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Chapter 5 Rhythm Strip Interpretation and Sinus Rhythms Learning Outcomes 51 Explain the process of evaluating ECG tracings and determining the presence of dysrhythmias 52 Describe the criteria used for classification of dysrhythmias, including rhythm, rate, P wave configuration, PR interval measurement, and QRS duration measurementRationale 1 Normal sinus rhythm is defined as regular rhythm with a rate of 60 to 100 beats per minute The PR and QRS measurements are normal, 012 to 0 second and 006 to 010 second respectively Rationale 2 The rhythm is regular, which is not a characteristic of sick sinus syndrome Rationale 3 The rate is too fast for sinus bradycardiaSinus bradycardia is discussed including the ECG criteria, causes and symptoms when a part of sick sinus syndrome (SSS)

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Sinus bradycardia rhythm 6 second strip

Sinus bradycardia rhythm 6 second strip-Sinus Rhythms are aptly named due to the locus of stimulation being the SA (sinoatrial) node With Sinus Bradycardia the locus of stimulation is the same as normal sinus rhythm, just now the rate will be less than 60 bpm Recall that "brady" means slow The only difference between sinus bradycardia and normal sinus rhythm is the rate• Cycles/6 second strip 10 = Rate • When there are 10 large squares between similar waves, the rate is 30/minute Sinus Rhythm origin is the SA Node ("Sinus Node"), normal sinus rate is 60 to 100/minute • Rate more than 100/min = Sinus Tachycardia (page 68) • Rate less than 60/min = Sinus Bradycardia (page 67)

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2906 · Sinus Tachycardia Originates from the SA node Atrial and ventricular rates are the same and are between 100 and 150 beats per minute Increased heart rate could be normal response to recent exercise Sinus tachycardia can cause low cardiac output Patient may complain of heart fluttering or palpitations Criteria for rhythm, P wave morphology, PR interval, and QRS duration and morphology are the same as in sinus rhythm and sinus bradycardiaNote The rate of a Normal Sinus Rhythm is beats per minute;The following rhythm strips are for your practice We suggest you practice with these prior to taking the post test (All strips are sixsecond strips unless otherwise indicated) Rhythm Strip #1 ECG Criteria Heart rate

 · This rhythm strip tracing shows an atrial tachyarrhythmia (atrial flutter/tachycardia) that suddenly terminates The tachycardia is followed by a 34second pause and then sinus bradycardia The combination of a tachycardia that is suddenly followed by a bradycardia is characteristic of tachybrady syndromeAssume each strip is a 6 second strip Passing is 80% 1 Identify the following rhythm a Asystole b Ventricular fibrillation c Atrial fibrillation d Torsade de pointes 2 What is the most appropriate treatment for this patient?Rate and Rhythm Sinus Bradycardia and Sinus Tachycardia Watch later Share Copy link Info Shopping Tap to unmute If playback doesn't begin shortly, try restarting your device Up next

Basic Dysrhythmias Sinus Arrhythmias Basic Rhythm Strip Interpretation6 Cardiac physiology 10 The P wave 13 The PR interval 15 The QRS complex 18 The ST segment The T wave 22 Determining the rate 24 Myocardial Infarction 27 Sinus Rhythm (SR) 29 Sinus Bradycardia (SB) 31 Sinus Tachycardia (ST) 33 Atrial Tachycardia 34 Atrial Fibrillation (AF) 36 Atrial Flutter 38 Junctional Escape RhythmBradycardia sinus bradycardia is seen in a skipped rhythm, Causes are second and third degree AV block, sinoatrial block and arrest termed sinus node dysfunction enabling quicker appraisal of heart rate based on a 6second strip the procedure is as follows Obtain a printed strip of sufficient length, covering more than 6 seconds,

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To determine if the atrial rate is regular or irregular, measure the distance between two consecutive PP intervals Use a point from one P wave to the same point on the next P wave · basic rhythm strip review 1 rhythm strip review 2 measuring intervals 3 measuring intervals 4 sinus rhythms 5 normal sinus rhythm 6 sinus arrhythmia 7 sinus tachycardia 8 sinus bradycardia 9 sinus pause 10 sinus arrest 11 atrial rhythms 123012 · We cannot use the guestimation method here, because this is not a 6second strip In fact, it's about a 3second strip, so that would put us around 60bpm which would just be normal sinus rhythm so you can see why this method is not as accurate, and on a test, you'd have gotten this question wrong if you used that method

