Slide 1 of 250 Next Back Close Copyright © 2011 by Mosby Inc. All rights reserved. Rhythm...

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Copyright © 2011 by Mosby Inc. All rights reserved.

Rhythm Recognition - Part 1Rhythm Recognition - Part 1

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Ventricular rate/rhythmVentricular rate/rhythm 68 bpm/regular68 bpm/regular

Atrial rate/rhythmAtrial rate/rhythm 68 bpm/regular68 bpm/regular

PR intervalPR interval 0.24 sec0.24 sec

QRS durationQRS duration 0.06 to 0.08 sec0.06 to 0.08 sec

IdentificationIdentification Sinus rhythm with first-degree Sinus rhythm with first-degree AV block, ST-segment elevationAV block, ST-segment elevation

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Ventricular rate/rhythmVentricular rate/rhythm 83 bpm (sinus beats)/ 83 bpm (sinus beats)/

Regular except for the eventRegular except for the event

Atrial rate/rhythmAtrial rate/rhythm 83 bpm (sinus beats)/ 83 bpm (sinus beats)/




IdentificationIdentification Sinus rhythm with two PJCs, Sinus rhythm with two PJCs,

ST-segment elevationST-segment elevation

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This rhythm strip is from an 83-year-old This rhythm strip is from an 83-year-old woman with syncope. woman with syncope.

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Ventricular rate/rhythmVentricular rate/rhythm 38 to 75 bpm/irregular38 to 75 bpm/irregular


PR intervalPR interval LengtheningLengthening


IdentificationIdentification Second-degree AV block, type ISecond-degree AV block, type I

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This rhythm strip is from an 82-year-old man This rhythm strip is from an 82-year-old man complaining of back pain. complaining of back pain.

Top = lead II, bottom = MCL1Top = lead II, bottom = MCL1

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Atrial rate/rhythmAtrial rate/rhythm 56 to 125 bpm/irregular56 to 125 bpm/irregular


QRS durationQRS duration 0.12 sec0.12 sec

IdentificationIdentification Sinus rhythm with a nonconducted PACSinus rhythm with a nonconducted PAC

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This rhythm strip is from an 86-year-old This rhythm strip is from an 86-year-old woman who experienced a cardiopulmonary woman who experienced a cardiopulmonary arrest. The initial rhythm was asystole. The arrest. The initial rhythm was asystole. The following rhythm resulted after IV following rhythm resulted after IV administration of epinephrine and atropine. administration of epinephrine and atropine.

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Atrial rate/rhythmAtrial rate/rhythm NoneNone

PR intervalPR interval NoneNone


IdentificationIdentification Idioventricular rhythm (IVR) Idioventricular rhythm (IVR) (ventricular escape rhythm)(ventricular escape rhythm)

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This rhythm strip is from a 69-year-old man This rhythm strip is from a 69-year-old man complaining of shortness of breath. Lung complaining of shortness of breath. Lung sounds reveal bilateral rales. Blood pressure: sounds reveal bilateral rales. Blood pressure: 160/58. 160/58.

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Regular except for the eventsRegular except for the events



PR intervalPR interval 0.20 sec (sinus beats)0.20 sec (sinus beats)

QRS durationQRS duration 0.08 sec (sinus beats)0.08 sec (sinus beats)

IdentificationIdentification Sinus tachycardia with uniform PVCsSinus tachycardia with uniform PVCs

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IdentificationIdentification Sinus rhythm with first-degree AV Sinus rhythm with first-degree AV block, ST-segment depressionblock, ST-segment depression

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Atrial rate/rhythmAtrial rate/rhythm Unable to determineUnable to determine

PR intervalPR interval Unable to determineUnable to determine


IdentificationIdentification Monomorphic ventricular tachycardiaMonomorphic ventricular tachycardia

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Ventricular rate/rhythmVentricular rate/rhythm 214 bpm (VT) to 71 bpm (atrial fib)/ 214 bpm (VT) to 71 bpm (atrial fib)/ IrregularIrregular



QRS durationQRS duration 0.12 to 0.16 sec (VT) to 0.12 to 0.16 sec (VT) to 0.06 sec 0.06 sec (atrial fib)(atrial fib)

IdentificationIdentification Monomorphic VT to atrial fibrillationMonomorphic VT to atrial fibrillation

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IdentificationIdentification Atrial flutter with ST-segment Atrial flutter with ST-segment depressiondepression

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None (junctional beats) to regular None (junctional beats) to regular (sinus beats)(sinus beats)



IdentificationIdentification Junctional bradycardia with ST-Junctional bradycardia with ST-segment depression to sinus segment depression to sinus bradycardia, inverted T wavesbradycardia, inverted T waves

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PR intervalPR interval VariesVaries


IdentificationIdentification Complete (third-degree) AV block Complete (third-degree) AV block with inverted T waveswith inverted T waves

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This rhythm strip is from a 52-year-old man This rhythm strip is from a 52-year-old man found unresponsive, apneic, and pulseless. found unresponsive, apneic, and pulseless.

