By Lippincott Williams & Wilkins
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Rate: Atrial and ventricular rates exceed 100 beats/minute (usually between 100 and 200 beats/minute). Atrial rate may be difficult to determine if the P wave is hidden in the QRS complex or if it precedes the T wave. • P wave: Usually inverted; it may occur before or after the QRS complex or be hidden in the QRS complex. 12 second); otherwise, the PR interval can’t be measured. • QRS complex: Duration within normal limits; usually normal configuration. indd 37 10/7/2011 4:17:59 PM RECOGNIZING CARDIAC ARRHYTHMIAS 38 • T wave: Usually normal configuration but may be abnormal if the P wave is hidden in the T wave.
Then locate the small markings at the top of the strip. Each marking represents 3 seconds. Count the number of P waves (to determine atrial rate) or R waves (to determine ventricular rate) over a 6-second time period (two 3-second markings). Multiply by 10. 1,500 method Use the 1,500 method only if the patient’s heart rhythm is regular. First, identify two consecutive P waves on the rhythm strip. Next, select identical points in each wave and count the number of small squares between the points.
With type II seconddegree AV block, you won’t see a warning on the ECG before a dropped beat. What the ECG tells you • Rhythm: The atrial rhythm is regular. The ventricular rhythm can be regular or irregular. Pauses correspond to the dropped beat. If the block is intermittent, the rhythm is often irregular; if the block stays constant (for example, 2:1 or 3:1), the rhythm is regular. • Rate: The atrial rate is usually within normal limits. The ventricular rate, slower than the atrial rate, may be within normal limits.
