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Copyright © 2006 by Mosby Inc. All rights reserved. Chapter 4 Practice Rhythms Strips.

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1 Copyright © 2006 by Mosby Inc. All rights reserved. Chapter 4 Practice Rhythms Strips

2 Copyright © 2006 by Mosby Inc. All rights reserved. Figure 4-23 This rhythm strip is from at 35-year-old woman complaining of chest pain and palpitations. This rhythm strip is from at 35-year-old woman complaining of chest pain and palpitations. Ventricular rate/rhythm Atrial rate/rhythm PR interval QRS duration Identification

3 Copyright © 2006 by Mosby Inc. All rights reserved. Figure 4-23 This rhythm strip is from at 35-year-old woman complaining of chest pain and palpitations. This rhythm strip is from at 35-year-old woman complaining of chest pain and palpitations. Ventricular rate/rhythm 188/min, regular Atrial rate/rhythm Unable to determine PR interval Unable to determine QRS duration 0.06 sec Identification Narrow-QRS tachycardia (AVNRT) with ST-segment depression

4 Copyright © 2006 by Mosby Inc. All rights reserved. Figure 4-24 Ventricular rate/rhythm Atrial rate/rhythm PR interval QRS duration Identification

5 Copyright © 2006 by Mosby Inc. All rights reserved. Figure 4-24 Ventricular rate/rhythm 83 (sinus beats) / regular except for events Atrial rate/rhythm 83 (sinus beats) / regular except for events PR interval 0.16 sec QRS duration sec Identification Sinus rhythm at 83 bpm with frequent PACs (atrial bigeminy), ST-segment depression, inverted T waves

6 Copyright © 2006 by Mosby Inc. All rights reserved. Figure 4-25 Ventricular rate/rhythm Atrial rate/rhythm PR interval QRS duration Identification

7 Copyright © 2006 by Mosby Inc. All rights reserved. Figure 4-25 Ventricular rate/rhythm 98 bpm/ regular Atrial rate/rhythm 98 bpm/ regular PR interval 0.16 sec QRS duration sec Identification Sinus rhythm at 98 bpm; ST-segment elevation

8 Copyright © 2006 by Mosby Inc. All rights reserved. Figure 4-26 Ventricular rate/rhythm Atrial rate/rhythm PR interval QRS duration Identification This rhythm strip is from a 96-year-old man complaining of chest pain and palpitations. Medications include Lanoxin and Coumadin.

9 Copyright © 2006 by Mosby Inc. All rights reserved. Figure 4-26 Ventricular rate/rhythm /min / irregular Atrial rate/rhythm Unable to determine PR interval Unable to determine QRS duration 0.08 second Identification Atrial fibrillation at bpm This rhythm strip is from a 96-year-old man complaining of chest pain and palpitations. Medications include Lanoxin and Coumadin.

10 Copyright © 2006 by Mosby Inc. All rights reserved. Figure 4-27 Ventricular rate/rhythm Atrial rate/rhythm PR interval QRS duration Identification

11 Copyright © 2006 by Mosby Inc. All rights reserved. Figure 4-27 Ventricular rate/rhythm 93/min / regular except for the event Atrial rate/rhythm 93/min / regular except for the event PR interval 0.16 sec QRS duration 0.04 sec Identification Sinus rhythm at 93 bpm with a PAC

12 Copyright © 2006 by Mosby Inc. All rights reserved. Figure 4-28 Ventricular rate/rhythm Atrial rate/rhythm PR interval QRS duration Identification This rhythm strip is from a 57-year-old man with no cardiac history.

13 Copyright © 2006 by Mosby Inc. All rights reserved. Figure 4-28 Ventricular rate/rhythm 111 bpm / regular except for event Atrial rate/rhythm 111 bpm / regular except for event PR interval 0.18 second QRS duration 0.08 sec Identification Sinus tachycardia at 111 bpm with a nonconducted PAC This rhythm strip is from a 57-year-old man with no cardiac history.

14 Copyright © 2006 by Mosby Inc. All rights reserved. Figure 4-29 Ventricular rate/rhythm Atrial rate/rhythm PR interval QRS duration Identification This rhythm strip is from a 74-year-old woman with difficulty breathing.

15 Copyright © 2006 by Mosby Inc. All rights reserved. Figure 4-29 Ventricular rate/rhythm /min / irregular Atrial rate/rhythm Unable to determine PR interval Unable to determine QRS duration 0.08 sec Identification Atrial flutter at /min This rhythm strip is from a 74-year-old woman with difficulty breathing.

16 Copyright © 2006 by Mosby Inc. All rights reserved. Figure 4-30 Ventricular rate/rhythm Atrial rate/rhythm PR interval QRS duration Identification This rhythm strip is from a 71-year-old man complaining of shoulder pain that has been present for 3 weeks.

17 Copyright © 2006 by Mosby Inc. All rights reserved. Figure 4-30 Ventricular rate/rhythm 115/min / regular except for events Atrial rate/rhythm 115/min / regular except for events PR interval 0.12 second (sinus beats) QRS duration 0.08 second (sinus beats) Identification Sinus tachycardia at 115/min with PACs and ST-segment elevation This rhythm strip is from a 71-year-old man complaining of shoulder pain that has been present for 3 weeks.

