Fernandez, Erik Geuel R.

2016

September

BSN III-B
Types of Arrhythmia
Type

Description

I.
Supraventricular Rhythms
1. Normal
Rate: 60 to 100 BPM
sinus
Rhythm: Regular
rhythm
P:QRS: 1:1
(NSR)
PR interval: 0.12 to
0.20 sec
QRS complex: 0.6 to
0.10 sec
2. Sinus
Rate: 60 to 100 BPM
arrhyth
Rhythm: Irregular,
mia
varying
with respirations
P:QRS: 1:1
PR interval: 0.12 to
0.20 sec
QRS complex: 0.6 to
0.10 sec

3. Sinus
tachyca
rdia

Rate: 101 to 150

BPM
Rhythm: Regular
P:QRS: 1:1 (With
very fast rates,
P wave may be
hidden in preceding
T wave)
PR interval: 0.12 to
0.20 sec

Picture

Signs and
Symptoms

Management

None

None; normal
heart rhythm

The rate
increases during
inspiration and
decreases
with expiration.
Sinus
arrhythmia is
common in the
very young
and the very old

Generally none;
considered a
normal
rhythm in the
very young
and very old.

Manifestations
of sinus
tachycardia
include a rapid
pulse
rate. The
patient may
complain of
feeling that the
heart is

Treated only if
symptomatic
or patient is at
risk
for myocardial
damage.
Treat underlying
cause
(e.g.,
hypovolemia,

QRS complex: 0.6 to

0.10 sec

4. Sinus
bradyca
rdia

Rate: < 60 BPM

Rhythm: Regular
P:QRS: 1:1
PR interval: 0.12 to
0.20 sec
QRS complex: 0.6 to
0.10 sec

racing,
shortness of
breath, and
dizziness. In the
presence of
heart
disease, sinus
tachycardia
may precipitate
chest pain.
Sinus
bradycardia
may be
asymptomatic;
it is important
to
assess the
patient before
treating the
rhythm.
Manifestations
of
decreased
cardiac output,
such as
decreased level
of
consciousness,
syncope
(faintness), or
hypotension
indicate a need
for intervention.

fever, pain).
Beta blockers or
verapamil
may be used.

Treated only if
symptomatic.
Intravenous
atropine or
isoproterenol,
and/or pacemaker
therapy
may be used.

5. Premat
ure
atrial
contrac
tions
(PAC)

Rate: Variable
Rhythm: Irregular,
with normal rhythm
interrupted by early
beats arising in
the atria
P:QRS: 1:1
PR interval: 0.12 to
0.20 sec, but may
be prolonged
QRS complex: 0.6 to
0.10 sec

6. Paroxys
mal
suprave
ntricula
r
tachyca
rdia
(PSVT)

Rate: 100 to 280

BPM (usually 150 to
200 BPM)
Rhythm: Regular
P:QRS: P waves
often not identifiable
PR interval: Not
measured
QRS complex: 0.6 to
0.10 sec

PACs cause few

manifestations.
If frequent, they
may cause
palpitations or a
fluttering
sensation in the
chest. Early
beats
may be noted
on auscultating
or palpating the
pulse.
Its
manifestations
include
complaints of
palpitations and
a racing heart,
anxiety,
dizziness,
dyspnea,
anginal pain,
diaphoresis,
extreme fatigue,
and
polyuria (urine
output may
reach up to 3 L
in the first few
hours
after PSVT
onset).

Usually require
no treatment.
Advise to reduce
alcohol
and caffeine
intake, to
reduce stress, and
to
stop smoking.
Beta blocker may
be prescribed.

Treat if
symptomatic.
Treatment may
include
vagal maneuvers
(Valsalva, carotid
sinus
massage); oxygen
therapy;
adenosine or a
beta
blocker;
temporary
pacing,
or synchronized
cardioversion.

7. Atrial
flutter

Rate: Atrial 240 to

360
Rate: Atrial 240 to
360 BPM; ventricular
rate depends on
degree of AV block
and usually is < 150
BPM
Rhythm: Atrial
regular; ventricular
usually
regular
P:QRS: 2:1, 4:1, 6:1;
may vary
PR interval: Not
measured
QRS complex: 0.6 to
0.10 sec

Patients with
atrial flutter
may complain
of palpitations
or a
fluttering
sensation in the
chest or throat.
If the ventricular
rate
is rapid,
manifestations
of decreased
cardiac output,
such as
decreased level
of
consciousness,
hypotension,
decreased
urinary
output, and cool
clammy skin,
may be noted.
The atrial
kick (additional
ventricular
filling with atrial
contraction) is
lost because of
inadequate
atrial filling.

Synchronized
cardioversion;
medications to
slow ventricular
response
such as a beta
blocker or
calcium channel
blocker,
followed by a
class I
antidysrhythmic
agent
or amiodarone.

8. Atrial
fibrillati
on

Rate: Atrial 300 to

600 BPM (too rapid
to count); ventricular
100 to 180 BPM
in untreated patients
Rhythm: Irregularly
irregular
P:QRS: Variable
PR interval: Not
measured
QRS complex: 0.06
to 0.10 sec

9. Junction
al
escape
rhythm

Rate: 40 to 60 BPM;
junctional
tachycardia
60 to 140 BPM
Rhythm: Regular
P:QRS: P waves may
be absent,

Manifestations
of atrial
fibrillation relate
to the rate of
the
ventricular
response. With
rapid response
rates,
manifestations
of decreased
cardiac output
such as
hypotension,
shortness of
breath, fatigue,
and angina may
develop.
Patients with
extensive
heart disease
may develop
syncope or
heart failure.
Peripheral
pulses are
irregular and of
variable
amplitude
(strength).
Junctional
rhythms may be
accompanied by
symptoms or
may be entirely
asymptomatic.
Palpitations,

Synchronized
cardioversion;
medications to
reduce ventricular
response rate:
metoprolol,
diltiazem, or
digoxin;
anticoagulant
therapy to
reduce risk of clot
formation
and stroke.

