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

Slide 2 of 250 Next Back Close Copyright © 2011 by Mosby Inc. All rights reserved. Ventricular rate/rhythm 68 bpm/regular Atrial rate/rhythm 68 bpm/regular PR interval 0.24 sec QRS duration 0.06 to 0.08 sec Identification Sinus rhythm with first-degree AV block, ST-segment elevation

Slide 3 of 250 Next Back Close Copyright © 2011 by Mosby Inc. All rights reserved. Rhythm Recognition - Part 1

Slide 4 of 250 Next Back Close Copyright © 2011 by Mosby Inc. All rights reserved. Ventricular rate/rhythm 83 bpm (sinus beats)/ Regular except for the event Atrial rate/rhythm 83 bpm (sinus beats)/ Regular except for the event PR interval 0.20 sec QRS duration 0.08 to 0.10 sec Identification Sinus rhythm with two PJCs, ST-segment elevation

Slide 5 of 250 Next Back Close Copyright © 2011 by Mosby Inc. All rights reserved. Rhythm Recognition - Part 1  This rhythm strip is from an 83-year-old woman with syncope.

Slide 6 of 250 Next Back Close Copyright © 2011 by Mosby Inc. All rights reserved. Ventricular rate/rhythm 38 to 75 bpm/irregular Atrial rate/rhythm 75 bpm/regular PR interval Lengthening QRS duration 0.06 to 0.08 sec Identification Second-degree AV block, type I

Slide 7 of 250 Next Back Close Copyright © 2011 by Mosby Inc. All rights reserved. Rhythm Recognition - Part 1  This rhythm strip is from an 82-year-old man complaining of back pain.  Top = lead II, bottom = MCL1

Slide 8 of 250 Next Back Close Copyright © 2011 by Mosby Inc. All rights reserved. Ventricular rate/rhythm 41 to 73 bpm/irregular Atrial rate/rhythm 56 to 125 bpm/irregular PR interval 0.20 sec QRS duration 0.12 sec Identification Sinus rhythm with a nonconducted PAC

Slide 9 of 250 Next Back Close Copyright © 2011 by Mosby Inc. All rights reserved. Rhythm Recognition - Part 1  This rhythm strip is from an 86-year-old woman who experienced a cardiopulmonary arrest. The initial rhythm was asystole. The following rhythm resulted after IV administration of epinephrine and atropine.

Slide 10 of 250 Next Back Close Copyright © 2011 by Mosby Inc. All rights reserved. Ventricular rate/rhythm 40 bpm/regular Atrial rate/rhythm None PR interval None QRS duration 0.18 sec Identification Idioventricular rhythm (IVR) (ventricular escape rhythm)

Slide 11 of 250 Next Back Close Copyright © 2011 by Mosby Inc. All rights reserved. Rhythm Recognition - Part 1  This rhythm strip is from a 69-year-old man complaining of shortness of breath. Lung sounds reveal bilateral rales. Blood pressure: 160/58.

Slide 12 of 250 Next Back Close Copyright © 2011 by Mosby Inc. All rights reserved. Ventricular rate/rhythm 107 bpm (sinus beats)/ Regular except for the events Atrial rate/rhythm 107 bpm (sinus beats)/ Regular except for the events PR interval 0.20 sec (sinus beats) QRS duration 0.08 sec (sinus beats) Identification Sinus tachycardia with uniform PVCs

Slide 13 of 250 Next Back Close Copyright © 2011 by Mosby Inc. All rights reserved. Rhythm Recognition - Part 1

Slide 14 of 250 Next Back Close Copyright © 2011 by Mosby Inc. All rights reserved. Ventricular rate/rhythm 68 bpm/regular Atrial rate/rhythm 68 bpm/regular PR interval 0.28 sec QRS duration 0.06 sec Identification Sinus rhythm with first-degree AV block, ST-segment depression

Slide 15 of 250 Next Back Close Copyright © 2011 by Mosby Inc. All rights reserved. Rhythm Recognition - Part 1

Slide 16 of 250 Next Back Close Copyright © 2011 by Mosby Inc. All rights reserved. Ventricular rate/rhythm 214 bpm/regular Atrial rate/rhythm Unable to determine PR interval Unable to determine QRS duration 0.14 sec Identification Monomorphic ventricular tachycardia

Slide 17 of 250 Next Back Close Copyright © 2011 by Mosby Inc. All rights reserved. Rhythm Recognition - Part 1