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IdentificationIdentification Accelerated idioventricular rhythm Accelerated idioventricular rhythm (AIVR)(AIVR)

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Regular except for the event(s)Regular except for the event(s)





IdentificationIdentification Sinus rhythm with first-degree AV Sinus rhythm with first-degree AV block and PACsblock and PACs

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IdentificationIdentification Second-degree AV block type II Second-degree AV block type II with ST-segment depressionwith ST-segment depression

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Atrial paced activity?Atrial paced activity? YesYes

Ventricular paced activity?Ventricular paced activity? YesYes

Paced interval ratePaced interval rate 7171

IdentificationIdentification 100% paced rhythm – 100% paced rhythm – AV sequential pacemakerAV sequential pacemaker

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These rhythm strips are from a 78-year-old These rhythm strips are from a 78-year-old man complaining of shortness of breath. He man complaining of shortness of breath. He has a history of COPD, coronary artery has a history of COPD, coronary artery disease, and hypertension. disease, and hypertension.

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IdentificationIdentification Atrial fibrillation (controlled)Atrial fibrillation (controlled)

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This rhythm strip is from a 97-year-old This rhythm strip is from a 97-year-old woman after a fall. woman after a fall.

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IdentificationIdentification Sinus rhythm with first-degree AV Sinus rhythm with first-degree AV block, ST-segment depressionblock, ST-segment depression

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This rhythm strip is from a 70-year-old man This rhythm strip is from a 70-year-old man complaining of a sharp pain across his complaining of a sharp pain across his shoulders. Blood pressure: 218/86. shoulders. Blood pressure: 218/86.

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Ventricular rate/rhythmVentricular rate/rhythm 115 bpm (sinus beats)/115 bpm (sinus beats)/


Atrial rate/rhythmAtrial rate/rhythm 115 bpm (sinus beats)/115 bpm (sinus beats)/





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This rhythm strip is from a 76-year-old man This rhythm strip is from a 76-year-old man complaining of indigestion. complaining of indigestion.

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IdentificationIdentification Junctional bradycardia with Junctional bradycardia with ST-segment depression and ST-segment depression and inverted T wavesinverted T waves

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This rhythm strip is from an 80-year-old This rhythm strip is from an 80-year-old woman complaining of weakness. woman complaining of weakness.

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Atrial paced activity?Atrial paced activity? NoNo



IdentificationIdentification 100% ventricular paced rhythm100% ventricular paced rhythm

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Regular except for the event (every Regular except for the event (every other beat is an ectopic beat)other beat is an ectopic beat)




QRS durationQRS duration 0.08 to 0.10 sec (sinus beats)0.08 to 0.10 sec (sinus beats)

IdentificationIdentification Sinus bradycardia with ventricular Sinus bradycardia with ventricular bigeminybigeminy

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This rhythm strip is from a 90-year-old woman This rhythm strip is from a 90-year-old woman complaining of hip pain after a fall. complaining of hip pain after a fall.

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IdentificationIdentification Sinus rhythm with Sinus rhythm with ST-segment depressionST-segment depression

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This rhythm strip is from an 86-year-old This rhythm strip is from an 86-year-old woman complaining of chest pain that she woman complaining of chest pain that she rates a 4 on a scale of 0 to 10. Blood rates a 4 on a scale of 0 to 10. Blood pressure: 142/72. pressure: 142/72.

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IdentificationIdentification Sinus rhythmSinus rhythm

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This rhythm strip is from a 78-year-old man This rhythm strip is from a 78-year-old man complaining of palpitations. Note the point at complaining of palpitations. Note the point at which the patient was defibrillated. which the patient was defibrillated.

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Ventricular rate/rhythmVentricular rate/rhythm 63 to 79 bpm (sinus beats)/ 63 to 79 bpm (sinus beats)/ Irregular (sinus beats)Irregular (sinus beats)

Atrial rate/rhythmAtrial rate/rhythm 63 to 79 bpm (sinus beats)/ 63 to 79 bpm (sinus beats)/ Irregular (sinus beats)Irregular (sinus beats)



IdentificationIdentification Monomorphic ventricular Monomorphic ventricular tachycardia – shock – ventricular tachycardia – shock – ventricular beats – sinus arrhythmiabeats – sinus arrhythmia

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Ventricular rate/rhythmVentricular rate/rhythm 68 bpm /68 bpm /


Atrial rate/rhythmAtrial rate/rhythm 68 bpm / 68 bpm /




IdentificationIdentification Sinus rhythm with uniform PVCsSinus rhythm with uniform PVCs

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Atrial rate/rhythmAtrial rate/rhythm 115 bpm / 115 bpm /




IdentificationIdentification Sinus tachycardia with PACsSinus tachycardia with PACs

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This rhythm strip is from a 3-month-old This rhythm strip is from a 3-month-old infant who had an altered level of infant who had an altered level of responsiveness. She was limp with a responsiveness. She was limp with a respiratory rate of 4 breaths/min. Blood respiratory rate of 4 breaths/min. Blood sugar was 174. sugar was 174.