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C) Sinus bradycardirrest 2 Identify on rrest 3 Systematically evaluate each rhythm for the following criteria a) Rate, b) Rhythm Regular/irregular,Identify on rrest 3 Systematically evaluate each rhythm for the following criteria a) Rate, b) Rhythm Regular/irregular,Sinus bradycardia ECG, causes & management Definition of sinus bradycardia Sinus bradycardia fulfills the criteria for sinus rhythm but the heart rate is slower than 50 beats per minute ECG criteria follows Regular rhythm with ventricular rate slower than 50 beats per minute Pwaves with constant morphology preceding every QRS complex

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0118 · Sinus rhythm refers to the pace of your heart beat that's set by the sinus node, your body's natural pacemaker A normal sinus rhythm means your heart rate is within a normal range · Even people who are physically fit can experience sinus bradycardia Bradycardia is often indicative of low blood pressure, pulmonary edema and congestion, abnormal rhythm, discomfort in the chest, shortness of breath, lightheadedness, and/or confusion On the other hand, symptomatic bradycardia should be attended to with the ACLS SurveyHowever, from a cardiologist or EP perspective, this is coarse atrial fibrillation (pseudo flutter waves changing morphology and rate) 32 Sinus Tachycardia

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Sinus bradycardia is characterized by sinus rhythm with heart rates below normal for age (see Fig 165) Slow heart rates can be observed during sleep or at times of high vagal tone When there is significant sinus bradycardia, a slow junctional escape rhythm or a slow atrial rhythm originating from an ectopic focus can be presentWhen assessing the rhythm strip, the nurse takes care first to identify the underlying rhythm (eg, sinus rhythm, sinus arrhythmia) Then the PR interval is assessed for the possibility of an AV block AV blocks occur when the conduction of the impulse through the AV0807 · A 6second strip is made up of 30 big boxes Each big block is 02 seconds in duration, so 5 big blocks is equal 1 second in total duration (2 x 5 = 1), meaning you would need a total of 30 big boxes to make a 6second strip Once you know you are dealing with a 6 second strip, you count the number of QRS complexes within those 6 seconds and multiply by 10 For example, if we count 5 QRS complexes within a 6 second strip,

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Atrial rate (#P waves in 6second strip)*(10) Ventricular rate (#QRS complexes waves in 6second strip)*(10)An ECG rhythm strip shows a ventricular rate of 128, a regular rhythm, a PR interval of 016 second, a QRS duration of 008, and one upright P wave before each QRS This rhythm29 Accellerated Junctional Rhythm (heart rate is 80) 30 Sinus Bradycardia with 1st degree AV block (PR 022 seconds) HR=50 31 Atrial flutter with varying conduction (saw tooth baseline);

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Bradycardia is the most common feature of sick sinus syndrome Very few patients, however, will actually experience symptoms unless their heart rate drops to Identify on a 6second strip the following rhythms a) Sinus rhythm Sinus bradycardia happens when the sinus node does not send enough electrical impulses to the heart, resulting in a heart rate that is lower than 60 BPMThe 6 second method Denotes a 6 second interval on EKG strip Strip is marked by 3 or 6 second tick marks on the top or bottom of the graph paper Count the number of QRS complexes occurring within the 6 second interval, and then multiply that number by 10 Using rate determination chart More accurate calculation of HRThe normal ST segment is flat, isoelectric Could be indicative of some ischemia or an electrolyte disorder

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Sinus rhythm, bradycardia and tachycardia · Sinus Bradycardia The rhythm is regular There is one upright P wave associated with each QRS complex The PR interval falls within normal range There are no ectopic beats The rate is < 60 beats/min What do you notice about the ST segment?Step Two Determine the Rhythm Is the rhythm is regular or irregular?

