Cardiac Dysrhythmias Question and Answers
6 questions for EKG analysis
-Is it regular?
-Does every P have a QRS and does every QRS have a P?
-What is the Rate?
-Is the PR interval WNL?
-Is the QRS WNL?
-Is the ST segment prolonged, short or elevated?
Normal heart rate
60-100 bpm
Normal PR interval length
0.12-0.20 sec
1 small box on the EKG is
0.04 sec
1 big box is on the EKG is
0.20 sec
30 big boxes on the EKG are
6 sec
To determine HR on the EKG
count the R waves in 6 sec and multiply by 10
Normal QRS length
< 0.12 or equal to 0.12
Normal ST segment
0.08 to 0.12, not elevated
Normal sinus rhythm
-regular
-every P has a QRS
-rate 70 bpm
-PR interval is 0.20, WNL
-QRS length is 0.04 WNL
-ST segment is 0.08, WNL
Sinus Tachycardia
-regular
-every P has a QRS
-rate 140 bpm (high)
-PR interval is 0.12, WNL
-QRS length is 0.04 WNL
-ST segment is 0.08, WNL
TX: only if symptomatic, treat underlying cause
Sinus Bradycardia
-regular
-every P has a QRS
, -rate <60 bpm
-PR WNL
-QRS length WNL
-ST segment is WNL
TX: only if symptomatic, IV atropine or isoproterenol, and/or pacemaker
Premature Atrial Beat
Result of an irritable ectopic electrical impulse from with in the atria is initiated early.
-Rhythm: irregular
-every P has a QRS - no there will be extra p waves, some may be hidden
-rate - can be WNL, <60, or >100
-PR WNL
-QRS length WNL
-ST segment is WNL
TX: Usually requires no treatment, teach reduce alcohol, caffeine intake, stress, and
smoking. MD may RX beta blocker.
Paroxysmal Supraventricular Tachycardia (PSVT)
-Rhythm: regular
-every P has a QRS - no, P waves often not identifiable
-rate - can be 100-280bpm (most often 150-200bpm)
-PR interval - not measurable
-QRS length - 0.6-0.10 WNL
-ST segment may be difficult to distinguish
TX: treat if symptomatic, vagal maneuvers, O2, adenosine, beta blocker, temp. pacing,
synchronized cardioversion.
Atrial Flutter
-Rhythm: regular (may vary depending on AV conduction)
-every P has a QRS - no, 2:1, 4:1, 6:1
-rate - Atrial: 240-360, Ventricular varies, usually <150bmp
-PR interval - not measurable
-QRS length - WNL
-ST segment and T waves are not identifiable
TX: Synchronized cardioversion, medication to slow ventricular response such as beta
blockers, Ca channel blockers, followed by a class I antidysrhythmic agent or
amiodarone.
Atrial Fibrillation
-Rhythm: irregularly irregular
-every P has a QRS - variable
-rate - atrial 300-600 (to rapid to count), ventricular 100-180bpm in untreated clients
-PR interval - not measurable
-QRS length - WNL
-ST segment - slight depression
TX: Synchronized cardioversion, medication to slow ventricular rate: metaprolol,
diltiazem, or digoxin, and anticoagulants to reduce risk of clots.
Junctional Escape Rhythm
-Rhythm: regular
-every P has a QRS - P waves may be absent, inverted and immediately preceding or
6 questions for EKG analysis
-Is it regular?
-Does every P have a QRS and does every QRS have a P?
-What is the Rate?
-Is the PR interval WNL?
-Is the QRS WNL?
-Is the ST segment prolonged, short or elevated?
Normal heart rate
60-100 bpm
Normal PR interval length
0.12-0.20 sec
1 small box on the EKG is
0.04 sec
1 big box is on the EKG is
0.20 sec
30 big boxes on the EKG are
6 sec
To determine HR on the EKG
count the R waves in 6 sec and multiply by 10
Normal QRS length
< 0.12 or equal to 0.12
Normal ST segment
0.08 to 0.12, not elevated
Normal sinus rhythm
-regular
-every P has a QRS
-rate 70 bpm
-PR interval is 0.20, WNL
-QRS length is 0.04 WNL
-ST segment is 0.08, WNL
Sinus Tachycardia
-regular
-every P has a QRS
-rate 140 bpm (high)
-PR interval is 0.12, WNL
-QRS length is 0.04 WNL
-ST segment is 0.08, WNL
TX: only if symptomatic, treat underlying cause
Sinus Bradycardia
-regular
-every P has a QRS
, -rate <60 bpm
-PR WNL
-QRS length WNL
-ST segment is WNL
TX: only if symptomatic, IV atropine or isoproterenol, and/or pacemaker
Premature Atrial Beat
Result of an irritable ectopic electrical impulse from with in the atria is initiated early.
-Rhythm: irregular
-every P has a QRS - no there will be extra p waves, some may be hidden
-rate - can be WNL, <60, or >100
-PR WNL
-QRS length WNL
-ST segment is WNL
TX: Usually requires no treatment, teach reduce alcohol, caffeine intake, stress, and
smoking. MD may RX beta blocker.
Paroxysmal Supraventricular Tachycardia (PSVT)
-Rhythm: regular
-every P has a QRS - no, P waves often not identifiable
-rate - can be 100-280bpm (most often 150-200bpm)
-PR interval - not measurable
-QRS length - 0.6-0.10 WNL
-ST segment may be difficult to distinguish
TX: treat if symptomatic, vagal maneuvers, O2, adenosine, beta blocker, temp. pacing,
synchronized cardioversion.
Atrial Flutter
-Rhythm: regular (may vary depending on AV conduction)
-every P has a QRS - no, 2:1, 4:1, 6:1
-rate - Atrial: 240-360, Ventricular varies, usually <150bmp
-PR interval - not measurable
-QRS length - WNL
-ST segment and T waves are not identifiable
TX: Synchronized cardioversion, medication to slow ventricular response such as beta
blockers, Ca channel blockers, followed by a class I antidysrhythmic agent or
amiodarone.
Atrial Fibrillation
-Rhythm: irregularly irregular
-every P has a QRS - variable
-rate - atrial 300-600 (to rapid to count), ventricular 100-180bpm in untreated clients
-PR interval - not measurable
-QRS length - WNL
-ST segment - slight depression
TX: Synchronized cardioversion, medication to slow ventricular rate: metaprolol,
diltiazem, or digoxin, and anticoagulants to reduce risk of clots.
Junctional Escape Rhythm
-Rhythm: regular
-every P has a QRS - P waves may be absent, inverted and immediately preceding or
