This is because junctional rhythms originate from the AV junction, which has a slower intrinsic rate than that of the SA node. If you have been following along in this series, you may be wondering why the otherwise normal heart rate of 60-100BPM is considered accelerated in this case. Accelerated junctional rhythms have an expected rate of 60-100 BPM. We know it's not a regular junctional rhythm because that inherent rate is supposed to be between 40-60 BPM, and this rate is higher at 83. If we use the small box method to calculate this heart rate shown above, we can see that there are 18 small boxes between the R waves. With this accelerated junctional EKG strip, we see that the P wave is missing, which is our clue that tells us this is junctional. Accelerated junctional rhythm Rhythm regularity (atrial and ventricular)īecause we are dealing with a regular rhythm, this enables us to use one of the standard methods for calculating heart rate. TreatmentĪgain, remember that you would NOT use digoxin in patients with junctional dysrhythmias as it is contraindicated. With these clues, we know it is a junctional rhythm.
The QRS complex is narrow (under three small boxes wide), which rules out a ventricular rhythm. The P wave in this rhythm is inverted, which is not normal. This means 33 beats per minute, which is a very slow heart rate. If we use the small box method to calculate this heart rate shown above, we can see that there are 46 small boxes between the R waves. The P waves, though they look strange, are also regular they have an equal distance between them. There are equal distances between the R waves, meaning the ventricular rhythm is regular. This rhythm is regular you can see that its movement pattern is repeated the same way across the entirety of the EKG strip. Junctional bradycardia Rhythm regularity (atrial and ventricular) Studying Pharmacology? Both atropine and digoxin are some of the key important meds covered in our Pharmacology flashcards for nursing students. Digoxin toxicity is one of the most common causes of junctional rhythms. One important tip to keep in mind is that you would NOT use digoxin in patients with junctional dysrhythmias. However, if the heart rate is too slow to maintain adequate cardiac output, then atropine can be used to increase the heart rate.
Treatment of junctional rhythms is typically not necessary. So, with all of the clues we have gathered thus far, we can fairly safely conclude that this is a junctional rhythm. The QRS complex is narrow, which rules out a ventricular rhythm. This is a clear sign we are looking at a junctional rhythm. Remember that junctional rhythms have an inherent rate between 40-60 BPM. There are approximately 34 small boxes between each R wave. In this example, we can use the small box method. So the atrial rhythm is also regular.īecause we are dealing with a regular rhythm, this enables us to use one of the standard methods for calculating heart rate. This rhythm is regular its movement pattern is repeated the same way across the entirety of the EKG strip.
Rhythm regularity (atrial and ventricular) When you encounter an EKG strip on a test, looking for those abnormal P wave conditions can help you identify a rhythm as junctional.Īll the rhythms we will explain in this article are technically junctional rhythm, but this section covers regular junctional rhythms, or junctional rhythms with the expected heart rate. The P rate will be either absent, inverted, in the wrong place, or with a very short PR interval. The key characteristic of a junctional rhythm is an abnormal P rate. The inherent rate of a junctional rhythm is slower than a normal heart rate, usually between 40 and 60 beats per minute. When the sinus node fails to kick off an electrical impulse to make the heart beat, the atrial foci are the first backup, and if that fails, the junctional foci are the next backup.
Junctional escape rhythm series#
The EKG Interpretation video series follows along with our EKG Interpretation Flashcards, which are intended to help RN and PN nursing students study for nursing school exams, including the ATI, HESI exams, and NCLEX.Īs we explained in our article on the natural pacemakers of the heart, a junctional rhythm is the secondary backup for the heart. In this article, you will learn about the different junctional dysrhythmias, including junctional rhythms, junctional bradycardia, accelerated junctional rhythms, and junctional tachycardia.
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