EKG Rhythm Strips 15: Sinus Rhythms
Identify the following sinus rhythms
1.
6.
7.
8.
Sinus Arrhythmia. The rhythm is irregular. There is one upright P wave for each QRS complex. The rate is between 60-100. The rhythm is determined by measureing the distance between the adjacent R waves, called the R-R interval. If the rhythm is regular, the R-R interval should be the same. With sinus arrhythmia, the difference between the shortest and longest R-R interval is over 0.12. sec. and the PR interval should be the same. Some normal rhythmic variation occurs with respirations. The heart rate speeds up slightly with inspiration and decelerates with expiration.
Normal Sinus Rhythm. The rhythm is regular. There is one upright P wave with each QRS complex. the PR interval is < 0.12 sec. There are no ectopic beats. The rate is 79. A PR interval > .20 seconds is characteristic of what heart block?
1.
2.
3.
4.
5.
7.
9.
10.
Answers:
1.
|
| Sinus Arrhythmia |
2.
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| Normal Sinus Rhythm |
3.
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| Sinus Bradycardia |
Sinus Bradycardia. The rhythm is regular. There is one upright P wave associated with each QRS complex. The PR interval falls within normal range. What is the normal PR interval? There are no ectopic beats. The rate is < 60 beats/min.
4.
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| Sinus Bradycardia |
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? The normal ST segment is flat, isoelectric. Could be indicative of some ischemia or an electrolyte disorder.
5.
|
| Normal Sinus Rhythm |
Normal Sinus Rhythm. The rhythm is regular. There is one upright P wave with each QRS complex. the PR interval is < 0.12 sec. There are no ectopic beats. The rate is 65 beats/min.
6.
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| Sinus Rhythm with Sinus Arrest |
Sinus Rhythm with Sinus Arrest. Except for the pauses, the rhythm is regular. There is one upright P wave for each QRS complex. The PR interval is 0.16 sec. There are no ectopic beats. One cause for the sinus arrest may be sick sinus syndrome. If theses pauses occur frequently causing the patient to be unstable, then immediate transcutaneous pacing is indicated. What are some other possible cause of unstable bradycardia? (Think Hs&Ts).
7.
|
| Sinus Arrhythmia |
Sinus Arrhythmia. The rhythm is irregular. There is one upright P wave for each QRS complex. The rate is between 60-100. In this rhythm strip, the difference between the shortest and longest R-R interval is over 0.12. sec. and the PR intervals should be the same.
8.
|
| Sinus Tachycardia |
Sinus Tachycardia. The rhythm is regular. There is one upright P wave with each QRS complex. the PR interval is < 0.12 sec. There are no ectopic beats. The actual rate is ____ beats/min. Sinus tachycardia is a symptom of some underlying problem: anxiety, fever, pain, dehydration and so forth. Always look for the underlying cause. How would you distinguish between SVT and sinus tachycardia? With Sinus tachycardia the rate is between 100-150. With SVT the rate is usually over 150. With sinus tachycardia there are identifiable P waves. In SVT the P waves are not generally seen. With sinus tachycardia, you can usually relate it to a primary cause. When you treat the cause, the rate slows down. However, with SVT it may not be related to a primary cause such as fever, activity, or pain. It is usually sustained, though it may occur in paroxsyms. With sinus tachycardia the electrical impulse from the SA node follows the usual conduction pathway. But with SVT, the electrical impulse gets caught in an reentry pathway. Let me pick you brain some more. What medication is indicated for the treatment of SVT? One are the initial and subsequent dosages? Describe the technique for administering the medication? Hint: it has a very short half life.
9.
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| Bradycardia with Sinus Arrhythmia |
Bradycardia with Sinus Arrhythmia. The rhythm is irregular. There is one upright P wave associated with each QRS complex. The PR interval falls within normal range and the PR intervals are the same. There are no ectopic beats. The rate is < 60 beats/min. If the P waves were of different morphology and the PR intervals were different then you would expect the arrhythmia to be ectopic in origin. What is the difference between the shortest and longest P-P interval?
10.
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| Sinus Rhythm with Sinus Arrest |
Sinus Rhythm with Sinus Arrest. As above (#6), except for the pause, the rhythm is regular. The is one upright P wace for each QRS complex. The PR interval is 0.16 sec. There are no ectopic beats.
How many seconds does the pause last? Physiologically, this represent an abrupt cessation in blood flow so the patient may experience a syncopal episode.
Reviewed 2/28/16
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