18 Copyright © 2006 by Mosby Inc. All rights reserved. Figure 4-31 Ventricular rate/rhythm Atrial rate/rhythm PR interval QRS duration Identification

19 Copyright © 2006 by Mosby Inc. All rights reserved. Figure 4-31 Ventricular rate/rhythm 180/min / regular Atrial rate/rhythm Unable to determine PR interval Unable to determine QRS duration 0.04 sec Identification AVNRT at 180 bpm, ST-segment elevation

20 Copyright © 2006 by Mosby Inc. All rights reserved. Figure 4-32 Ventricular rate/rhythm Atrial rate/rhythm PR interval QRS duration Identification This rhythm strip is from an 82-year-old man complaining of back pain. Lead II Lead MCL 1

21 Copyright © 2006 by Mosby Inc. All rights reserved. Figure 4-32 Ventricular rate/rhythm 75/min / regular except for event Atrial rate/rhythm 75/min / regular except for event PR interval 0.20 sec QRS duration 0.12 sec Identification Sinus rhythm at 75 bpm with a wide QRS and a nonconducted PAC This rhythm strip is from an 82-year-old man complaining of back pain. Lead II Lead MCL 1

22 Copyright © 2006 by Mosby Inc. All rights reserved. Figure 4-33 Ventricular rate/rhythm Atrial rate/rhythm PR interval QRS duration Identification

23 Copyright © 2006 by Mosby Inc. All rights reserved. Figure 4-33 Ventricular rate/rhythm 88/min / regular Atrial rate/rhythm Unable to determine PR interval Unable to determine QRS duration 0.06 sec Identification Atrial flutter at 88 bpm with ST-segment depression

24 Copyright © 2006 by Mosby Inc. All rights reserved. Figure 4-34 Ventricular rate/rhythm Atrial rate/rhythm PR interval QRS duration Identification

25 Copyright © 2006 by Mosby Inc. All rights reserved. Figure 4-34 Ventricular rate/rhythm 70/min / regular Atrial rate/rhythm 70/min (sinus beats) / Unable to determine PR interval Varies QRS duration Varies IdentificationUnderlying rhythm is sinus but pacemaker site varies; ventricular rate approx 70 bpm; patient with known WPW; note delta waves

26 Copyright © 2006 by Mosby Inc. All rights reserved. Figure 4-35 Ventricular rate/rhythm Atrial rate/rhythm PR interval QRS duration Identification 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.

27 Copyright © 2006 by Mosby Inc. All rights reserved. Figure 4-35 Ventricular rate/rhythm 55-94/min / irregular Atrial rate/rhythm Unable to determine PR interval Unable to determine QRS duration 0.10 sec Identification Controlled atrial fibrillation at bpm 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.

28 Copyright © 2006 by Mosby Inc. All rights reserved. Figure 4-36 Ventricular rate/rhythm Atrial rate/rhythm PR interval QRS duration Identification

29 Copyright © 2006 by Mosby Inc. All rights reserved. Figure 4-36 Ventricular rate/rhythm 29/min / regular Atrial rate/rhythm Unable to determine PR interval Unable to determine QRS duration 0.10 sec Identification Controlled atrial fibrillation at 29/min Note: This patient was diagnosed with digitalis toxicity.

30 Copyright © 2006 by Mosby Inc. All rights reserved. Figure 4-37 Ventricular rate/rhythm Atrial rate/rhythm PR interval QRS duration Identification This rhythm strip is from a 67-year-old woman complaining of dizziness and a funny feeling in her chest. She denies chest pain and is not short of breath.

31 Copyright © 2006 by Mosby Inc. All rights reserved. Figure 4-37 Ventricular rate/rhythm 186/min / regular Atrial rate/rhythm Unable to determine PR interval Unable to determine QRS duration 0.06 sec Identification AVNRT at 186 bpm with ST-segment depression This rhythm strip is from a 67-year-old woman complaining of dizziness and a funny feeling in her chest. She denies chest pain and is not short of breath.

32 Copyright © 2006 by Mosby Inc. All rights reserved. Figure 4-38 Ventricular rate/rhythm Atrial rate/rhythm PR interval QRS duration Identification

33 Copyright © 2006 by Mosby Inc. All rights reserved. Figure 4-38 Ventricular rate/rhythm 170/min / regular Atrial rate/rhythm 170/min / regular PR interval 0.08 sec QRS duration 0.06 sec Identification Atrial tachycardia at 170 bpm

34 Copyright © 2006 by Mosby Inc. All rights reserved. Figure 4-39 Ventricular rate/rhythm Atrial rate/rhythm PR interval QRS duration Identification

35 Copyright © 2006 by Mosby Inc. All rights reserved. Figure 4-39 Ventricular rate/rhythm 78/min / regular except for the event Atrial rate/rhythm 78/min / regular except for the event PR interval 0.16 sec QRS duration 0.06 sec Identification Sinus rhythm at 78 bpm with a PAC

36 Copyright © 2006 by Mosby Inc. All rights reserved. Questions?


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