Brief Overview of Arrhythmias (Nurse)

Normal EKG

Sinus Tachycardia

• Pulse over 100/min., acceleration occurs gradually.
• The rhythm is regular.
• P waves normal shape, QRS normal.

Sinus bradycardia

• P below 60/min.
• The rhythm is regular.
• P waves and QRS normal.

Atrial extrasystoles

• Premature P-QRS-T complex (comes earlier).
• The P wave has a different shape, the QRS is normal.
• Incomplete compensation break.

Flutter the halls

• P waves are saw-shaped, partially extending below the isoline, frequency around 300/min. (F waves)
• The pulse depends on the degree of blocked waves (mostly around 150).
• The rhythm is regular in the untreated and irregular in the treated.
• QRS normal.

Atrial fibrillation

• Pulse around 150–200/ min.
• Irregular rhythm.
• Abnormal P waves with a frequency of around 600/min., difficult to distinguish.
• QRS normal.

Junctional, substitute rhythm

• Pulse around 40–60/min.
• The rhythm is regular.
• P waves negative, in leads II, III, aVF located before, after or in the QRS.
• QRS normal.

Ventricular extrasystole

• Irregular rhythm.
• Premature contraction followed by a complete pause.
• Wide QRS.

• Accumulated extrasystoles are dangerous.

Ventricular Tachycardia

• Pulse 150-200/min.
• QRS bizarre shape, tall.
• Sudden ending and beginning.
• The P wave is usually not visible.

Ventricular Flutter

• Pulse over 200/min.
• QRS wide, bizarre, change in amplitude.

Ventricular fibrillation

• This is ventricular fibrillation, when cardiac activity without mechanical work can be seen on the ECG.
• QRS replaced by waves.

S-A blockades

• The entire P-QRS-T complex drops out, only isolines.
• In partial block, the resulting pause is a multiple of the P-P time of the previous rhythm.
• In complete block, the pause is usually interrupted by a junctional rhythm or a replacement ventricular rhythm.

A-V Blocks

A-V Block I Grade

• Longer time between P-Q → everything will be converted, but slowly.
• Rhythm regular, waves normal.

A-V II. degree, 1. type

• Gradual lengthening of P-Q and after a certain number one complex falls out and only the P wave remains.
• QRS blocking periodically repeats, they are of normal width.

A-V block II. degree, 2nd type

• Sudden dropout of the QRS and only the P wave is recorded, without prolongation of the P-Q interval.
• QRS blocking comes irregularly, QRS wide.

A-V block III. degrees

• P 40-60/min.
• P wave frequency is higher than QRS, P waves are unrelated to QRS.
• QRS normal or widened.
• May result in ventricular arrest where only P waves are visible on the EKG.

Blockade P Tawar arms

• QRS widening, in lead V1.2 resembles the letter M.
• In lead V6, I, aVL there is a markedly wide S or QS.
• The T wave is the opposite of the QRS deflection.

Asystole

• This is cardiac arrest, without electrical activity.