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EKGRefreshand Practice
Normal SinusRhythm
. Rate: 60 - 100beatsperminute
r Rhythrn: Atrial - Regular
Ventricular- Regular
o Pwaves: Uniform in appearance
Upright w/ normal shape
OnePrecedingeachQRS
Nor morethan.10 second
o PR interval: 0.12- 0.20second
r QRS: 0.10secondor less
P-Waves:
Shouldbe no morethan 2.5 mm in height,andno morethan .10^ secondin width
PRInterval:
Includesthe p-waveasit leavesthe^ baselineandendsat the^ betinningofthe QRScomplex
QRSComplex:
Measuredfrom the beginningof the QRS complex(asthe first wave^ leavesthe^ baseline)to the end^ of
the eRS complex(whenthelast wave^ beginsto level out into the ST segment).The end^ of the QRS
complexis calledthe J-Point'
Normally positive^ in lead^ II
ST Segment:
Beginswith the endof the QRS complexandendswith the onsetof the T-wave. Normally flat.
Coisideredelevatedif it is abovethe baselineanddepressedif it is below the^ baseline.^ An elevatedST
segrnentis a sign^ of myocardialinfarct.
T-Wave:
Beginsasthe deflectiongraduallyslopesupwardfrom the ST segmentand^ endswhenthe waveform
retumsto baseline. Shouldbe^ positive^ in a LeadII.
Analyzing a Rhythm StriP
o What is the rate?
o Is it regularor irregular?
o If irregular,is therea pattem^ of irregularity?
o Are thereP-waves?...are they all the same?
o If so, is the P-R interval of normal length^ andarethey all the same?
o Is thereonly oneP-Wavefor everyQRS complex?
Normal Sinus Rhythm (NSR)^
Regular 60 to 100
Positive; Rounded;Normal PR Interval; One P wave for each QRS complex
Narrow
Sinus Bradvcardia Regular^ Lessthan
Positive;Rounded;Normal PR Interval; One P wave for each QRS complex
Narrow
Sinua Tachycardia Regular^100 to 170
Positive;Rounded;NormalPR Interval;OneP wavefor each QRScomplex
Narrow
SinusBlockor SinusArrest
Regular with SuddenPause^
60 to 100
Positive; Rounded;Normal PR Interval; May seeone non- conducting P before pause
Narrow
Atrial Flutter Regular or Irregular
Atrial: 250-400: Ventricular usuallv60-
Positive; Peakedor "Sawtooth" Appearanceto Baseline;Unable to measurePR Interval
Narrow
Atrial Fibrillation Irregular
Atrial: No coordinated systole; Ventricular usuallv60-
None; Wavy deflectionsaffecting baselineas atria quiver Narrow
Junctional Rhvthm Regular 40 to 60 lnverted;May occurbefore/after ORScomplexor be^ hidden^
Narrow
Accelerated Junctional Regular 60 to 100 Inverted;May occurbefore/after QRScomplexor be^ hidden^
Narrow
Junctional Tachvcardia Regular Morethan 100 Inverted; May occur before/after QRS complex^ or be hidden^
Narrow
2" AV Block, Mobitz II
Usually Regular,May be Iregular
Atrial: Varies, Ventricular: UsuallyLess Than
Positive;Rounded;PR^ Interval for conductingbeatsis always WNL; More than I P wavefor eachQRSComplex
UsuallyNarrow
3' AV Block (CompleteHeart Block)
Atrial and Ventricular Regularbut not Corresponding
Atrial: 60 to 100, Ventricular: Usuallv20-
Positive; Rounded;Unable to MeasurePR Interval; P:QRS Ratio variable; P waves may be hidden in QRS or T waves
TypicallyWidened
Bundle Branch Block
Thatof Underlying Rhvthm
That of Underlying Rhrrthm
Positive; Rounded;Normal PR Interval; One P wave for each QRS Complex
BorderlineWide:0. 0.14sec;Usually Notched(QRR'S)
Idioventricular Rhythm GVR) Regular 20 to 40^ Absent^ Wide
AcceleratedIVR Regular 40 to 100 Absent^ Wide
L
Premature Ventricular Conntraction (PVC)
Thatof Underlying Rhythmwith Isolated Anomaly
Thatof Underlying Rhythm
That of Underlying Rhythm; No P Wave PreceedinePVC
Thatof Underlying Rhythm;PVC Wide andMay Have OppositeDeflection from Underlying Rhrrthm