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PR intervalPR interval 0.12 to 0.16 sec0.12 to 0.16 sec


IdentificationIdentification Sinus tachycardia with an Sinus tachycardia with an interpolated PVCinterpolated PVC

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This rhythm strip is from an 83-year-old man This rhythm strip is from an 83-year-old man complaining of chest pain. He had a new complaining of chest pain. He had a new pacemaker implanted 5 days ago. His blood pacemaker implanted 5 days ago. His blood pressure is 148/60. pressure is 148/60.

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This rhythm strip is from a 52-year-old man This rhythm strip is from a 52-year-old man with substernal chest pain. He has a history with substernal chest pain. He has a history of COPD and mitral valve regurgitation. Blood of COPD and mitral valve regurgitation. Blood pressure: 140/78. pressure: 140/78.

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IdentificationIdentification Sinus rhythm with ST-segment Sinus rhythm with ST-segment depressiondepression

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IdentificationIdentification 2:1 AV block, probably type I2:1 AV block, probably type I

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PR intervalPR interval LengthensLengthens


IdentificationIdentification Second-degree AV block, type ISecond-degree AV block, type I

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IdentificationIdentification Accelerated junctional rhythmAccelerated junctional rhythm

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Ventricular rate/rhythmVentricular rate/rhythm NoneNone



QRS durationQRS duration NoneNone

IdentificationIdentification AsystoleAsystole

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These rhythm strips are from a 46-year-old These rhythm strips are from a 46-year-old woman complaining of abdominal pain. woman complaining of abdominal pain.

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This rhythm strip is from a 61-year-old man This rhythm strip is from a 61-year-old man with a history of heart failure. with a history of heart failure.

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Ventricular rate/rhythmVentricular rate/rhythm 65 to 75 bpm (sinus beats)/Irregular65 to 75 bpm (sinus beats)/Irregular

Atrial rate/rhythmAtrial rate/rhythm 65 to 75 bpm (sinus beats)/Irregular65 to 75 bpm (sinus beats)/Irregular



IdentificationIdentification Sinus rhythm with first-degree AV Sinus rhythm with first-degree AV block, wide QRS (bundle branch block, wide QRS (bundle branch block), multiform PVCs, and ST-block), multiform PVCs, and ST-segment elevationsegment elevation

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This rhythm strip is from a 1-month-old infant This rhythm strip is from a 1-month-old infant after a 3-minute seizure. after a 3-minute seizure.

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IdentificationIdentification Sinus tachycardiaSinus tachycardia

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IdentificationIdentification Complete (third-degree) AV blockComplete (third-degree) AV block

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This rhythm strip is from a 72-year-old man This rhythm strip is from a 72-year-old man complaining of chest pain. complaining of chest pain.

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This rhythm strip is from a 77-year-old woman This rhythm strip is from a 77-year-old woman with a congested cough. with a congested cough.

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IdentificationIdentification Atrial fibrillation (uncontrolled)Atrial fibrillation (uncontrolled)

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Ventricular Ventricular rate/rhythmrate/rhythm

30 bpm (junctional beats) to 56 bpm (sinus beats)/ 30 bpm (junctional beats) to 56 bpm (sinus beats)/

Irregular (junctional beats) to regular (sinus beats)Irregular (junctional beats) to regular (sinus beats)

Atrial rate/rhythmAtrial rate/rhythm None (junctional beats) to 56 bpm (sinus beats)/ None (junctional beats) to 56 bpm (sinus beats)/

None (junctional beats) to regular (sinus beats)None (junctional beats) to regular (sinus beats)

PR intervalPR interval None (junctional beats) to 0.18 (sinus beats)None (junctional beats) to 0.18 (sinus beats)

QRS durationQRS duration 0.04 sec (junctional beats) to 0.08 (sinus beats)0.04 sec (junctional beats) to 0.08 (sinus beats)

IdentificationIdentification Junctional bradycardia to sinus bradycardiaJunctional bradycardia to sinus bradycardia

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Ventricular rate/rhythmVentricular rate/rhythm 83 bpm (sinus beats)/regular83 bpm (sinus beats)/regular

Atrial rate/rhythmAtrial rate/rhythm 83 bpm (sinus beats)/regular83 bpm (sinus beats)/regular



IdentificationIdentification Atrial flutter to sinus rhythmAtrial flutter to sinus rhythm

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This rhythm strip is from a 54-year-old man This rhythm strip is from a 54-year-old man who had a syncopal episode. who had a syncopal episode.

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IdentificationIdentification Sinus bradycardiaSinus bradycardia

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This rhythm strip is from a 66-year-old man This rhythm strip is from a 66-year-old man complaining of chest pain. Blood pressure: complaining of chest pain. Blood pressure: 170/96. 170/96.

