lOMoARcPSD|17042315
Cardiac Rhythms and Dysrhythmias
Rhythm and Strip ECG Characteristics Management
Normal sinus rhythm Rate: 60 – 100 bpm This is a normal heart rhythm so no
Rhythm: regular treatment is required
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 This is only treated if client is
Rhythm: regular symptomatic or is at risk for
There is one P for every QRS but may myocardial damage
be hidden with T wave due to speed If there is an underlying cause, beta-
PR interval: 0.12 – 0.20 seconds blockers or verapamil can be used
QRS complex: 0.06 – 0.10 seconds
Sinus bradycardia Rate: < 60 bpm This is only treated if client is
Rhythm: regular symptomatic; administer IV atropine,
There is one P for every QRS isoproterenol, and/or pacemaker may
be used
PR interval: 0.12 – 0.20 seconds
QRS complex: 0.06 – 0.10 seconds
Premature atrial contractions (PAC) Rate: varies This usually requires no treatment.
Rhythm: regular with early beats Advise client to reduce alcohol intake,
originating in atria reduce stress, and stop smoking
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 This is treated with synchronized
rate depends on degree of AV block cardioversion; meds to reduce
Rhythm: regular ventricular response such as beta-
P:QRS ratio: 2:1. 4:1, 6:1, or variable blocker or calcium channel blocker
PR interval: not measured followed by a class I antidysrhythmic
or amiodarone
QRS complex: 0.06 – 0.10 seconds
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lOMoARcPSD|17042315
Atrial fibrillation Rate: 300 – 600 bpm; ventricular 100 – This is treated with synchronized
180 bpm in untreated clients cardioversion; meds to reduce
Rhythm: irregularly regular ventricular response rate such as
P:QRS ratio is variable metoprolol, diltiazem, or digoxin;
anticoagulant therapy to reduce risk of
PR interval: not measured
clot formation and stroke
QRS complex: 0.06 – 0.10 seconds
Premature ventricular contractions (PVC) Rate: variable This is treated if client is symptomatic;
Rhythm: irregular; PVC interrupts advise against using stimulants
underlying rhythm and followed by a (caffeine, nicotine); drug therapy
compensatory pause includes, class I and III
No P wave noted before a PVC antidysrhythmics and possibly addition
PR interval: absent of a beta blocker
QRS complex: wide, > 0.12 seconds
Ventricular tachycardia Rate: 100 – 250 bpm This is treated if VT is sustained or if
Rhythm: regular client is symptomatic; treatment
No indentifiable P wave includes IV procainamide, lidocaine.
PR interval: not measured If unstable, a class III antidysrhythmic
QRS complex: ≥ 0.12 seconds; bizarre and immediate cardioversion; ablation
shape surgery or internal defibrillator for
repeated episodes
Ventricular fibrillation Rate: too rapid to count Immediate defibrillation
Rhythm: grossly irregular
No identifiable P waves
PR interval: none
QRS complex: bizzare, varying in
shape and direction
First-degree AV block Rate: 60 – 10 bpm No treatment required
Rhythm: regular
There in one P for every QRS
PR interval: > 0.20 seconds
QRS complex: 0.06 – 0.10 seconds
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lOMoARcPSD|17042315
Second-degree AV block type 1 (Mobitz 1, Wenckebach) 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
Second-degree AV block type 2 (Mobitz 2) 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
Third-degree block (complete heart block) 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:
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