart rate. During
normal breathing, the heart rate tends to increase
during inhalation and decrease during exhalation. This
is known as respiratory sinus arrhythmia and is often
seen in healthy individuals, particularly in children and
young adults. It occurs because the vagus nerve, which
is part of the parasympathetic nervous system, is more
active during exhalation, slowing down the heart rate.
When you inhale, the vagus nerve's activity decreases,
allowing the heart rate to speed up. Sinus arrhythmia
can also occur in response to certain medical conditions
or medications. In these cases, it may not be linked to
the respiratory cycle but can still result in irregular heart
rhythms originating from the sinus node.

Origin: Sinoatrial Node

Characteristics:
Rate: 60-100 bom
Rhythm: Varies with respiration
ECG:
- P wave: Normal; constant morphology
- P:QRS ratio: 1:1
- PR interval: Normal
- QRS width: Normal

Rhythm: Premature atrial contraction ECG tracing

Mechanism: Premature atrial contraction occurs when

the atria (the upper chambers of the heart) contract
prematurely, before the normal electrical signal from the
sinus node. The mechanism behind PACs involves an
ectopic (abnormal) electrical signal originating from a
location within the atria other than the sinus node.This
abnormal signal is typically triggered by an irritable
focus of cardiac cells within the atria. PACs can be
caused by factors such as stress, caffeine, medications,
or underlying heart conditions.

Origin: Atria, specifically areas other than the sinoatrial

node

Characteristics:
Rate: Depends on the underlying sinus rate
Rhythm: Irregular
ECG:
- P wave: Present; may be a different shape; premature
with different morphology, depending on the
location of the ectopic focus from which the
impulse is discharged
- P:QRS ratio: 1:1
- PR interval: Varies in the APC, otherwise
normal
- QRS width: Normal

Rhythm: Atrial flutter ECG tracing

Mechanism: Atrial flutter is an abnormal heart rhythm

where the atria (the heart's upper chambers) contract
rapidly and regularly, causing a fast and often regular
ventricular response (contraction of the lower
chambers). The mechanism behind atrial flutter involves
a reentrant circuit within the atria, where electrical
signals circulate in a circular pattern, often around the
tricuspid valve. This continuous loop of electrical activity
leads to the atria contracting at a fast rate, typically
between 250 to 350 beats per minute. The ventricles
receive some of these electrical impulses, resulting in a
rapid and usually regular heartbeat. Atrial flutter can be
associated with various underlying conditions, such as
heart disease.

Origin: Atria, typically begins in the right atrium, near

the tricuspid valve

Characteristics:
Rate: 250-350 bpm
Rhythm: Usually regular but may be variable
ECG:
- P wave: Saw toothed appearance, “F waves”
- P:QRS ratio: Variable, most commonly 2:1
- PR interval: Variable
- QRS width: Normal
Rhythm: Atrial fibrillation ECG tracing

Mechanism: Atrial fibrillation is an irregular heart

rhythm characterized by chaotic and rapid electrical
activity in the atria (the upper chambers of the heart).
The mechanism behind AFib involves multiple, rapidly
firing electrical impulses originating from various
locations within the atria, instead of the normal single
impulse from the sinus node. These irregular impulses
result in the atria quivering or fibrillating instead of
contracting effectively. As a result, the ventricles (lower
chambers of the heart) also beat irregularly and often at
a fast rate. AFib can be triggered or worsened by
factors such as heart disease, hypertension, or other
underlying medical conditions.

Origin: Atria

Characteristics:
Rate: Variable, ventricular response can be
fast or slow
Rhythm: “Irregularly irregular”
ECG:
- P wave: None; chaotic atrial activity
- P:QRS ratio: None
- PR interval: None
- QRS width: Normal

Rhythm: Premature ventricular contraction ECG tracing

Mechanism: Premature ventricular contraction occurs

when the ventricles (the lower chambers of the heart)
contract prematurely due to an abnormal electrical
signal originating in the ventricular tissue. This signal
disrupts the normal sequence of electrical conduction in
the heart. PVCs are often caused by irritants or triggers,
such as stress, caffeine, certain medications, or
underlying heart conditions. These early contractions
can be felt as a "skipped" or "extra" beat in the chest.