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IdentificationIdentification Sinus tachycardia with Sinus tachycardia with

first-degree AV blockfirst-degree AV block

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This rhythm strip is from a 43-year-old woman This rhythm strip is from a 43-year-old woman complaining of palpitations. complaining of palpitations.

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IdentificationIdentification Narrow-QRS tachycardiaNarrow-QRS tachycardia

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A 43-year-old woman is complaining of palpitations. A 43-year-old woman is complaining of palpitations. The patient has a history of SVT and states she The patient has a history of SVT and states she cannot tolerate adenosine. The following rhythm is cannot tolerate adenosine. The following rhythm is observed on the cardiac monitor after diltiazem observed on the cardiac monitor after diltiazem

administration.administration.

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Ventricular rate/rhythmVentricular rate/rhythm 187 bpm (atrial beats)/ 187 bpm (atrial beats)/

Regular (atrial beats)Regular (atrial beats)



QRS durationQRS duration 0.08 sec (atrial beats)0.08 sec (atrial beats)

IdentificationIdentification Junctional to sinus Junctional to sinus to narrow-QRS tachycardiato narrow-QRS tachycardia

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Ventricular rate/rhythmVentricular rate/rhythm Unable to determineUnable to determine



QRS durationQRS duration Unable to determineUnable to determine

IdentificationIdentification Ventricular fibrillation (coarse)Ventricular fibrillation (coarse)

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IdentificationIdentification Sinus bradycardia with first-degree Sinus bradycardia with first-degree AV block, wide-QRS (probable AV block, wide-QRS (probable bundle branch block), bundle branch block), ST-segment depressionST-segment depression

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This rhythm strip is from a 76-year-old woman This rhythm strip is from a 76-year-old woman complaining of back pain. Her medical history complaining of back pain. Her medical history includes a myocardial infarction 2 years ago. includes a myocardial infarction 2 years ago.

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This rhythm strip is from an 80-year-old man This rhythm strip is from an 80-year-old man found sitting in a chair. He is unresponsive, found sitting in a chair. He is unresponsive, apneic, and pulseless. apneic, and pulseless.

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IdentificationIdentification Asystole – the electrical activity Asystole – the electrical activity shown is caused by pacemaker shown is caused by pacemaker spikes from the patient’s spikes from the patient’s permanent pacemaker (no permanent pacemaker (no capture)capture)

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This rhythm strip is from an 88-year-old This rhythm strip is from an 88-year-old woman complaining of hip pain after a fall woman complaining of hip pain after a fall injury. injury.

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IdentificationIdentification Atrial fibrillationAtrial fibrillation

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IdentificationIdentification Second-degree AV block type I Second-degree AV block type I with a ventricular complexwith a ventricular complex

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Ventricular rate/rhythmVentricular rate/rhythm 48 bpm (junctional beats)/regular48 bpm (junctional beats)/regular

Atrial rate/rhythmAtrial rate/rhythm Unable to determine (junctional beats)Unable to determine (junctional beats)

PR intervalPR interval Unable to determine (junctional beats)Unable to determine (junctional beats)


IdentificationIdentification Sinus bradycardia with a first-degree Sinus bradycardia with a first-degree AV block to junctional escape rhythmAV block to junctional escape rhythm

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This rhythm strip is from a 67-year-old woman This rhythm strip is from a 67-year-old woman found unresponsive on the side of the road. found unresponsive on the side of the road. Outdoor temperature is 112°F. Blood Outdoor temperature is 112°F. Blood pressure: 238/110, respiratory rate: 60/min. pressure: 238/110, respiratory rate: 60/min.

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IdentificationIdentification Sinus tachycardia with Sinus tachycardia with

ST-segment depressionST-segment depression

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This rhythm strip is from an 84-year-old man This rhythm strip is from an 84-year-old man complaining of dizziness. He had a triple complaining of dizziness. He had a triple bypass 4 days ago. bypass 4 days ago.

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IdentificationIdentification Sinus rhythm with ventricular Sinus rhythm with ventricular bigeminy, ST-segment depressionbigeminy, ST-segment depression

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This rhythm strip is from an 81-year-old This rhythm strip is from an 81-year-old woman with an altered level of woman with an altered level of responsiveness. Blood pressure: 160/70, responsiveness. Blood pressure: 160/70, blood sugar: 114. blood sugar: 114.

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IdentificationIdentification Sinus bradycardia with Sinus bradycardia with

first-degree AV blockfirst-degree AV block

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This rhythm strip is from a 80-year-old woman who This rhythm strip is from a 80-year-old woman who was playing Bingo when she felt dizzy and slumped was playing Bingo when she felt dizzy and slumped over in her chair. Bystanders state she was over in her chair. Bystanders state she was unresponsive for approximately 5 minutes. A pulse is unresponsive for approximately 5 minutes. A pulse is present. present.

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This rhythm strip is from a 91-year-old woman This rhythm strip is from a 91-year-old woman complaining of chest pain and difficulty complaining of chest pain and difficulty breathing. breathing.

