Rhythm RecognitionAndey bin Rahman

Tachyarrhythmia

Narrow complexRegular•SVT•Sinus tachycardia•Atrial flutter•Junctional rhythm

Irregular•Atrial fibrillation•Atrial flutter with variable block•Multifocal atrial tachycardia

Narrow Complex

Sinus Rhythm

Sinus Tachycardia

Atrial Flutter

Rate A: 300 V:<150Rhythm RegularQRS NarrowFeature sawtooth

Supraventricular Tachycardia

Rate >150Rhythm RegularQRS NarrowFeature P not visible

Junctional rhythm Rate 40-60Rhythm RegularQRS NarrowFeature P not visible,

inverted or after QRS

Atrial fibrillation

Rate A: 600 V:variableRhythm irregularQRS NarrowFeature Irregularly irregular

Atrial flutter with variable block

Rate A: 300 V:<150Rhythm IrregularQRS NarrowFeature sawtooth

Multifocal Atrial Tachycardia

Rate VariableRhythm IrregularQRS NarrowFeature 3 or more P waves

that differ in polarity (up/down),shape, and size

Wide complex

Ventricular TachycardiaRate >150Rhythm IrregularQRS wideFeature No visible p

SVT with aberancy

Ventricular fibrillation

Rate Very fastRhythm IrregularQRS bizarreFeature no recognizable P,

QRS, or T waves

Torsades de pointes

Rate V: 150-200

Rhythm IrregularQRS QRS complexes display

“spindle-node” patternFeature no recognizable P &T

waves, prolong QT before occurence

Bradyarrhythmia

Bradyarrhythmia

Sinus Bradycardi

a1st degree

Heart block2nd degree Heart block (Mobitz 1)

2nd degree Heart block (Mobitz 2)

3rd degree Heart block

Sinus Bradycardia

1st degree Heart block• P-R Interval > 200msec (5 small box)• No dropped beat

2nd degree heart block , Mobitz 1 (Wenckebach)• Progressive prolongation of P-R intervals• P-P intervals constant• Dropped beat • PR interval is longest immediately before the dropped beat• PR interval is shortest immediately after the dropped beat

2nd degree HB Mobitz II• Intermittent non-conducted P waves without progressive prolongation of the PR

interval• PR interval in the conducted beats remains constant• P-P constant• RR interval surrounding the dropped beat(s) is an exact multiple of the preceding

RR interval

3rd degree HB (complete HB)• complete absence of AV conduction (AV dissociation)• Perfusing rhythm is maintained by a junctional or ventricular escape rhythm

Pulseless Electrical Activity (PEA)

• presence of coordinated electrical activity in myocardium but no detectable cardiac output• formerly known as EMD

(electromechanical dissociation)

Asystole

Arrest rhythm

• VF• VT• PEA• Asystole

ACLS 2010

Thank you