Slide 18 of 250 Next Back Close Copyright © 2011 by Mosby Inc. All rights reserved. Ventricular rate/rhythm 214 bpm (VT) to 71 bpm (atrial fib)/ Irregular Atrial rate/rhythm Unable to determine PR interval Unable to determine QRS duration 0.12 to 0.16 sec (VT) to 0.06 sec (atrial fib) Identification Monomorphic VT to atrial fibrillation

Slide 19 of 250 Next Back Close Copyright © 2011 by Mosby Inc. All rights reserved. Rhythm Recognition - Part 1

Slide 20 of 250 Next Back Close Copyright © 2011 by Mosby Inc. All rights reserved. Ventricular rate/rhythm 88 bpm/regular Atrial rate/rhythm Unable to determine PR interval Unable to determine QRS duration 0.06 sec Identification Atrial flutter with ST-segment depression

Slide 21 of 250 Next Back Close Copyright © 2011 by Mosby Inc. All rights reserved. Rhythm Recognition - Part 1

Slide 22 of 250 Next Back Close Copyright © 2011 by Mosby Inc. All rights reserved. Ventricular rate/rhythm 32 bpm/regular Atrial rate/rhythm 32 bpm (sinus beats)/ None (junctional beats) to regular (sinus beats) PR interval 0.14 sec (sinus beats) QRS duration 0.04 to 0.06 sec Identification Junctional bradycardia with ST- segment depression to sinus bradycardia, inverted T waves

Slide 23 of 250 Next Back Close Copyright © 2011 by Mosby Inc. All rights reserved. Rhythm Recognition - Part 1

Slide 24 of 250 Next Back Close Copyright © 2011 by Mosby Inc. All rights reserved. Ventricular rate/rhythm 35 bpm/regular Atrial rate/rhythm 71 bpm/regular PR interval Varies QRS duration 0.12 sec Identification Complete (third-degree) AV block with inverted T waves

Slide 25 of 250 Next Back Close Copyright © 2011 by Mosby Inc. All rights reserved. Rhythm Recognition - Part 1  This rhythm strip is from a 52-year-old man found unresponsive, apneic, and pulseless.

Slide 26 of 250 Next Back Close Copyright © 2011 by Mosby Inc. All rights reserved. Ventricular rate/rhythm 88 bpm/regular Atrial rate/rhythm None PR interval None QRS duration 0.12 to 0.14 sec Identification Accelerated idioventricular rhythm (AIVR)

Slide 27 of 250 Next Back Close Copyright © 2011 by Mosby Inc. All rights reserved. Rhythm Recognition - Part 1

Slide 28 of 250 Next Back Close Copyright © 2011 by Mosby Inc. All rights reserved. Ventricular rate/rhythm 79 bpm (sinus beats)/ Regular except for the event(s) Atrial rate/rhythm 79 bpm (sinus beats)/ Regular except for the event(s) PR interval 0.24 sec (sinus beats) QRS duration 0.08 sec (sinus beats) Identification Sinus rhythm with first-degree AV block and PACs

Slide 29 of 250 Next Back Close Copyright © 2011 by Mosby Inc. All rights reserved. Rhythm Recognition - Part 1

Slide 30 of 250 Next Back Close Copyright © 2011 by Mosby Inc. All rights reserved. Ventricular rate/rhythm 48 to 83 bpm/irregular Atrial rate/rhythm 167 bpm/regular PR interval 0.24 sec QRS duration 0.12 sec Identification Second-degree AV block type II with ST-segment depression

Slide 31 of 250 Next Back Close Copyright © 2011 by Mosby Inc. All rights reserved. Rhythm Recognition - Part 1

Slide 32 of 250 Next Back Close Copyright © 2011 by Mosby Inc. All rights reserved. Atrial paced activity? Yes Ventricular paced activity? Yes Paced interval rate 71 Identification 100% paced rhythm – AV sequential pacemaker

Slide 33 of 250 Next Back Close Copyright © 2011 by Mosby Inc. All rights reserved. Rhythm 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.

Slide 34 of 250 Next Back Close Copyright © 2011 by Mosby Inc. All rights reserved. Ventricular rate/rhythm 55 to 94 bpm/irregular Atrial rate/rhythm Unable to determine PR interval Unable to determine QRS duration 0.10 sec Identification Atrial fibrillation (controlled)

Slide 35 of 250 Next Back Close Copyright © 2011 by Mosby Inc. All rights reserved. Rhythm Recognition - Part 1  This rhythm strip is from a 97-year-old woman after a fall.