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IdentificationIdentification Atrial fibrillation with Atrial fibrillation with

ST-segment elevationST-segment elevation

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This rhythm strip is from an 85-year-old This rhythm strip is from an 85-year-old woman complaining of numbness in her legs. woman complaining of numbness in her legs.

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IdentificationIdentification Sinus bradycardiaSinus bradycardia

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This rhythm strip is from a 59-year-old woman This rhythm strip is from a 59-year-old woman who complained of sudden weakness in her who complained of sudden weakness in her legs and fell to the floor in her kitchen. legs and fell to the floor in her kitchen.

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IdentificationIdentification Atrial fibrillation (controlled) Atrial fibrillation (controlled) with ST-segment elevationwith ST-segment elevation

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This rhythm strip is from an 82-year-old This rhythm strip is from an 82-year-old woman with vomiting x 2 days. woman with vomiting x 2 days.

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This rhythm strip is from a 62-year-old woman This rhythm strip is from a 62-year-old woman complaining of chest pain. Her blood complaining of chest pain. Her blood pressure is 146/104, respirations are 20. pressure is 146/104, respirations are 20. Breath sounds are clear. Breath sounds are clear.

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IdentificationIdentification Narrow-QRS tachycardia (SVT) Narrow-QRS tachycardia (SVT) with ST-segment depressionwith ST-segment depression

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This rhythm strip is from a 6-year-old boy This rhythm strip is from a 6-year-old boy immediately after a seizure. immediately after a seizure.

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IdentificationIdentification Sinus arrhythmiaSinus arrhythmia

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This rhythm strip is from a 76-year-old man This rhythm strip is from a 76-year-old man who was playing golf and experienced a who was playing golf and experienced a syncopal episode. syncopal episode.

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IdentificationIdentification Sinus rhythm with ST-segment Sinus rhythm with ST-segment elevationelevation

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These rhythm strips are from a 44-year-old These rhythm strips are from a 44-year-old woman complaining of chest pain. woman complaining of chest pain.

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IdentificationIdentification Monomorphic ventricular Monomorphic ventricular tachycardiatachycardia

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IdentificationIdentification Complete (third-degree) AV block Complete (third-degree) AV block with ST-segment elevationwith ST-segment elevation

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This rhythm strip is from an 81-year-old This rhythm strip is from an 81-year-old woman complaining of chest pain. woman complaining of chest pain.

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This rhythm strip is from a 74-year-old woman This rhythm strip is from a 74-year-old woman complaining of weakness. complaining of weakness.

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IdentificationIdentification Ventricular demand pacemakerVentricular demand pacemaker

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IdentificationIdentification Atrial flutterAtrial flutter

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ventricular bigeminyventricular bigeminy

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These rhythm strips are from a 63-year-old woman These rhythm strips are from a 63-year-old woman who experienced a syncopal episode. Blood who experienced a syncopal episode. Blood pressure is 200/90, blood sugar is 98. pressure is 200/90, blood sugar is 98.

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This rhythm strip is from an 84-year-old This rhythm strip is from an 84-year-old woman with a nosebleed. Blood pressure: woman with a nosebleed. Blood pressure: 250/74. 250/74.

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IdentificationIdentification Sinus rhythmSinus rhythm

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This rhythm strip is from a 79-year-old man This rhythm strip is from a 79-year-old man complaining of palpitations. His initial blood complaining of palpitations. His initial blood pressure was 112/84. His second blood pressure was 112/84. His second blood pressure, 8 minutes after the first, was 78/P. pressure, 8 minutes after the first, was 78/P.

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IdentificationIdentification Narrow-QRS tachycardia (SVT)Narrow-QRS tachycardia (SVT)with ST-segment depressionwith ST-segment depression

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This rhythm strip is from an 80-year-old man This rhythm strip is from an 80-year-old man complaining of weakness and dizziness. complaining of weakness and dizziness. Blood pressure is 160/98, blood sugar is 88. Blood pressure is 160/98, blood sugar is 88.

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IdentificationIdentification Second-degree AV block type IISecond-degree AV block type II

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This rhythm strip is from a 58-year-old man This rhythm strip is from a 58-year-old man with chest pain that he rates as a 2 on a scale with chest pain that he rates as a 2 on a scale of 0 to 10. He states he recently began taking of 0 to 10. He states he recently began taking pills for weight control. pills for weight control.

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IdentificationIdentification Sinus rhythm with uniform PVCs, Sinus rhythm with uniform PVCs, ST-segment depressionST-segment depression

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This rhythm strip is from a 60-year-old woman This rhythm strip is from a 60-year-old woman complaining of palpitations and shortness of complaining of palpitations and shortness of breath. breath.

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IdentificationIdentification Atrial fibrillation with a rapid Atrial fibrillation with a rapid ventricular response (RVR)ventricular response (RVR)

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This rhythm strip is from a 60-year-old woman This rhythm strip is from a 60-year-old woman complaining of palpitations and shortness of complaining of palpitations and shortness of breath after administration of adenosine 6 mg breath after administration of adenosine 6 mg IV. IV.

