Basic Arrhythmia Rules
Basic Arrhythmia Rules
Basic Arrhythmia Rules
Eina Jane & Co. © 2008 Last Updated: 06 October 2008
Walraven, G. (2006). Basic arrhythmias. Upper Saddle River, New Jersey: Brady Prentice Hall/Health.
Basic Arrhythmia Course Exam: 10 October 2008
P=P, P>QRS, QRS narrow/wide, P, wide/bizarre QRS
functioning impulse with
gatekeeper
1° Heart Block AV Block Algorithm Premature Ventricular Contraction
Delay true block; “toll” in Does PRI change? Underlying rhythm, rate; disrupted by
AV junction NO YES ectopic beat
Underlying rhythm/rate / \ P Wave: not preceded by P; dissociated
P Wave: normal upright, Are QRS missing? Is R‐R regular? P may be seen near PVC
followed by QRS / \ PRI: focus in ventricles none
PRI: ≥0.20s; constant across NO NO QRS: wide and bizarre; ≥0.12s, T wave
strip; prolonged PRI 1°HB 2°HB T1 in opposite direction from R wave
QRS: <0.12s Wenckebach
YES YES
2°HB T2 3° Complete HB
Classical Mobitz II
2° HB Type 1: Wenckebach Ventricular Tachycardia
(Mobitz I) Regular, slightly irregular, 150‐250
2 consecutive long PRI then bpm; >250 moves to flutter; usually
drop in QRS after P <150
Irregular, slightly lower than P Wave: not preceded by P; dissociated
normal rate (vary) P may be seen near PVC
P Waves: normal, upright; PRI: focus in ventricles none
not always followed by QRS QRS: wide and bizarre; ≥0.12s, T wave
QRS: >0.12s in opposite direction from R wave
2° HB Type II: Classical (Mobitz 3° HB: Complete Heart Block Ventricular Fibrillation
II) Atria & ventricle dissociation, Chaotic with no discernable waves or
Intermittent block, communication complexes
pattern; count # of blocks Regular Irregular compared to regular V‐tach
R‐R regular/irregular; P‐P P Waves: normal upright, P>QRS, Cannot determine rate
regular; bradycardia rate: ½ superimposed QRS Coarse vs. fine
to 1/3 slower than normal PRI: may not exist Treatment
depending on block Junctional Rate: 40‐60 narrow QRS o Defibrillate
PRI: constantly paired with (<0.12s) o Epinephrine
QRS; can be >0.20s Vetricular Rate: 20‐40, wider QRS o Atropine or amiodarone
QRS: <0.12s (≥0.12s) o Defibrillate
o Vasopressin
Eina Jane & Co. © 2008 Last Updated: 06 October 2008
Walraven, G. (2006). Basic arrhythmias. Upper Saddle River, New Jersey: Brady Prentice Hall/Health.
Basic Arrhythmia Course Exam: 10 October 2008
Idioventricular Rhythm
Usually regular, can be unreliable due
to lower site; 20‐40 bpm, can drop
below 20 bpm
P Wave: none
PRI: none
QRS: wide and bizarre: ≥0.12s
Accelerated Idioventricular Rhythm
Regular, unreliable due to slower rate;
ventricular escape ≥40 bpm
P Wave: none
PRI: none
QRS: wide and bizarre: ≥0.12s
Agonal Rhythm
Terminal, lethal arrhythmia, especially
when it has stopped beating in a
reliable pattern
“Dying heart”
1‐2 beats of wide, bizarre QRS
Treat as asystole
Asystole
No electrical activity in at least 2 leads
“Straight” line
Pulseless Electrical Activity
Rhythms on the monitor, but patient
has no pulse
Treat the cause
Eina Jane & Co. © 2008 Last Updated: 06 October 2008
Walraven, G. (2006). Basic arrhythmias. Upper Saddle River, New Jersey: Brady Prentice Hall/Health.