ECG Summary

ECG Result Description Rate Rhythm P wave PR QRS Intervention

Interval Complex
Nornal Sinus Rhythm Normal Regular Normal Normal Normal
60-100 Upright (0.12- (0.06-0.10
bpm and 0.20 seconds)
uniform seconds)

Sinus Arrhythmia - SA node discharges 60 -100 Irregular Normal Normal Normal

irregularly bpm , varies
Inc. w/ with
inspiratio respirati
n, dec. on
w/
expiratio
n

Sinus Bradycardia -Normal in atheletes Below 60 Regular Normal Normal Normal - Only treat if s/s are
during sleep bpm developed
- Not pathological -Oxygen is always appropriate
-At rest usually Intervention sequence:
asymptomatic Atropine 0.5 to 1 mg IV if
-Physical sign vagal mechanism
Transcutaenous pacing if
available
If S&S are sever, consider
catecholamine infusions:
o Dopamine 5 to 20
ug/kg/min
o Epinephrine 2 to 10
ug/min
o Isoproterenol 2 to 10
ug/min
Sinus Tachycardia - May be caused by Fast Regular Normal Normal Normal Treat only the causes of the
 exercise, anxiety, fever, >100bp
hypoxemia,
hypovolemia or cardiac
failure
- Not pathological,
Physical sign
tachycardia. NEVER
m countershock.
Treat only if the client is at
risk/experiencing symptoms of
MI or myocardial damage
B-blockers; verapamil
Tachycardia is more life
threatening to a patient with
MI

Atrial Arrhythmias
(P waves differ in apperance from sinus P wave; After the dropped beat, cycles continue on time)
ECG Result Description Rate Rhythm P wave PR QRS Intervention
Interval Complex
Atrial Flutter -Atrial focus captures Atrial: Irregular - no true Variable Usually Treatment: digitalis preparations
the heart rhythm and 250-350 but P wave normal, but (enhances the block of AV node
discharges impulses at bpm; more - flutter may appear thus slows down atrial rate);
a rate bet. 200- regular waves widened if quinidine (controls ectopic foci);
400x/min Ventricul than in "saw flutter calcium channel blockers (for
dysrhythmias); Propanolol (B
-"saw tooth" pattern ar: atrial tooth waves are
adrenergic blocker); amnioderol;
-A-flutter may be the slow or fibrillatio pattern" buried in
electrical cardioversion (giving
first indication of fast n QRS small doses of electric current)
cardiac disease Emergency drugs:
-Causes: Atrial V - Verapamil
stretching, MI, CHF, I - Inderal
elevated atrial pressure, D - Diltiazem
hyperthyroidism,
pericarditis
Atrial Fibrillation - A fib is a dysrhythmia Atrial: "Irregula - no true None Normal Treatment (same sa Atrial Flutter)
that is caused by a 350 or rly P wave, Diltiazem, Ca channel blocker
(decreases work load & O2 demand),
rapid & chaotic firing by greater irregular chaotic
beta blocker
atrial impulses caused bpm; " atrial Amiodarone (B blocker; class III anti-
by a multitude of (too activity dysrhythmic; prolongs repolarization
ectopic foci rapid to during ventricular dysrhythmia)
- Causes: CHF, cor Digoxin (for purposes of reverting
count)
irregular rhythm to sinus rhythm)
pulmonale, CHD, Cardioversion (giving of small
pericarditis, pulmonary Ventricul electrical impulses (100 200
 emboli, hyperthyroidism ar: joules)
-s/s: DOE, SOB, Acute For an impaired heart:
slow or
Heparin or other anticoagulants (but
Pulmonary Edema fast do NOT give to patients with
hemorrhagic stroke)
Quinidine (purpose: suppresses
ectopic foci)
Emergency drugs:
V - Verapamil
I - Inderal
D - Diltiazem
Atrial Tachycardia Causes: common in 150-250 Regular Normal May be Normal but Treatment:
elderly patients with bpm but short in can be Usually no treatment b/c
COPD differ in rapid aberrant at underlying cause cannot be
resolved
shape waves times
Usually refractory to any
from (<0.12 s)
treatment
sinus P Emergency drugs:
wave A - Adenosine