Treat cause if
symptomatic.

inverted and
immediately
preceding
or succeeding QRS
complex, or hidden
in QRS complex PR
interval:
< 0.10 sec
QRS complex: 0.06
to 0.10 sec

II.
Ventricular Rhythms
1. Prematu
Rate: Variable
re
Rhythm: Irregular,
ventricu
with PVC
lar
interrupting
contract
underlying rhythm
ions
and followed by
(PVC)
a compensatory
pause
P:QRS: No P wave
noted before PVC
PR interval: Absent

fatigue, or poor
exercise
tolerance:
These may
occur during a
period of
junctional
rhythm in
patients who
are abnormally
bradycardic for
their level of
activity.
Dyspnea:
Sudden onset of
symptoms and
sudden
termination of
symptoms may
occur,
especially in the
setting of
complete heart
block.
Presyncope.
Patients may
complain
of feeling their
hearts skip a
beat or of
palpitations.

Treat if
symptomatic or in
presence of
severe heart
disease. Advise
against
stimulant use
(caffeine,
nicotine). Beta
blockers,
or class I of III

with PVC
QRS complex: Wide
(> 0.12 sec) and
bizarre in
appearance; differs
from normal
QRS complex

2. Ventricu
lar
tachyca
rdia (VT
or V
tach)

Rate: 100 to 250

BPM
Rhythm: Regular
P:QRS: P waves
usually not
identifiable
PR interval: Not
measured
QRS complex: 0.12
sec or greater;
bizarre shape

The patient may

experience a
fluttering
sensation in the
chest or
complain of
palpitations and
brief shortness
of breath.
Patients in
sustained
VT generally
develop signs
and symptoms
of decreased
cardiac
output and
hemodynamic
instability,
including severe
hypotension, a
weak or
nonpalpable
pulse, and loss
of
consciousness.

antidysrhythmic
agents (see the
box on page 956)
may be
used in patients
with
severe heart
disease
who are
symptomatic.
Treat if VT is
sustained,
symptomatic, or
associated
with organic heart
disease.
Treatment
includes DC
cardioversion
or intravenous
procainamide,
lidocaine, or a
class III
antidysrhythmic
agent if
hemodynamic
instability
accompanies.
Surgical ablation
or antitachycardia
pacing with
an implanted
cardioverter/
defibrillator (ICD)
for
repeated
episodes.

3. Ventricu
lar
fibrillati
on (VF,
V fib)

Rate: Too rapid to

count
Rhythm: Grossly
irregular
P:QRS: No
identifiable P waves
PR interval: None
QRS: Bizarre,
varying in shape
and direction
III.
Atrioventricular Conduction Blocks
1. FirstRate: Usually 60 to
degree
100 BPM
AV block
Rhythm: Regular
P:QRS: 1:1
PR interval: > 0.21
sec
QRS complex: 0.06
to 0.10 sec
2. SecondRate: 60 to 100 BPM
degree
Rhythm: Atrial
AV
regular; ventricular
block,
irregular
type I
P:QRS: 1:1 until P
(Mobitz
wave blocked with
I,
no subsequent QRS
Wencke
complex
bach)
PR interval:
Progressively
lengthens
in a regular pattern
QRS complex: 0.06
to 0.10 sec; sudden
absence of QRS
complex

The patient
loses
consciousness
and stops
breathing as
perfusion
ceases.

Immediate
cardioversion/
defibrillation.

None.

None required.

Usually
asymptomatic.

Monitoring and
observation;
rarely progresses
to
a higher degree
of block
or requires
treatment.

3. Seconddegree
AV
block,
type II
(Mobitz
II)

4. Thirddegree
AV block
(Comple
te heart
block)

Rate: Atrial 60 to
100 BPM;
Ventricular < 60
BPM
Rhythm: Atrial
regular; ventricular
irregular
P:QRS: Typically 2:1,
may vary
PR interval: Constant
PR interval for
each conducted QRS
complex
QRS complex: 0.06
to 0.10 sec
Rate: Atrial 60 to
100 BPM;
ventricular 15 to 60
BPM
Rhythm: Atrial
regular; ventricular
regular
P:QRS: No
relationship between
P waves and QRS
complexes;
independent
rhythms
PR interval: Not
measured
QRS complex: 0.06
to 0.10 sec if
junctional
escape rhythm; >
0.12 sec if
ventricular escape
rhythm

Manifestations
of Mobitz type II
block depend on
the ventricular
rate.

Atropine or
isoproterenol;
pacemaker
therapy.

The slow
escape rhythm
significantly
affects cardiac
output, causing
manifestations
such as syncope
(known as a
Stokes-Adams
attack),
dizziness,
fatigue, exercise
intolerance, and
heart failure

Immediate
pacemaker
therapy.

Sources:
Beinart, S. C. (2015). Junctional Rhythm Clinical Presentation.
http://emedicine.medscape.com/article/155146-clinical

Retrieved

September

12,

2016,

from

LeMone, P., Burke, K., & Bauldoff, G. (2011). Medical-surgical nursing: Critical thinking in patient care (5th ed.) [PDF].
Upper Saddle River, New Jersey, United States of America: Pearson.