Cardiac Arrhythmias
Sinus Rhythms
Normal Sinus Rhythm
Heart PR Interval QRS
Rhythm P Wave
(sec.) (Sec.)
Rate
60 - Before each QRS,
Regular .12 - .20 <.12
100 Identical
Sinus Rhythms
Sinus Bradycardia
Heart PR Interval QRS
Rhythm P Wave
(sec.) (Sec.)
Rate
Before each QRS,
<60 Regular .12 - .20 <.12
Identical
Sinus Rhythms
Sinus Tachycardia
Heart PR Interval QRS
Rhythm P Wave
(sec.) (Sec.)
Rate
Before each QRS,
>100 Regular .12 - .20 <.12
Identical
Sinus Rhythms
Sinus Arrhythmia
Heart PR Interval QRS
Rhythm P Wave
(sec.) (Sec.)
Rate
Before each QRS,
Var. Irregular .12 - .20 <.12
Identical
• If low rate – Atropine
• If high rate and low CO – Cardiac glycosides
Atrial Rhythms
Premature Atrial Contraction (PAC)
Heart PR Interval QRS
Rhythm P Wave
(sec.) (Sec.)
Rate
Premature &
NA Irregular abnormal or .12 - .20 <.12
hidden
Atrial Rhythms
Atrial Fibrillation
Heart PR Interval QRS
Rhythm P Wave
(sec.) (Sec.)
Rate
Var. Irregular Wavy irregular NA <.12
Atrial Rhythms
Atrial Flutter
PR Interval QRS
Heart Rate Rhythm P Wave
(sec.) (Sec.)
Atrial=250
Not
– 400
Irregular Sawtooth Measur- <.12
Ventricular
able
Var.
Management
Amiodarone and Flecainide.
Digoxin
Beta-blockers
Calcium channel blockers
Anticoagulants
Junctional Rhythms
Premature Junctional Contraction PJC
Heart PR Interval QRS
Rhythm P Wave
(sec.) (Sec.)
Rate
Premature,
Usually Short Normal
Irregular abnormal, may be
<.12 <.12
inverted or
normal
hidden
Junctional Rhythms
Junctional Tachycardia
Heart PR Interval QRS
Rhythm P Wave
(sec.) (Sec.)
Rate
May be inverted or Short Normal
>100 Regular
hidden <.12 <.12
Junctional Rhythms
Junctional Escape
Heart PR Interval QRS
Rhythm P Wave
(sec.) (Sec.)
Rate
40 – Absent, inverted Short Normal
Regular
60 or after QRS <.12 <.12
Rx:
1. Vagal manoeuvre - such as gagging, holding your breath
and bearing down (Valsalva manoeuvre), coughing
2. Mammalian diving reflex
3. Carotid sinus massage/ Czermak Hering test – u/l for 15-
20 sec
4. Oculo cardiac reflex/ Aschner reflex
5. Adenosine 6mg as a rapid push :- Inj.Atropine and
Salbutamol nebulization kept ready
Ventricular Rhythms
Premature Ventricular Contraction (PVC)
PR
Heart QRS
Rhythm P Wave Interval
(Sec.)
Rate (sec.)
No P waves
Wide
Var. Irregular associated with NA
>.12
premature
beat
Classification
Unifocal — Arising from a single ectopic focus
Multifocal — Arising from two or more ectopic foci
Bigeminy — every other beat is a PVC.
Trigeminy — every third beat is a PVC.
Quadrigeminy — every fourth beat is a PVC.
Couplet — two consecutive PVCs.
Triplet — three consecutive PVCs.
Rx: Anti-arrhythmic medication: Lidocaine
Nx: Avoid common PVC triggers :caffeine or tobacco
Monitor therapeutic range of digoxin & S.K+
Ventricular Rhythms
Ventricular Flutter
Heart PR Interval QRS
Rhythm P Wave
(sec.) (Sec.)
Rate
150 – Wide
Regular No P waves NA
300 >.12
Ventricular Rhythms
Ventricular Flutter
“Extreme V-
Tach”
Call code
Begin
CPR
Ventricular Rhythms
Ventricular Tachycardia
Heart PR Interval QRS
Rhythm P Wave
(sec.) (Sec.)
Rate
No P waves
100 –
Regular corresponding to QRS, NA >.12
250
a few may be seen
Ventricular Rhythms
Ventricular Fibrillation
Heart PR Interval QRS
Rhythm P Wave
(sec.) (Sec.)
Rate
0 Chaotic None NA None
Management
VT with pulse and normal cardiac output - can be managed
with lidocaine and amiodarone
VT with pulse and decreased cardiac output -can be
managed with cardioversion
Pulseless VT -Should be managed with defibrillation
Cardioversion vs
Defibrillation
Regular vs Irregular with Narrow complex vs Wide complex
