Sinus Rhythms- Pacemaker originating from SA node and following normal conduction pathway.
	Rate		Rhythm		P wave appearance	PRI	QRS	Special Considerations/ Can occur on the strip:
	P	QRS	P	QRS
Sinus Rhythm	60-100	60-100	reg	reg	uniform, 1 per QRS	0.12-0.20	<0.12	NSR
Sinus Brady	<60	<60	reg	reg	uniform, 1 per QRS	0.12-0.20	<0.12	Irregular if off by more than a small box
Sinus Tach	101-180	101-180	reg	reg	uniform, 1 per QRS	0.12-0.20	<0.12	Upper limit for adults 150, Peds is 180
Sinus Arrhythmia	usu WNL	usu WNL	irreg	irreg	uniform, 1 per QRS	0.12-0.20	<0.12	Irregularity due to intrathoracic pressure changes
Sinoatrial Block	varies	varies	reg	reg	uniform, 1 per QRS	0.12-0.20	<0.12	Underlying rhythm usually WNL, "on time"
Sinus Arrest	varies	varies	reg	reg	uniform, 1 per QRS	0.12-0.20	<0.12	Underlying rhythm usually WNL, "off time"
Atrial Rhythms- Atrial ectopic focus other than SA node (diff p wave form), conduction continues normally through the ventricles. P waves may or may not distort QRS or T.
Usually the atrial ectopic focus causes the ventricles to beat faster, however the AV junction can be selective as to which conduction will pass through.
	Rate		Rhythm		P wave appearance	PRI	QRS	Special Considerations/ Can occur on the strip:
	P	QRS	P	QRS
PAC	usu WNL	usu WNL	reg	reg	SR, PAC-early & different	WNL	WNL	SR except for PAC effects on rhythm-different and early p
Wand Atrial Pacemkr	usu WNL	usu WNL	reg/irreg	reg/irreg	varing size & shape	variable	usu WNL	>3 diff p wave configurations seen in same lead to be WAP
Multifocal AT	>100	>100	reg/irreg	reg/irreg	varing size & shape	variable	usu WNL	WAP + HR >100 = MAT
SVT/ PSVT	150-250	150-250	reg	reg	varing size & shape	usu WNL	usu WNL	SVT-generally fast rhythm of unk origin
Atrial Tach/ PAT	150-250	150-250	reg	reg	varing size & shape	usu WNL	usu WNL	specific rhythm. >3 sequential PAC w/ HR >100.
Atrial Flutter	250-450	<180	reg	reg/irreg	saw-tooth appearance	UTD	usu WNL	QRS could appear wider due to p waves.  2:1, 3:1, 4:1, etc.
Atrial Fib	400-600	<180	irreg	irreg	chaotic p waves	UTD	usu WNL	"irregularly irregular"  <100-controlled, >100-uncontrolled
Junctional Rhythms- AV junction becomes the pacemaker due to sinus failure/blockage or irritable junctional tissue, should have normal ventricular conduction.
	Inverted p waves (retrograde conduction), found before, during, and after, with usually a normal QRS complex.
	Rate		Rhythm		P wave appearance/	PRI	QRS	Special Considerations/ Can occur on the strip:
	P	QRS	P	QRS	Junctional effects
PJC	usu WNL	usu WNL	reg	reg	SR, PJC-early & inverted	WNL	WNL	SR, PJC effects on rhythm- early and inverted p ~irritable
Junct Escape Beat	usu WNL	usu WNL	reg	reg	SR, JEB-late & inverted	WNL	WNL	SR, JEB effects on rhythm- late and inverted p ~waited
Junct Escape Rhythm	40-60	40-60	reg	reg	inverted-before, no, after	WNL/ no	WNL	JER due to >3 sequential JEB, intrinsic rate of AV junction
Accel Junct Rhythm	61-100	61-100	reg	reg	inverted-before, no, after	WNL/ no	WNL	JER + HR >60 =AJR.  Caused by enhanced automaticity.
Junctional Tach/ PJT	101-180	101-180	reg	reg	inverted-before, no, after	WNL/ no	WNL	AJR due to >3 sequential PJC, HR >150 - AT or JT? ~SVT
~ Paroxysmal rhythms start and stop suddenly.