ECG Result Description Rate Rhythm P wave PR QRS Intervention

Interval Complex
Paroxysmal Supraventricular - Pathophysiology: 150 - Regular Frequen Usually Normal but Treatment:
Reentry phenomenon: 250 bpm tly not may be Just try to treat the cause /
Tachycardia (PSVT)
impulses arise & recycle Preserved heart function:
buried possible wide if
repeatedly in the AV node o B blocker
in to abnormally
because of areas of o Calcium channel
unidirectional block in the
precedi measure conducted
blocker
Purkinje fibers ng T through o Digoxin
- S&S: Palpitations felt by waves ventricles o DC cardioversion
pt. at the paroxysmal and o Parenteral
onset; becomes anxious, difficult antiarrhythmic:
uncomfortable, Exercise to see procainamide,
tolerance low with very amiodarone
high rates, Symptoms of Impaired heart function:
"not o DC cardioversion
unstable tachycardia may
identi- o Digoxin
occur
-Etiology: fiable" o Amiodarone
 Factors that provoke the o Diltiazem
paroxysm: caffeine,
hypoxia, cigarettes,
stress, anxiety, sleep
deprivation, numerous
medications
Also increased frequency
of PSVT in unhealthy
patients with CAD, COPD,
CHF

Junctional Arrhythmias
ECG Result Description Rate Rhythm P wave PR QRS Intervention
Interval Complex
Junctional Rhythm (Junctional Arrhythmias) 40 - 60 Regular Absent, None, Normal Treatment:
-The atria and SA node do If specific dx is unknown, attempt
bpm inverted short or
not perform their normal therapeutic/diagnostic maneuver
, buried retrograd with vagal stimulation,
pacemaking functions.
or e adenosine, THEN
A junctional escape retrogra Preserved heart function:
 rhythm begins. de o B blocker, Ca channel
blocker, amiodarone
o No DC cardioversion!
If impaired heart function:
o Amiodarone
o No DC cardioversion!

Accelerated Junctional Rhythm 61 -100 Regular Absent, None, Normal - Monitor the patient for
bpm inverted short or clinical improvement, not just
, buried retrograd ECG
or e
retrogra
de

Junctional Tachycardia -s/s of decreased cardiac 101 - Regular Absent, None, Normal
output may be seen in 180 bpm inverted short or
response to the rapid rate
, buried retrograd
or e
retrogra
de
Junctional Escape Beat -an escape complex comes Depends Irregular Absent, None, Normal
later than the next on rate wheneve inverted short or
expected sinus complex
of r an , buried retrograd
underlyin escape or e
g rhythm beat retrogra
occurs de in
the
escape
beat
Premature Junctional Contraction -enhanced automaticity in Depends Irregular Absent, None, Normal
the AV junction produces on rate wheneve inverted short or
(PJC)
PJC
of r a PJC , buried retrograd
-before deciding that the
underlyin occurs or e
isolated PJC may be g rhythm retrogra
significant, consider the de in
cause the PJC

Ventricular Arrhythmias
 ECG Result Description Rate Rhythm P wave PR QRS Intervention
Interval Complex
Ventricular Fibrilation Two types: Too rapid Chaotic None None None Treatment
Fine dili kaau distorted to count Early defib is essential
ang imong rhythm or Agents given to prolong
imong firing of impulses period reversible death
Indeter-
Coarse the firing of oxygen, CPR, intubation,
minate
impulses are either epinephrine, vasopressin
chaotic or disorganized Agents given to prevent refib
after a shock causes defib
Condition where patient lidocaine, amiodarone,
goes into a complete procainamide, B blockers
arrest Agents given to adjust
metabolic milieu sodium
Characterized by bicarbonate, magnesium
random & chaotic Priority management
discharging of impulses electrical defib; ideal current:
within the ventricles at 200-400 watts/sec
rates that exceed 300BPM Successful defib will stop the
heart and allowing it to
Produces clinical death restart; once restarted, it will
& must be reversed be controlled by the normal
immediately sinus pace

