Wh en the rhythm is irregular, the rate should be evaluated by cardiac aus- Irregular rhythms include atrial fi-

cultation, because beats that occur earlier than others may not be detected brillation and atrial or ventricular peripherally and the heart rate can thus be seriously underestimated. premature contractions.

Rhythm. To begin your assessment of rhythm, feel the radial pulse. If there are any irregularities, check the rhythm again by listening with your stethoscope at the cardiac apex. Is the rhythm regular or irregular? If irregular, try to identify a pattern: (1) Do early beats appear in a basically regular rhythm? (2) Does the irregularity vary consistently with respiration? (3) Is the rhythm totally irregular?

Palpation of an irregularly irregular rhythm reliably indicates atrial fibrillation. For all other irregular patterns, an ECG is needed to identify the arrhythmia.

See Table 3-10, Selected Heart

Rates and Rhythms (p._) and

Table 3-11, Selected Irregular Rhythms (p._).

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