No relation between P waves and QRS complexes.Ventricular rhythm regular and rate slower than atrial rate.
Third-degree AV block (complex heart block)
Discontinuation of digoxin if appropriate. Temporary or permanent pacemaker for symptomatic bradycardia. Atropine, epinephrine, and dopamine for symptomatic bradycardia. Severe coronary artery disease, anterior wall MI, acute myocarditis. PR interval shorter after dropped beat. PR interval progressively, but only slightly, longer with each cycle until QRS complex disappears. Second-degree AV block Mobitz I (Wenckebach) Cautious use of digoxin, calcium channel blockers, and beta-adrenergic blockers. Possibly atropine if PR interval exceeds 0.26 second or symptomatic bradycardia develops. Use of quinidine, procainamide, beta-adrenergic blockers, calcium. Inferior wall MI or ischemia or infarction, hypothyroidism, hypokalemia, hyperkalemia. PR interval (when present) 0.20 second. P waves preceding, hidden within (absent), or after QRS complex usually inverted if visible. Dual chamber atrial pacing, implantable atrial pacemaker, or surgical maze procedure may also be used. Anticoagulation therapy to prevent emboli. If stable, drug therapy may include calcium channel blockers, beta-adrenergic blockers, digoxin, procainamide, quinidine, ibutilide, or amiodarone. Heart failure, COPD, thyrotoxicosis, constrictive pericarditis, ischemic heart disease, sepsis, pulmonary embolus, rheumatic heart disease, hypertension, mitral stenosis, atrial irritation, complication of coronary bypass or valve replacement surgery. No P waves, or P waves that appear as erratic, irregular base-line fibrillatory waves. Ventricular rhythm grossly irregular, rate 160 to 180 bpm. Atrial rhythm grossly irregular rate > 300 to 600 bpm. Anticoagulation therapy may be necessary. If patient is stable, drug therapy may include calcium channel blockers, beta-adrenergic blocks, or antiarrhythmics. If patient is unstable with ventricular rate > 150bpm, prepare for immediate cardioversion. Heart failure, tricuspid or mitral valve disease, pulmonary embolism, cor pulmonale, inferior wall MI, carditis. QRS complexes uniform in shape but often irregular in rate. Ventricular rate variable, depending on degree of AV block. Atrial rhythm regular, rate, 250 to 400 bpm. If patient has an ejection fraction less than 40%, consider amiodarone. If patient has normal ejection fraction, consider calcium channel blockers, beta-adrenergic blocks or amiodarone. bolus injection to rapidly convert arrhythmia. If patient is stable, vagal stimulation, or Valsalva’s maneuver, carotid sinus massage. If patient is unstable prepare for immediate cardioversion. Use of caffeine, marijuana, or central nervous system stimulants. Intrinsic abnormality of AV conduction system. Physical exertion, emotion, stimulants, rheumatic heart diseases. When a normal P wave is present, it’s called paroxysmal atrial tachycardia when a normal P wave isn’t present, it’s called paroxysmal junctional tachycardia. Sudden onset and termination of arrhythmia. P waves regular but aberrant difficult to differentiate from preceding T wave. Regular atrial and ventricular rhythms. Beta-adrenergic blockers or calcium channel blockers for symptomatic patients. Atropine, epinephrine, quinidine, caffeine, nicotine, and alcohol use. May accompany shock, left-sided heart failure, cardiac tamponade, hyperthyroidism, and anemia. Normal physiologic response to fever, exercise, anxiety, dehydration, or pain. Atrial and ventricular rhythms are regular. Atropine if rate decreases below 40 bpm. Can be seen in digoxin toxicity and inferior wall MI. Normal variation of normal sinus rhythm in athletes, children, and the elderly. Normal P wave preceding each QRS complex. Irregular atrial and ventricular rhythms. To download, simply click on the images below and save. Sinus Tachycardiaĭownload the printable cheat sheet for EKG interpretation below. It takes time to develop a skill in interpreting EKGs, but once you get the hang of it, you’ll be able to interpret any squiggly line in the EKG paper. IVCD RHYTHM STRIP HOW TO
Premature Ventricular Contractions (PVC)Įver wonder how nurses and doctors be able to read ECG papers at ease? How they differentiate atrial tachycardia from atrial fibrillation or on how to even know what atrial fibrillation or tachycardia is?ĮKG interpretation takes some serious skill, a keen eye and a good theoretical foundations on the different arrhythmias and the concepts around heart’s conduction and about the EKG machine itself.
Third Degree AV Block (Complete Heart Block). Second Degree AV Block Mobitz I (Wenckebach).
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