By Lippincott Williams & Wilkins
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Extra resources for ACLS Review Made Incredibly Easy
Torsades may be paroxysmal, starting and stopping suddenly. Although sinus rhythm sometimes resumes spontaneously, torsades de pointes usually degenerates into ventricular fibrillation. indd 44 Torsades de pointes may start and stop suddenly. 10/7/2011 4:18:03 PM RECOGNIZING WIDE COMPLEX TACHYCARDIAS 45 What the ECG tells you • Rhythm: Atrial rhythm can’t be determined. Ventricular rhythm is regular or irregular. • Rate: Atrial rate can’t be determined. Ventricular rate is 150 to 250 beats/minute.
What the ECG tells you • Rhythm: Atrial and ventricular rhythms are regular. • Rate: The atrial rate is characterized by three or more successive ectopic atrial beats at a rate of 150 to 250 beats/minute. The rate rarely exceeds 250 beats/minute. The ventricular rate depends on the AV conduction ratio. • P wave: Usually upright, the P wave may be aberrant or hidden in the previous T wave. If visible, it precedes each QRS complex. • PR interval: May be unmeasurable if the P wave can’t be distinguished from the preceding T wave.
P wave: Normal size and configuration. • PR interval: Typically progressively longer (only slightly) with each cycle until a P wave appears without a QRS complex; the PR interval after the nonconducted beat is shorter than the interval preceding it. • QRS complex: Duration usually remains within normal limits because the block commonly lies above the bundle of His; the complex is absent periodically. • T wave: Normal size and configuration but its deflection may be opposite that of the QRS complex.