~ With any rhythm, it can have several dysrhythmias/ ectopic beats with in it.  Also, it can start as one type and go to another type of rhythm or convert itself to a sinus rhythm.
Example: a sinus rhythm with a nonconducted PAC and then a junctional escape beat (Fig. 5-18).
~ Use the rules to rule out possible rhythms!!
Ventricular Rhythms- Ventricles become the pacemaker (least efficient) due to sinus &/or junctional failure/blockage or irritable ventricular tissue. If seen, retrograde p waves.
	Usually, wide QRS complexes (asynchronized) and changes in T wave and ST segment (abnormal repolarization) - Opposite direction as QRS complex.
	Rate		Rhythm		P wave appearance/	PRI	QRS	Special Considerations/ Can occur on the strip:
	P	QRS	P	QRS	QRS effects
PVC	usu WNL	usu WNL	reg	reg	SR, PVC-early & retro/no	WNL	WNL	SR, PVC-wide QRS. Fusion beat, interpolated, R on T- VT/VF
Vent Escape Beat	usu WNL	usu WNL	reg	reg	SR, VEB-late & retro/no	WNL	WNL	SR, VEB-wide QRS.  Protective mechanism
Vent Escape Rhythm	UTD	20-40	UTD	reg	absent or retro	none	>0.12	Idioventricular Rhythm.  >3 sequential VEB.
Accel Idiovent Rhy	UTD	41-100	UTD	reg	absent or retro	none	>0.12	VER/IVR + HR >40 = AIVR.
Ventricular Tach	UTD	101-250	UTD	reg	absent or retro	none	>0.12	>3 sequential PVC.  Monomorphic & Polymorphic. PVT too.
Ventricular Fib	UTD	UTD	irreg	irreg	UTD	none	UTD	Chaotic rhythm.  <3 mm - fine VF & >3 mm- coarse VF
Asystole	possible	none	reg	none	may see p waves	none	none	No ventricular electrical activity.  Possible p wave asystole
PEA	tach/brady	tach/brady	reg/irreg	reg/irreg	present or absent	possible	possible	A rhythm other than VT, organized activity w/o pulses
Atrioventricular Blocks- The electrical impulse is either delayed, partially blocked, or completely blocked within the AV node, Bundle of His, Bundle Branches, and Purkinjies.
	PRI is normal or abnormal.  QRS is either narrow or wide, depending on the location of the block.  P waves are normal in size and shape.
	With dropped beats, SA node fires when the ventricles are in absolute refractory period, no depolarization.
	If Narrow QRS, block above Bundle of His (1st, 2nd Type I, 3rd).  If Wide QRS, block below Bundle of His- asynchronized cond (2nd Type II, 3rd).
	2nd degree, type I is also Wenkebach and Mobitz I ~ 2nd degree, type II is Mobitz II ~ 3rd degree is complete AV block.
	Rate		Rhythm		P wave appearance/	PRI	QRS	Special Considerations/ Can occur on the strip:
	P	QRS	P	QRS	Block effects on QRS
1st degree AV Block	usu WNL	usu WNL	reg	reg	uniform, 1 per QRS	>0.20	WNL	SR, with a prolonged PRI.  Impulses delayed at AV node.
2nd degree, Type I	usu WNL	<atrial rate	reg	irreg	uniform, dropped QRS	increasing	WNL	Inc PRI until dropped QRS. QRS - off time
2nd degree, Type II	usu WNL	<atrial rate	reg	irreg	uniform, dropped QRS	constant	N or W	WNL or prolonged PRI. QRS - on time
2nd degree, 2:1	usu WNL	1/2 atrial rt	reg	reg	uniform, 2:1 ratio	constant	N or W	Narrow QRS 2nd, Type I & Wide QRS 2nd, Type II
3rd drgree AV Block	usu WNL	<atrial rate	reg	reg	uniform, No relation	none	N or W	Narrow QRS-junct pacer  & Wide QRS-vent pacer
								~ QRS rate depends on the pacemaker-
								Junctional origin (40-60) & ventricle origin (20-40)
~ Use the rules to rule out possible rhythms!!