Origin: Ventricles

Characteristics:
Rate: Depends on the underlying rhythm
Rhythm: Irregular
ECG:
- P wave: Not present on the PVC
- P:QRS ratio: No P waves on the PVC
- PR interval: None
- QRS width: Wide (=0.12 seconds), bizarre
appearance

Rhythm: Junctional rhythms ECG tracing

Mechanism: Junctional rhythms are abnormal heart

rhythms that occur when the electrical impulses
controlling the heartbeat originate from the
atrioventricular (AV) node or nearby tissues instead of
the usual site, the sinus node. The AV node is a backup
pacemaker that can take over if the sinus node fails to
function properly. Junctional rhythms often result in a
slower heart rate than normal, as the AV node typically
produces a slower electrical signal. These rhythms can
occur due to various reasons, such as sinus node
dysfunction, medication side effects, or heart disease.

Origin: Atrioventricular Junction

Characteristics:
Rate: 40-60 bpm
Rhythm: regular
ECG:
- P wave: Variable (none, antegrade, or retrograde)
- P:QRS ratio: None; or 1:1 if antegrade or retrograde
- PR interval: None, short, or retrograde; if present,
does not represent atrial stimulation of the ventricles.
- QRS width: Normal

Rhythm: Ventricular tachycardia ECG tracing

Mechanism: Ventricular tachycardia is an abnormal

heart rhythm characterized by rapid and regular
electrical impulses originating in the ventricles (the
heart's lower chambers). This abnormal rhythm typically
occurs when a single point or circuit within the
ventricles starts firing electrical signals at a rapid rate,
often exceeding 100 beats per minute. Ventricular
tachycardia can be life-threatening and is often
associated with underlying heart conditions, such as
heart disease or scar tissue from a previous heart
attack. It can compromise the heart's ability to pump
blood effectively, leading to serious consequences.

Origin: Ventricles

Characteristics:
Rate: 100-200 bpm
Rhythm: regular
ECG:
- P wave: Dissociated atrial rate
- P:QRS ratio: Variable
- PR interval: None
- QRS width: Wide, bizarre

Rhythm: Torsades de pointes ECG tracing

Mechanism: Torsades de pointes is a type of

ventricular tachycardia characterized by a distinctive
twisting pattern on an electrocardiogram (ECG). It
occurs due to a disturbance in the heart's electrical
system, often associated with abnormalities in the QT
interval (which represents the time it takes for the
heart's ventricles to repolarize/ restart after a heartbeat)
on an electrocardiogram (ECG). When the QT interval
is prolonged, it increases the risk of a chaotic and
irregular heartbeat, leading to torsades de pointes,
which can be life-threatening if not promptly treated.
The mechanism involves a reentrant circuit where the
electrical signals in the heart's ventricles circulate in a
spiral pattern instead of a normal coordinated
contraction. This can result from various factors,
including certain medications, electrolyte imbalances, or
inherited conditions.

Origin: Ventricles

Characteristics:
Rate: 200-250 bpm
Rhythm: Irregular
ECG: Associated with QT interval prolonged
- P wave: None
- P:QRS ratio: None
- PR interval: None
- QRS width: Variable

Rhythm: Ventricular fibrillation ECG tracing

Mechanism: Ventricular fibrillation is a life-threatening

heart rhythm disorder where the ventricles (the heart's
lower chambers) quiver rapidly and irregularly. The
mechanism behind VFib involves the chaotic,
disorganized electrical impulses that arise from multiple
points in the ventricles simultaneously. These chaotic
signals disrupt the heart's ability to pump blood
effectively, leading to a medical emergency. Immediate
defibrillation and advanced life support measures are
required to restore a normal heart rhythm and prevent
cardiac arrest. Underlying causes of VFib can include
heart disease, heart attack, electrolyte imbalances, or
certain medications.
Origin: Ventricles

Characteristics:
Rate: Cannot be determined
Rhythm: Chaotic
ECG:
- P wave: None
- P:QRS ratio: None
- PR interval: None
- QRS width: None

Rhythm: Asystole ECG tracing

Mechanism: Asystole, often referred to as "flatline," is

a state of cardiac arrest where there is no discernible
electrical activity in the heart. The mechanism behind
asystole involves the complete absence of any
coordinated electrical impulses in the heart's conduction
system. This results in the heart's inability to contract
and pump blood. Asystole can occur due to severe
cardiac conditions, extensive heart damage, or as a
progression from other life-threatening arrhythmias.
Immediate and aggressive interventions, such as
cardiopulmonary resuscitation (CPR) and advanced life
support measures, are necessary to attempt to restore
a viable heart rhythm, but the prognosis is generally
very poor. Addressing the underlying cause, such as
treating reversible factors like electrolyte imbalances or
administering medications to stimulate the heart, is also
critical.

Origin: Atria and Ventricles

Characteristics:
Rate: None
Rhythm: None
ECG: No waveform present on the cardiac
monitor, only an isoelectric “flat” line.