Slide 36 of 250 Next Back Close Copyright © 2011 by Mosby Inc. All rights reserved. Ventricular rate/rhythm 88 bpm/regular Atrial rate/rhythm 88 bpm/regular PR interval 0.24 sec QRS duration 0.06 sec Identification Sinus rhythm with first-degree AV block, ST-segment depression

Slide 37 of 250 Next Back Close Copyright © 2011 by Mosby Inc. All rights reserved. Rhythm Recognition - Part 1  This rhythm strip is from a 70-year-old man complaining of a sharp pain across his shoulders. Blood pressure: 218/86.

Slide 38 of 250 Next Back Close Copyright © 2011 by Mosby Inc. All rights reserved. Ventricular rate/rhythm 115 bpm (sinus beats)/ Regular except for the events Atrial rate/rhythm 115 bpm (sinus beats)/ Regular except for the events PR interval 0.18 sec (sinus beats) QRS duration 0.06 sec (sinus beats) Identification Sinus tachycardia with uniform PVCs

Slide 39 of 250 Next Back Close Copyright © 2011 by Mosby Inc. All rights reserved. Rhythm Recognition - Part 1  This rhythm strip is from a 76-year-old man complaining of indigestion.

Slide 40 of 250 Next Back Close Copyright © 2011 by Mosby Inc. All rights reserved. Ventricular rate/rhythm 32 bpm/regular Atrial rate/rhythm None PR interval None QRS duration 0.06 sec Identification Junctional bradycardia with ST-segment depression and inverted T waves

Slide 41 of 250 Next Back Close Copyright © 2011 by Mosby Inc. All rights reserved. Rhythm Recognition - Part 1  This rhythm strip is from an 80-year-old woman complaining of weakness.

Slide 42 of 250 Next Back Close Copyright © 2011 by Mosby Inc. All rights reserved. Atrial paced activity? No Ventricular paced activity? Yes Paced interval rate 83 Identification 100% ventricular paced rhythm

Slide 43 of 250 Next Back Close Copyright © 2011 by Mosby Inc. All rights reserved. Rhythm Recognition - Part 1

Slide 44 of 250 Next Back Close Copyright © 2011 by Mosby Inc. All rights reserved. Ventricular rate/rhythm 55 bpm (sinus beats)/ Regular except for the event (every other beat is an ectopic beat) Atrial rate/rhythm 55 bpm (sinus beats)/ Regular except for the event (every other beat is an ectopic beat) PR interval 0.12 sec (sinus beats) QRS duration 0.08 to 0.10 sec (sinus beats) Identification Sinus bradycardia with ventricular bigeminy

Slide 45 of 250 Next Back Close Copyright © 2011 by Mosby Inc. All rights reserved. Rhythm Recognition - Part 1  This rhythm strip is from a 90-year-old woman complaining of hip pain after a fall.

Slide 46 of 250 Next Back Close Copyright © 2011 by Mosby Inc. All rights reserved. Ventricular rate/rhythm 75 bpm/regular Atrial rate/rhythm 75 bpm/regular PR interval 0.18 sec QRS duration 0.08 to 0.10 sec Identification Sinus rhythm with ST-segment depression

Slide 47 of 250 Next Back Close Copyright © 2011 by Mosby Inc. All rights reserved. Rhythm Recognition - Part 1  This rhythm strip is from an 86-year-old woman complaining of chest pain that she rates a 4 on a scale of 0 to 10. Blood pressure: 142/72.

Slide 48 of 250 Next Back Close Copyright © 2011 by Mosby Inc. All rights reserved. Ventricular rate/rhythm 60 bpm/regular Atrial rate/rhythm 60 bpm/regular PR interval 0.20 sec QRS duration 0.06 sec Identification Sinus rhythm

Slide 49 of 250 Next Back Close Copyright © 2011 by Mosby Inc. All rights reserved. Rhythm Recognition - Part 1  This rhythm strip is from a 78-year-old man complaining of palpitations. Note the point at which the patient was defibrillated.

Slide 50 of 250 Next Back Close Copyright © 2011 by Mosby Inc. All rights reserved. Ventricular rate/rhythm 63 to 79 bpm (sinus beats)/ Irregular (sinus beats) Atrial rate/rhythm 63 to 79 bpm (sinus beats)/ Irregular (sinus beats) PR interval 0.12 sec (sinus beats) QRS duration 0.04 to 0.06 sec (sinus beats) Identification Monomorphic ventricular tachycardia – shock – ventricular beats – sinus arrhythmia

Slide 51 of 250 Next Back Close Copyright © 2011 by Mosby Inc. All rights reserved. Rhythm Recognition - Part 1