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This rhythm strip is from a 60-year-old woman This rhythm strip is from a 60-year-old woman complaining of palpitations and shortness of complaining of palpitations and shortness of breath 1 minute after administration of breath 1 minute after administration of adenosine 12 mg IV. adenosine 12 mg IV.

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This rhythm strip is from a 60-year-old woman This rhythm strip is from a 60-year-old woman complaining of palpitations and shortness of complaining of palpitations and shortness of breath two minutes after administration of breath two minutes after administration of adenosine 6 mg IV. adenosine 6 mg IV.

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IdentificationIdentification Atrial fibrillation with a rapid Atrial fibrillation with a rapid ventricular response (RVR)ventricular response (RVR)

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Ventricular rate/rhythmVentricular rate/rhythm 30 bpm (junctional beats)/irregular30 bpm (junctional beats)/irregular

Atrial rate/rhythmAtrial rate/rhythm None (junctional beats)/irregularNone (junctional beats)/irregular



IdentificationIdentification Sinus beat - two junctional beats - Sinus beat - two junctional beats - sinus beat; ST-segment depressionsinus beat; ST-segment depression

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This rhythm strip is from a 90-year-old woman This rhythm strip is from a 90-year-old woman with shortness of breath. with shortness of breath.

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PR intervalPR interval 0.16 to 0.18 sec (sinus beats)0.16 to 0.18 sec (sinus beats)



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Ventricular rate/rhythmVentricular rate/rhythm 100 bpm (sinus beats) to 150 bpm 100 bpm (sinus beats) to 150 bpm (VT)/Regular(VT)/Regular

Atrial rate/rhythmAtrial rate/rhythm 100 bpm (sinus beats)/100 bpm (sinus beats)/

Regular to unable to determineRegular to unable to determine



IdentificationIdentification Sinus rhythm with first-degree AV Sinus rhythm with first-degree AV block to monomorphic ventricular block to monomorphic ventricular tachycardia (VT)tachycardia (VT)

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IdentificationIdentification Complete (third-degree) AV block Complete (third-degree) AV block with ST-segment elevationwith ST-segment elevation

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IdentificationIdentification P-wave asystoleP-wave asystole

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This rhythm strip is from a 74-year-old woman This rhythm strip is from a 74-year-old woman with chest pain. Blood pressure: 192/90. She with chest pain. Blood pressure: 192/90. She rates her pain as a 9 on a scale of 0 to 10. rates her pain as a 9 on a scale of 0 to 10.

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Ventricular rate/rhythmVentricular rate/rhythm 91 bpm/91 bpm/


Atrial rate/rhythmAtrial rate/rhythm 91 bpm/91 bpm/




IdentificationIdentification Sinus rhythm with a nonconducted PACSinus rhythm with a nonconducted PAC

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NoteNote U waves are present U waves are present

(they follow the T waves)(they follow the T waves)



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This rhythm strip is from a 97-year-old man This rhythm strip is from a 97-year-old man with chest pain. with chest pain.

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Atrial paced activity?Atrial paced activity? YesYes



IdentificationIdentification AV sequential pacemaker with AV sequential pacemaker with failure to capturefailure to capture

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This rhythm strip is from an 85-year-old This rhythm strip is from an 85-year-old woman with an altered level of woman with an altered level of responsiveness. Blood pressure: 136/78, responsiveness. Blood pressure: 136/78, blood sugar is 96. blood sugar is 96.

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IdentificationIdentification Sinus tachycardia with a PVC and Sinus tachycardia with a PVC and a ventricular coupleta ventricular couplet

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This rhythm strip is from an 88-year-old man This rhythm strip is from an 88-year-old man complaining of chest pain that he rates as a 6 complaining of chest pain that he rates as a 6 on a scale of 0 to 10. Blood pressure: 170/80. on a scale of 0 to 10. Blood pressure: 170/80.

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IdentificationIdentification Sinus tachycardia with PACsSinus tachycardia with PACs

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Ventricular rate/rhythmVentricular rate/rhythm 29 bpm/essentially regular29 bpm/essentially regular




IdentificationIdentification Junctional bradycardia Junctional bradycardia with ST-segment depressionwith ST-segment depression

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Ventricular rate/rhythmVentricular rate/rhythm 88 bpm/regular 88 bpm/regular

Atrial rate/rhythmAtrial rate/rhythm 88 bpm/regular 88 bpm/regular

PR intervalPR interval 0.28 sec 0.28 sec

QRS durationQRS duration 0.08 sec 0.08 sec

IdentificationIdentification Sinus rhythm at 88 bpm with first-Sinus rhythm at 88 bpm with first-degree AV block; ST-segment degree AV block; ST-segment elevation elevation

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Rhythm Recognition - Part 1Rhythm Recognition - Part 1 This rhythm strip is from a 44-year-old construction This rhythm strip is from a 44-year-old construction

worker with a sudden onset of chest pressure. worker with a sudden onset of chest pressure.