Rhythm: 1st degree heart blocks ECG tracing

Mechanism: First-degree heart block is a condition

characterized by a delayed conduction of electrical
signals between the atria (upper chambers) and
ventricles (lower chambers) of the heart. The
mechanism involves a prolonged PR interval on an
electrocardiogram (ECG). In this type of heart block, the
electrical impulses originating in the atria travel more
slowly than usual through the atrioventricular (AV) node,
which is responsible for transmitting signals between
the atria and ventricles. As a result, the PR interval on
the ECG, which represents the time it takes for the
electrical signals to pass through the AV node, is longer
than the normal range. Despite the delay, all atrial
impulses eventually reach the ventricles, causing a
consistent but slightly slower heart rate. First-degree
heart block is usually a benign condition and may not
require specific treatment in many cases.

Origin: Atrioventricular Node / Bundle of His

Characteristics:
Rate: Depends on underlying rhythm
Rhythm: Regular
ECG:
- P wave: Normal
- P:QRS ratio: 1:1
- PR interval: Prolonged > 0.20 second
- QRS width: Normal

Rhythm: Mobitz I - 2nd degree heart block ECG tracing

Mechanism: Mobitz I - 2nd degree heart block, also

known as Wenckebach or second-degree AV block, is a
heart conduction disorder characterized by a
progressive delay in the electrical signal as it travels
from the atria (upper chambers of the heart) to the
ventricles (lower chambers). The mechanism behind
Mobitz Type 1 involves a gradual and progressive delay
in the electrical conduction through the atrioventricular
(AV) node, leading to a lengthening PR interval on an
electrocardiogram (ECG). Eventually, this delay
becomes so significant that an impulse may be
completely blocked, resulting in a skipped heartbeat.
Mobitz Type 1 is often associated with an
overstimulation of the parasympathetic nervous system
and is typically considered a benign condition.

Origin: Atrioventricular Node / Bundle of His

Characteristics:
Rate: Depends on underlying rhythm
Rhythm: “Regularly irregular”
ECG:
- P wave: Present
- P:QRS ratio: Variable: 2:1, 3:2, 4:3, 5:4, etc.
- PR interval: Variable
- QRS width: Normal
Rhythm: Mobitz II - 2nd degree heart block ECG tracing

Mechanism: Mobitz II, a type of second-degree heart

block, occurs when there are intermittent blocked
electrical signals between the atria (upper chambers)
and ventricles (lower chambers) of the heart. The
mechanism involves sudden and unpredictable skipped
beats without prior warning or a gradual change in the
PR interval, as seen in Mobitz I. In Mobitz II, the block
typically occurs below the atrioventricular (AV) node,
often in the bundle of His or bundle branches. Unlike
Mobitz I, where the delay is progressive and leads to a
skipped beat, Mobitz II results in abrupt dropped beats,
causing an irregular heart rhythm. Mobitz II is
considered more serious than Mobitz I and may require
medical intervention, such as a pacemaker, to maintain
a stable heart rhythm.

Origin: Atrioventricular Node, often within the Bundle of

His or the bundle branches

Characteristics:
Rate: Depends on underlying rhythm
Rhythm: “Regularly irregular”
ECG:
- P wave: Normal
- P:QRS ratio: X:X–1; e.g. 3:2, 4:3, 5:4, etc. The ratio
can also be variable on rare occasions.
- PR interval: Normal
- QRS width: Normal

Rhythm: Complete heart block ECG tracing

Mechanism: Complete heart block, also known as

third-degree heart block, occurs when there is a
complete blockage of electrical signals between the
atria and ventricles of the heart. This typically happens
at the atrioventricular (AV) node or bundle of His, which
are critical components of the heart's electrical
conduction system. In this condition, the atria and
ventricles beat independently of each other because
the electrical signals generated in the atria are unable
to reach the ventricles. As a result, the ventricles
generate their own electrical signals to maintain a slow,
often insufficient heart rate. Complete heart block is a
serious condition that often requires the implantation of
a pacemaker to regulate the heart's rhythm and ensure
coordinated atrial and ventricular contractions.
 Origin: Atrioventricular node, typically occurs at or
below the level of AV node.

Characteristics:
Rate: <45-50 bpm, Separate rates for the
underlying(sinus) rhythm and the escape rhythm.
Rhythm: Regular; P rate and QRS rate
are different.
ECG:
- P wave: Present
- P:QRS ratio: Variable
- PR interval: Variable; no pattern
- QRS width: Normal or wide
References:

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