Emergency Drug
S&S
E - Epinephrine
Pulse disappears with V - Vasopressin
onset of VF A - Amiodarone
Collapse, unconscious L - Lidocaine
Agonal breaths --- apnea (the same emergency drug in
in <5 min Pulseless V-tach)
Onset of reversible death

Causes
Acute MI; deteriorating
ventricular rhythms;
acidosis; electrolyte
disturbances
 ECG Result Description Rate Rhythm P wave PR QRS Intervention
Interval Complex
Ventricular Tachycardia Impulse conduction is 100-250 Regular None None Wide Treatment
(Monophormic) slowed around areas of bpm (not (> 0.10sec), Parenteral medications: any
ventricular injury, associat bizarre one
infarct or ischemia o B blockers
ed with appearance
These areas also serve as o Lidocaine (if pt. is
QRS)
source of ectopic unconscious, do not
impulses (irritable foci) give lidocaine;
These areas of injury can immediately defib
cause the impulse to instead)
take a circular course, o Amiodarone
leading to the reentry o Procainamide
o Sotalol
phenomenon and rapid
Impaired heart
repetitive
o Amiodarone
depolarizations
o Lidocaine then
Can be asymptomatic
discontinue
Majority of times,
cardioversion (to
symptoms of dec.
abolish all cardiac
cardiac output are seen
rhythms and allow
(orthostatic
normal pacemaker the
hypotension, syncope,
opportunity to restart)
exercise limitations,
if persists
etc.)
Endocardial resection,
Untreated & sustained will
removal of aneurysm,
deteriorate to unstable
aneurysmectomy,
V-Tach, often VF
antitachycardia pacemakers
Ventricular Tachycardia Areas serve as the 100-250 Regular None None Wide
if unresponsive to drugs
(Polymorphic) source of ectopic bpm or (not (> 0.10sec),
impulses (irritable irregular associat bizarre Emergency Drugs
foci); irritable foci ed with appearance A - Adenosine
occur in multiple areas QRS) A - Amiodarone
of the ventricles, thus
L - Lidocaine
polymorphic
P - Procainamide drip
These areas of injury
can cause impulses to
 take a circular course,
leading to the reentry
phenomenon and
rapid repetitive
depolarizations
Manifestations
Rare: asymptomatic
polymorphic VT
Majority of times:
symptoms of dec. CO are
seen (orthostatic
hypotension, syncope,
exercise limitations)
Tends toward rapid
deterioration to pulseless
VT or VF
ECG Result Description Rate Rhythm P wave PR QRS Intervention
Interval Complex
Torsades de pointes spindle-node pattern 200 - Irregular None None Display Treatment
Consequence of 250 bpm ventricul classic Treat ischemia
quinidine therapy ar Correct electrolytes if
Signs abnormal
rhythm Wide
Majority of times, Then therapies (any one):
(>0.10sec), Magnesium
patients have
symptoms of dec. CO bizarre Overdrive pacing (ventricular
Asymptomatic appearance pacing to override the
torsades, sustained ventricular rate & capture the
torsades, or stable rhythm)
torsades is uncommon Isoproterenol (pharmacologic
Tends towards overdrive pacing) [shortens Q-
sudden T interval]
deterioration to Phenytoin
pulseless VT or VF Lidocaine
Prolonged Q-T interval
(>0.6sec)

Pulseless Electrical Activity -Equivalent to asystole Treatment Per PEA algorithm

Rhythm displays Primary CABD (basic CPR)
C (IV epinephrine, AtSo4 if
organized electrical
activity (not electrical activity <60
VF/pulseless VT) complexes per minute)
 Seldom as organized Secondary AB (adv. Airway
as normal sinus and ventilation)
rhythm D (identify and treat reversible
Manifestations causes)
o Collapse; Key: identify & treat a
unconscious reversible cause of the PEA
o Agonal
respirations or Common Etiology:
apnea Mnemonic of 5 Hs and 5 Ts
o No pulse aids recall:
detectable by Hypovolemia
arterial Hypoxia
palpation (thus H+ ion acidosis
could still be as pneumothorax
high as 50- Hyper/hypoK+
60mmHg; in Hypothermia
such cases Tablets (drug OD, ingestions)
termed pseudo Tamponade
PEA) Cardiac tension
Thrombosis (ACS)
Thrombosis, pulmonary
embolism