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IdentificationIdentification Sinus arrhythmia at 52 to 94 bpmSinus arrhythmia at 52 to 94 bpm

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Atrial pacing?Atrial pacing? NoNo

Ventricular pacing?Ventricular pacing? YesYes

Paced intervalPaced interval 8080

IdentificationIdentification Ventricular-paced rhythm with Ventricular-paced rhythm with pacemaker malfunction pacemaker malfunction

(failure to capture)(failure to capture)

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Rhythm Recognition - Part 1Rhythm Recognition - Part 1 This rhythm strip is from an 82-year-old man This rhythm strip is from an 82-year-old man

complaining of back pain. complaining of back pain. Top = lead II, bottom = MCL1.Top = lead II, bottom = MCL1.

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QRS durationQRS duration 0.120.12

IdentificationIdentification Sinus rhythm at 41 to 73 bpm Sinus rhythm at 41 to 73 bpm with a nonconducted PACwith a nonconducted PAC

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Ventricular rate/rhythmVentricular rate/rhythm 78 bpm/regular except for the event 78 bpm/regular except for the event

Atrial rate/rhythmAtrial rate/rhythm 78 bpm/regular except for the event 78 bpm/regular except for the event



IdentificationIdentification Sinus rhythm at 78 bpm with a PAC, ST-Sinus rhythm at 78 bpm with a PAC, ST-segment elevation (PAC is the third segment elevation (PAC is the third

complex from left)complex from left)

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IdentificationIdentification Junctional rhythm at 44 bpm; ST-Junctional rhythm at 44 bpm; ST-segment elevationsegment elevation

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Ventricular rate/rhythmVentricular rate/rhythm 115 bpm (sinus beats)/regular 115 bpm (sinus beats)/regular except for the event except for the event

Atrial rate/rhythmAtrial rate/rhythm 115 bpm (sinus beats)/regular 115 bpm (sinus beats)/regular except for the event except for the event



IdentificationIdentification Sinus tachycardia at 115 bpm with Sinus tachycardia at 115 bpm with a PJC (fifth beat is the PJC)a PJC (fifth beat is the PJC)

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Rhythm Recognition - Part 1Rhythm Recognition - Part 1 This rhythm strip is from an 82-year-old man This rhythm strip is from an 82-year-old man

complaining of chest pain.complaining of chest pain.

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IdentificationIdentification Monomorphic ventricular Monomorphic ventricular tachycardia at 245 bpmtachycardia at 245 bpm

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Ventricular rate/rhythmVentricular rate/rhythm 21 bpm/irregular21 bpm/irregular

Atrial rate/rhythmAtrial rate/rhythm 21 bpm/irregular21 bpm/irregular



IdentificationIdentification Sinus bradycardia at 21 Sinus bradycardia at 21 bpm with junctional escape bpm with junctional escape

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48 to 83 bpm/irregular48 to 83 bpm/irregular

Atrial rate/rhythmAtrial rate/rhythm 167 bpm/regular 167 bpm/regular



IdentificationIdentification Second-degree AV block type II Second-degree AV block type II at 48 to 83 bpm; ST-segment at 48 to 83 bpm; ST-segment depressiondepression

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Atrial rate/rhythmAtrial rate/rhythm Unable to determine/irregularUnable to determine/irregular



IdentificationIdentification Multifocal atrial tachycardia Multifocal atrial tachycardia at 115 to 215 bpm with ST-at 115 to 215 bpm with ST-segment depressionsegment depression

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Ventricular rate/rhythmVentricular rate/rhythm 71 bpm, regular71 bpm, regular

Atrial rate/rhythmAtrial rate/rhythm 71 bpm, regular71 bpm, regular



IdentificationIdentification Sinus rhythm at 71 bpm with a wide QRS, Sinus rhythm at 71 bpm with a wide QRS,


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94 bpm (sinus beats)/irregular 94 bpm (sinus beats)/irregular

Atrial rate/rhythmAtrial rate/rhythm 94 bpm (sinus beats)/irregular 94 bpm (sinus beats)/irregular

PR intervalPR interval 0.16 sec (sinus beats) 0.16 sec (sinus beats)

QRS durationQRS duration 0.08 sec (sinus beats) 0.08 sec (sinus beats)

IdentificationIdentification Sinus rhythm with an episode of Sinus rhythm with an episode of couplets and a run of VT couplets and a run of VT

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Rhythm Recognition - Part 1Rhythm Recognition - Part 1 This rhythm strip is from a 73-year-old man complaining of chest pain. History of hypertension and lung disease. Medications include aspirin, albuterol, and Lotensin.

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IdentificationIdentification Sinus bradycardia at 44 bpm, ST-segment Sinus bradycardia at 44 bpm, ST-segment depression. Note the upright U waves depression. Note the upright U waves following each T wave. following each T wave.

