Rhythm Challenge Lecture Notes

Overview

• Presentation on identifying various arrhythmias.
• 45 different types to interpret.
• Encouraged to pause and interpret before revealing answers.

Key Arrhythmias Discussed

1. Atrial Fibrillation

• Fibrillatory waves.
• Irregularly irregular arrhythmia.
• No clear P waves.

2. Sinus Rhythm with First Degree AV Block

• Consistent prolonged PR interval.

3. Third Degree AV Block

• Regular P to P and R to R intervals.
• AV disassociation.

4. Accelerated Idioventricular Rhythm

• Retrograde P waves.
• Wide QRS complexes.
• Rate ~60 bpm.

5. Monomorphic Ventricular Tachycardia

• Very fast rhythm.
• Wide QRS complexes.

6. Mobitz 1 (Second Degree Type 1 AV Block or WinkyBach)

• Prolonging PR interval until a P wave without QRS complex.

7. Mobitz 2 (Second Degree Type 2 AV Block)

• Consistent PR interval with dropped beats.

8. Junctional Tachycardia

• No P waves before QRS complex.
• Narrow QRS complex.
• Regular rhythm, >100 bpm.

9. Two to One AV Block

• Can't determine between Mobitz 1 and 2.

10. Atrial Flutter with Variable Conduction

• Sawtooth pattern.
• Variable R to R intervals.

11. Sinus Rhythm with Ventricular Bigeminy

• Alternating sinus and PVC beats.

12. Ectopic Atrial Tachycardia with Block

• 3 to 1 conduction.

13. Supraventricular Tachycardia (SVT)

• Narrow QRS complexes.
• AV nodal reentry tachycardia.

14. Polymorphic Ventricular Tachycardia (Torsades de Pointes)

• Bowtie effect.
• Prolonged QT interval often causes.

15. Multifocal Atrial Tachycardia (MAT)

• Multiple P wave morphologies.

• 100 bpm.

16. Ventricular Fibrillation (V-Fib)

• Chaotic rhythm.

17. Junctional Escape Rhythm

• Slow, narrow, and regular rhythm.

18. Sinus Tachycardia

• Increased heart rate.
• No specific treatment other than addressing underlying causes.

19. Asystole

• Flatline, absence of electrical activity.

Additional Rhythms Explored

• Sinus rhythm with artifacts.
• Wandering atrial pacemaker.
• Ventricular standstill (P waves without QRS).
• Sinus rhythm with unifocal ventricular trigeminy.

Conclusion

• Encourage review if unsure about arrhythmias.
• Additional resources: ECG course, 12 lead courses.
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