ECG Result Description Rate Rhythm P wave PR QRS Intervention

Interval Complex
Asystole Manifestations None None None None None Do not defibrillate
Early stages: may see Treatment
agonal respirations o Always check for DNR
(labored); status
unconscious; o Primary CABD survey
unresponsive; no (basic CPR)
pulse; no blood o Secondary CABD survey
pressure; cardiac (ACLS)
arrest
Emergency Drug
E - Epinephrine
Atrioventricular (AV) Blocks
ECG Result Description Rate Rhythm P wave PR QRS Intervention
Interval Complex
1st degree AV Block Depends Regular Normal Prolonge Normal Rarely indicated
Impulse conduction is
 slowed (partial on the d (> 0.20 Treat only if patient has
block) at the AV rate of sec) (narrow, significant signs or symptoms
node by a fixed the <0.10sec in due to the bradycardia
amount underlyin absence of Oxygen is always appropriate
Closer to being a Intervention sequence for
g rhythm intraventric
physical sign than an bradycardia
abnormal arrhythmia
ular o Atropine 0.5-1 mg IV if
Usually AV block is benign, conduction vagal mechanism
but if associated with an defect) o Transcutaenous pacing
acute MI, it may lead to if available
further AV defects. If SS are severe, consider
catecholamine infusions
o Dopamine 5 to 20
ug/kg/min
o Epinephrine 2 to 10
ug/min
o Isoproterenol 2 to 10
ug/min
2nd degree AV Block - Mobitz I Site of pathology: AV Depends Irregular Normal Prog- Normal Treatment
(Wenkebach) node on the ressively o Atropine 0.5 to 1MG IV
AV node blood supply rate of longer if vagal mechanism
comes from branches o Transcutaneous pacing
the until one
of the right coronary o If SS are severe
underlyin P wave is Dopamine
artery
g rhythm blocked Epinephrine
Impulse conduction is
increasingly slowed
and QRS Isoproterenol
is Intervention for bradycardia
at the AV node
blocked d/t type II 2nd/3rd degree <3
causing increasing PR
block:
interval
o Prepare for
Until one sinus impulse
transvenous pacer
is completely blocked
o Atropine seldom
and a QRS complex
effective for infranodal
fails to follow
block
Due to bradycardia
2nd degree AV Block - Mobitz II o Symptoms:
Atrial Atrial Normal Normal Usually o Use transcutaneous
(Non-Wenkebach) rate regular (upright or wide (_0.10 pacing if available as a
chest pain,
(usually and and prolonge sec) bridge to transvenous
SOB, dec. level
60100 ventricul uniform) d but pacing (verify patient
of
bpm); ar ; more P constant tolerance and
consciousness
mechanical capture.
o Signs: faster irregular waves
Use sedation and
hypotension,
 shock, than than analgesic as needed)
pulmonary ventricul QRS Sever SS and unresponsive to
congestion, ar rate complex TCP
CHF, angina, MI o Dopamine
es o Epinephrine
o Isoproterenol

3rd degree AV Block Injury or damage to Atrial: Usually Normal Varies Normal if Intervention for
the cardiac conduction 60100 regular, (upright greatly ventricles bradycardia
system so that no bpm; but atria and are (view 2nd degree)
impulses pass and uniform) (NO activated
between atria and ventricul ventricle ; may relations by
ventricles (complete)
ar: s be hip bet. P junctional
This can occur at
several different
4060 act super- wave escape
anatomical areas: bpm if indepen- imposed and R focus; wide
o AV node escape dently on QRS wave) if escape
(high/supra/jun focus is complex focus is
ctional nodal junctiona es or T ventricular
block) l, <40 waves
o Bundle of his
bpm if
o Bundle branch
escape
(low-
nodal/infranoda focus is
l block) ventricul
No relationship ar
between atrial activity
& ventricular activity
Both chambers are
discharging impulses