U wave

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60 to 98 bpm/irregular60 to 98 bpm/irregular




IdentificationIdentification Second-degree AV block type I at Second-degree AV block type I at 68 to 90 bpm; ST-segment 68 to 90 bpm; ST-segment depressiondepression

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Rhythm Recognition - Part 1Rhythm Recognition - Part 1 This rhythm strip is from a 69-year-old man who is This rhythm strip is from a 69-year-old man who is

disoriented. He knows his name but has no idea disoriented. He knows his name but has no idea where he is or how he got there. BP: 172/98, R: 20. where he is or how he got there. BP: 172/98, R: 20. Blood sugar: 127 mg/dL.Blood sugar: 127 mg/dL.

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IdentificationIdentification Sinus rhythm at 79 bpmSinus rhythm at 79 bpm

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Rhythm Recognition - Part 1Rhythm Recognition - Part 1 This rhythm strip is from a 35-year-old woman This rhythm strip is from a 35-year-old woman

complaining of chest pain and palpitations. complaining of chest pain and palpitations.

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PR intervalPR interval Unable to determine Unable to determine


IdentificationIdentification Narrow-QRS tachycardia (AVNRT) Narrow-QRS tachycardia (AVNRT) with ST-segment depressionwith ST-segment depression

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Ventricular rate/rhythmVentricular rate/rhythm 64 bpm (sinus beats)/regular except for 64 bpm (sinus beats)/regular except for the event the event

Atrial rate/rhythmAtrial rate/rhythm 64 bpm (sinus beats)/regular except for 64 bpm (sinus beats)/regular except for the event the event



IdentificationIdentification Sinus rhythm with an episode of sinus Sinus rhythm with an episode of sinus arrest and a junctional escape beatarrest and a junctional escape beat

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Rhythm Recognition - Part 1Rhythm Recognition - Part 1 This rhythm strip is from an 82-year-old man complaining of back pain.

Lead II

Lead MCL1

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Ventricular rate/rhythmVentricular rate/rhythm 75 bpm/regular except for event 75 bpm/regular except for event

Atrial rate/rhythmAtrial rate/rhythm 75 bpm/regular except for event 75 bpm/regular except for event



IdentificationIdentification Sinus rhythm at 75 bpm with a wide QRS Sinus rhythm at 75 bpm with a wide QRS and a nonconducted PACand a nonconducted PAC

Lead II

Lead MCL1

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Rhythm Recognition - Part 1Rhythm Recognition - Part 1 This rhythm strip is from a 51-year-old man This rhythm strip is from a 51-year-old man

complaining of dull chest pain that began about 2 complaining of dull chest pain that began about 2 hours ago. He rates his discomfort as a 6 on a scale hours ago. He rates his discomfort as a 6 on a scale of 1 to 10. BP: 70/48, R: 24. His skin is cool, pale, of 1 to 10. BP: 70/48, R: 24. His skin is cool, pale, and diaphoretic.and diaphoretic.

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Atrial rate/rhythmAtrial rate/rhythm 71 bpm/slightly irregular71 bpm/slightly irregular



IdentificationIdentification Complete AV block at 48 bpm Complete AV block at 48 bpm with ST-segment elevationwith ST-segment elevation

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250 to 333 bpm/irregular 250 to 333 bpm/irregular

Atrial rate/rhythmAtrial rate/rhythm Unable to determine Unable to determine



IdentificationIdentification Polymorphic VT at 250 to Polymorphic VT at 250 to 333 bpm333 bpm

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Atrial pacing?Atrial pacing? NoNo

Ventricular Ventricular pacing?pacing?

YesYes

Paced intervalPaced interval 7474

IdentificationIdentification 100% ventricular paced rhythm 100% ventricular paced rhythm

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Rhythm Recognition - Part 1Rhythm Recognition - Part 1 These rhythm strips are from a 78-year-old man complaining of shortness of breath. He has a history of COPD, coronary artery disease, and hypertension.

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55-94 bpm/irregular55-94 bpm/irregular

Atrial rate/rhythmAtrial rate/rhythm Unable to determine Unable to determine



IdentificationIdentification Controlled atrial fibrillation at 55-94 bpm Controlled atrial fibrillation at 55-94 bpm

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50 bpm/regular 50 bpm/regular



QRS durationQRS duration 0.06 sec 0.06 sec

IdentificationIdentification Third-degree AV block at 50 Third-degree AV block at 50 bpm; ST-segment elevation bpm; ST-segment elevation

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Rhythm Recognition - Part 1Rhythm Recognition - Part 1 This rhythm strip is from a 1-year-old girl. Mom says This rhythm strip is from a 1-year-old girl. Mom says

the infant suddenly went limp and her limbs began the infant suddenly went limp and her limbs began shaking. The episode lasted about 45 sec. Her shaking. The episode lasted about 45 sec. Her temperature is normal. temperature is normal.

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IdentificationIdentification Sinus tachycardia at 215 bpmSinus tachycardia at 215 bpm

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