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EKG 2. Normal Sinus Rhythm. Sinus Node is the Pacemaker Rate 60-100 bpm R-R intervals constant; rhythm regular Rate: atrial and ventricular rates = P Waves: Uniform; One P Wave for every QRS complex PRI: .12-.20 seconds; constant across strip QRS measures less than .12 seconds.

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## EKG 2

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**Normal Sinus Rhythm**• Sinus Node is the Pacemaker • Rate 60-100 bpm • R-R intervals constant; rhythm regular • Rate: atrial and ventricular rates = • P Waves: Uniform; One P Wave for every QRS complex • PRI: .12-.20 seconds; constant across strip • QRS measures less than .12 seconds**Sinus Bradycardia**• Sinus Node is the PM; < 60 bpm • R-R intervals are constant; rhythm is regular • Atrial & Ventricular rates =; HR < 60 • Uniform P Waves • PRI interval measures b/t .12-.20 seconds • QRS complex measures < .12 seconds**Sinus Tachycardia**• Sinus Node is PM. Rate > 100 bpm • R-R regular • Atrial & Ventricular Rates = • HR usually b/t 100-160 bpm • Uniform P Wave in front of QRS • PRI interval b/t .12 - .20 seconds • QRS measures less than .12 seconds**Sinus Arrhythmia**• Sinus Node is PM • Rate increases as pt breathes in and decreases when breathing out • R-R intervals vary • HR usually 60-100 bpm but may be slower • Uniform P Wave in front of QRS • PRI interval b/t .12-.20 seconds • QRS measures less than .12 seconds**Premature Atrial Contraction**• Pacemaker is irritable focus in atrium • Single beat will interrupt regularity • Rate: Underlying rhythm • P Wave: Different Morphology - It will be flattened, notched, or otherwise unusual • PRI: .12-.20 seconds; may be prolonged • QRS: Less than .12 seconds**Wandering Pacemaker**• Pacemaker sites wanders b/t Sinus, Atria, and AV Junction • Slightly irregular • Atrial & Ventricular Rates = . Heart Rate usually b/t 60-100 bpm. Sometimes slower • Morphology of P Wave changes as PM site changes • PRI should be less than .20 seconds • QRS: Less than .12 seconds**Atrial Tachycardia**• PM is irritable site within atria • R-R constant ; Rhythm is regular • Atrial & Vent. Rates =. HR usually b/t 150-250 bpm • P Wave: One P to every QRS; May be flattened or notched; P Waves can be lost in preceding T Wave • PRI: .12-20 seconds • QRS measures less than .12 seconds**Atrial Flutter**• Single irritable focus in atria • Atrial rhythm is regular; Ventricualr rhythm may or may not be regualr • Rate: Atrial rate b/t 250-350 bpm • P Wave: “Saw tooth” or flutter waves. • PRI: Not measured • QRS: Less than .12 seconds**Atrial Fibrillation**• Several foci iniate impulses • Atrial & Ventricular rhythm is unmeasurable; chaotic • Rate: Atria - Too fast to count. Vent. = if less than 100 “controlled”, if > 100 then “rapid ventricular response”. • P Wave: No true P Waves • PRI: Not measured • QRS less than .12 seconds**First Degree Heart Block**• AV Node holds each Sinus impulse longer • Regularity will depend on underlying rhythm • P Waves: Upright and uniform. • PRI: Constant across the strip but will always be greater than .20 seconds • QRS less than .12 seconds**2nd Degree Heart Block (Classical)**• AV Node conducts/blocks some beats • If conduction ratio is consistant= regular; if not consistant the rhythm will be irregular • Atrial rate normal; ventricular rate usually bradycardia. • P Waves upright & uniform. More P Waves than QRS complexes • PRI may be longer than .20. QRS < .12**2nd Degree Heart BlockWenckebach**• Sinus Node initiates impulses; delayed in AV Node; One is finally blocked • R-R irregular. R-R interval gets progressively shorter as PRI gets longer • Rate: Usually a little slower than normal • PRI: PR gets longer, until one P Wave is not followed by QRS. Repeats cycle. • QRS: Less than .12 seconds**Third Degree Heart BlockComplete HB**• Complete block at AV Node. Atria and Ventricles function separately • P-P & R-R intervals are regular. • Atrial rate - normal. Ventricular rate slower • P Waves: Upright & Uniform - More P Waves than QRS complexes • PRI: There is no PRI • QRS: Depends on foci**Premature Ventricular Contraction**• Irritable focus within the ventricles • The underlying rhythm can be reular or irregular • Rate: Underlying rhythm • P Waves: The ectopic is not preceeded by a P Wave • PRI: No PRI • QRS: Wide and bizarre**PVC’s**• QRS: at least .12 seconds. T Wave frequently in the opposite direction from QRS • > 6 per minute • Two PVC’s - Couplet • Bigeminy, Trigeminy • Multifocal PVC’s**Idioventricular Rhythm**• Ventricles initiate a regular impulse at 20-40 bpm • The rhythm is usually regular, it can slow as the heart dies • Rate: 20-40 bpm • No P Waves • No PRI • QRS - Wide and bizarre at least .12**Ventricular Tachycardia**• Irritable focus in Ventricles • Usually regular • Rate: Atrial rate cannot be determined; Ventricular rate 150-250 bpm • P Waves: No P Waves with QRS’ • PRI: No PRI • QRS: Wide & bizarre, measuring at least .12 seconds.**Ventricular Fibrillation**• Multiple foci in ventricles become irritable; heart starts to fibrillate rather than contract • Regularity: Totally chaotic • Rate: Cannot be determined • P Waves: No discernible P Waves • PRI There is no PRI • QRS: No QRS complexes**Asystole**• The heart has no electrical activity • Check the leads!!!! • Only a straight line

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