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Ecg Quiz Accelerated Idioventricular Rhythm Arrhythmogenic Right Ventricular Dysplasia Arvd Ashman Phenomenon Asystole Atrial Fibrillation Atrial Flutter Atrial Tachycardia Atrioventricular Block Atrioventricular Dissociation Atrioventricular Nodal

 · Bradycardia is defined as a heart rate slower than 60 beats per minute Sinus bradycardia is a type of slow heartbeat that originates from the sinus node of your heart Your sinusSinus Rhythms Normal Sinus Rhythm Sinus Arrhythmia Sinus Arrest or Pause Sinus Tachycardia Sinus Bradycardia Atrial Rhythms Premature Atrial Contractions (PAC's) Wandering Atrial Pacemaker (WAP) Atrial Tachycardia Atrial measure P wave to P wave across a 6 second strip and note if the P waves are equally spaced (regular · A rhythm strip is at least a 6second tracing printed out on graph paper which shows activity from one or two leads Leads are "views" of the heart There are 12 leads that are traditionally obtained with a 12lead EKG, but most portable and bedside monitors only monitor 35 leads

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 · RHYTHM ECG rhythm characterized by a usual rate of anywhere between 6099 bpm, every P wave must be followed by a QRS and every QRS is preceded by P wave Normal duration of PR interval is 35 small squares The P wave is upright in leads I and II Normal Sinus Rhythm 36 Sinus Bradycardia RHYTHM Rate < 60bpm, otherwise normal 37A patient admitted with a new diagnosis of hypertension demonstrates sinus bradycardia with a heart rate of 52 bpm on the electrocardiogram (ECG) monitor The nurse assesses the patient and determines if the patient is asymptomaticRhythm Strip #3 Heart rate 40 Rhythm Regular P waves One present for each QRS PR interval 12 QRS width 08 Interpretation Sinus bradycardia with (unifocal) ventricular bigeminy

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SecondDegree Atrioventricular Block (Mobitz II) SinusBrdycrdia Sinus Tachycardia ThirdDegree Atrioventricular Block RHYTHM & M ETIOLOGY CRITERIA OVERVIEW UNIQUE CRITERIA SA PLE STRIS Normal Sinus Rhythm • Normal, None RHY – Regular R – P – Upright PRI – 01 QRS – None, normal rhythm Sinus Tachycardia1401 · So step 6 would be to identify the rhythm and we have sinus bradycardia So let's recap and break it down and look at the characteristics of sinus bradycardia Our rhythm is regular, our heart rate is 5051 beats per minute our P to QRS ratio is 1 to 1 our PR interval in normal and our QRS complex is normal so that gives us sinus bradycardiaSinus bradycardia is a type of slow heartbeat A special group of cells begin the signal to start your heartbeat These cells are in the sinoatrial (SA) node Normally, the SA node fires at about 60 to 100 times per minute at rest In sinus bradycardia, the node fires less than 60 times per minute

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Interpret the strip shown below A Sinus Bradycardia B Atrial Fibrillation with from MED 101 at University of Massachusetts, AmherstDefinition of Sinus Bradycardia Sinus bradycardia is a heart rhythm that originates in the sinus node with a rates less than 60 beats per minute Sinus bradycardia is a common condition in both healthy individuals, particularly athletes It can also occur normally during sleepC) Sinus rhythm at 60 bpm d) Sinus bradycardia A 76yearold man complaining of indigestion a) Junctional bradycardia with STsegment depression and inverted T waves b) Sinus bradycardia with inverted T waves c) Sinus bradycardia with 2nd degree type II d) Junctional bradycardia 21 A 61yearold man with a history of heart failure

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This ECG rhythm is called a) Sinus arrhythmia b) Junctional rhythm c) Junctional bradycardia d) Sinus bradycardia Answer c) Junctional bradycardia Explanation This extremely slow ECG rhythm includes narrow QRS complexes, no P waves and a rate of about 30/minute This rhythm originates from the AV junction Because this rhythm occursA normal heart should have a normal sinus rhythm, this rhythm can be identified by a ventricular rate of bpm, at a regular rate, with a normal PR interval (012 to 0 second) and a normal QRS complex (012 second and less) Sinus bradycardia is another regular rhythm however the ventricular rate is only between 4060 bpm, with a normalSinus tachycardia is recognized on an ECG with a normal upright P wave in lead II preceding every QRS complex, indicating that the pacemaker is coming from the sinus

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 · Section 1 Supraventricular rhythms Normal sinus rhythm Normal sinus rhythm with a normal U wave Sinus arrhythmia (irregular sinus rhythm) Sinus tachycardia Sinus bradycardia Atrial bigeminy Atrial trigeminy Ectopic atrial rhythm Multifocal atrial tachycardia Atrial fibrillation Atrial fibrillation with rapid ventricular response Atrial fibrillation and bundle branch block AtrialA Call the Code team, defibrillate, and administer Magnesium Sulfate B Call MD, review medications

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