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VARIOUS QRS
CONFIGURATIONS
RATE MEASUREMENT
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Method 1:
Method 2:
Small
boxes
Hardwire monitoring
TYPES OF INTERFERENCE
Muscle Tremors
Patient Movement
TYPES OF INTERFERENCE
Loose Electrode
60-Cycle Interference
Straight Line
SINUS BRADYCARDIA
Rate
54 beats/minute
Rhythm
Regular
P waves
Sinus
PR interval
0.20 second
QRS duration 0.06 to 0.08 second
Note
A notched P wave is usually indicative of left
atrial
hypertrophy
CHARACTERISTICS OF SINUS
TACHYCARDIA
Rate
101 TO 180 beats/min
Rhythm
Regular
P waves
Uniform in appearance, positive (upright) in lead II, one
precedes
each QRS complex; at very fast rates, it may be difficult
to
distinguish a P wave from a T wave
PR interval
0.12 to 0.20 sec and constant from beat to beat
QRS duration 0.10 sec or less
SINUS ARRHYTHMIA
Rate
60 beats/min
Rhythm
irregular
P waves
Normal in configuration; precede each QRS
PR interval
0.12 to 0.14 second
QRS duration 0.06 to 0.08 second
Rate
Basic rhythm 94 beats/minute
Rhythm
Basic rhythm regular, irregular during pause
P waves
Normal in normal in basic rhythm; absent during pause
PR interval
0.16 to 0.18 second in basic rhythm; absent during
pause
QRS duration 0.06 to 0.08 second in basic rhythm; absent during
pause
Rate
Basic rhythm 84 beats/minute
Rhythm
Basic rhythm regular, irregular during pause
P waves
Normal in normal in basic rhythm; absent during pause
PR interval
0.16 to 0.18 second in basic rhythm; absent during
pause
QRS duration 0.08 to 0.10 second in basic rhythm; absent during
pause
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JUNCTIONAL RHYTHM
Rhythm
Rate:
P waves
PR interval
QRS complex:
: Regular
: 50 beats/minute
: Hidden in QRS complex
: Not measurable
:Normal 0.06 to 0.08 second
JUNCTIONAL TACHYCARDIA
Rhythm
Rate:
P waves
PR interval
QRS complex:
: Regular
: 65 beats/minute
: Hidden in QRS complex
: Not measurable
:Normal 0.06 to 0.08 second
10
CHARACTERISTICS OF ATRIAL
FIBRILLATION
Rate
Atrial rate usually greater than 400-600 beats/min;
ventricular rate
variable
Rhythm
Ventricular rhythm usually irregularly irregular
P waves
No identifiable P waves; fibrillatory waves present.
Erratic,
wavy baseline
PR interval
Not measurable
QRS duration Usually less than 0.10 second but may be widened if
an
intraventricular conduction delay exists
11
CHARACTERISTICS OF FIRST-DEGREE AV
BLOCK
Rate
Usually within normal range but depends on underlying
rhythm
Rhythm
Regular
P waves
Normal in size and shape; one positive (upright) P wave
before
each QRS in leads II, III, and aVF
PR interval
Prolonged (greater than 0.20 sec) but constant
QRS duration Usually 0.10 sec or less unless an intraventricular
conduction
delay exists
CHARACTERISTICS OF FIRST-DEGREE AV
BLOCK
The AV node holds each sinus impulse longer than normal
before conducting if through to ventricles. Each impulse is
eventually conducted . Once into the ventricles, conduction
proceeds normally.
12
13
Regular
Usually regular but may be irregular if AV conduction ratios vary
That of the underlying rhythm
Depends on number of impulses conducted though AV node;
less than atrial rate
Sinus; two or three P waves (sometimes more) before each QRS
complex
May be normal or prolonged; remains constant
Normal is block at AV node or bundle of His; wide if
branches
Rate:
Atrial:
That of the underlying rhythm
Ventricular: 40 to 60 beats/minute if paced AV junction; less than 40
beats/minute of paced by ventricles; ventricular rate
less than atrial rate
P waves:
Sinus P waves present with no constant relationship to QRS
complex (P waves found marching through QRS
complexes and T waves)
PR interval:
Varies greatly
QRS complex:
Normal if block at AV node or bundle of His; wide if
block in bundle
branches
14
PACEMAKERS
Atrial pacing
Ventricular pacing
AV sequential pacing
15
wave)
PR interval
None with the PVC because the ectopic originates in the
ventricles
QRS duration
Greater than 0.12 sec, wide and bizarre, T wave
frequently in
opposite
direction of the QRS complex
16
CHARACTERISTICS OF MONOMORPHIC
VENTRICULAR TACHYCARDIA
Rate
Rhythm
P waves
101 to beats/min
Essentially regular
May be present or absent; if present, they have no set
relationship to the QRS complexes appearing between
the
QRSs at a rate different from that of the VT
PR interval
None
QRS duration Greater than 0.12 sec, often difficult to differentiate
between
the QRS and T wave
CHARACTERISTIC OF VENTRICULAR
FIBRILLATION (VF)
Rate
waves or
complexes to measure
Rhythm
Rapid and chaotic with no pattern or regularly
P waves Not discernible
PR interval
Not discernible
QRS
Not discernible
Fine VF
COARSE
VF
18