Slide 52 of 250 Next Back Close Copyright © 2011 by Mosby Inc. All rights reserved. Ventricular rate/rhythm 68 bpm / Regular except for the event Atrial rate/rhythm 68 bpm / Regular except for the event PR interval 0.18 sec (sinus beats) QRS duration 0.06 sec (sinus beats) Identification Sinus rhythm with uniform PVCs

Slide 53 of 250 Next Back Close Copyright © 2011 by Mosby Inc. All rights reserved. Rhythm Recognition - Part 1

Slide 54 of 250 Next Back Close Copyright © 2011 by Mosby Inc. All rights reserved. Ventricular rate/rhythm 115 bpm (sinus beats)/ Regular except for the event Atrial rate/rhythm 115 bpm / Regular except for the event PR interval 0.16 sec QRS duration 0.08 to 0.10 sec Identification Sinus tachycardia with PACs

Slide 55 of 250 Next Back Close Copyright © 2011 by Mosby Inc. All rights reserved. Rhythm Recognition - Part 1  This rhythm strip is from a 3-month-old infant who had an altered level of responsiveness. She was limp with a respiratory rate of 4 breaths/min. Blood sugar was 174.

Slide 56 of 250 Next Back Close Copyright © 2011 by Mosby Inc. All rights reserved. Ventricular rate/rhythm 125 bpm/regular Atrial rate/rhythm 125 bpm/regular PR interval 0.12 to 0.16 sec QRS duration 0.06 sec (sinus beats) Identification Sinus tachycardia with an interpolated PVC

Slide 57 of 250 Next Back Close Copyright © 2011 by Mosby Inc. All rights reserved. Rhythm Recognition - Part 1  This rhythm strip is from an 83-year-old man complaining of chest pain. He had a new pacemaker implanted 5 days ago. His blood pressure is 148/60.

Slide 58 of 250 Next Back Close Copyright © 2011 by Mosby Inc. All rights reserved. Ventricular rate/rhythm 79 bpm/regular Atrial rate/rhythm Unable to determine PR interval Unable to determine QRS duration 0.08 sec Identification Atrial fibrillation (controlled)

Slide 59 of 250 Next Back Close Copyright © 2011 by Mosby Inc. All rights reserved. Rhythm Recognition - Part 1  This rhythm strip is from a 52-year-old man with substernal chest pain. He has a history of COPD and mitral valve regurgitation. Blood pressure: 140/78.

Slide 60 of 250 Next Back Close Copyright © 2011 by Mosby Inc. All rights reserved. Ventricular rate/rhythm 75 bpm/regular Atrial rate/rhythm 75 bpm/regular PR interval 0.14 sec QRS duration 0.06 to 0.08 sec Identification Sinus rhythm with ST-segment depression

Slide 61 of 250 Next Back Close Copyright © 2011 by Mosby Inc. All rights reserved. Rhythm Recognition - Part 1

Slide 62 of 250 Next Back Close Copyright © 2011 by Mosby Inc. All rights reserved. Ventricular rate/rhythm 34 bpm/regular Atrial rate/rhythm 68 bpm/regular PR interval 0.14 to 0.16 sec QRS duration 0.10 sec Identification 2:1 AV block, probably type I

Slide 63 of 250 Next Back Close Copyright © 2011 by Mosby Inc. All rights reserved. Rhythm Recognition - Part 1

Slide 64 of 250 Next Back Close Copyright © 2011 by Mosby Inc. All rights reserved. Ventricular rate/rhythm 60 to 98 bpm/irregular Atrial rate/rhythm 111 bpm/regular PR interval Lengthens QRS duration 0.08 sec Identification Second-degree AV block, type I

Slide 65 of 250 Next Back Close Copyright © 2011 by Mosby Inc. All rights reserved. Rhythm Recognition - Part 1

Slide 66 of 250 Next Back Close Copyright © 2011 by Mosby Inc. All rights reserved. Ventricular rate/rhythm 75 bpm/regular Atrial rate/rhythm None PR interval None QRS duration 0.08 sec Identification Accelerated junctional rhythm

Slide 67 of 250 Next Back Close Copyright © 2011 by Mosby Inc. All rights reserved. Rhythm Recognition - Part 1

Slide 68 of 250 Next Back Close Copyright © 2011 by Mosby Inc. All rights reserved. Ventricular rate/rhythm 54 bpm/regular Atrial rate/rhythm Unable to determine PR interval Unable to determine QRS duration 0.08 sec Identification Atrial fibrillation (controlled)

Slide 69 of 250 Next Back Close Copyright © 2011 by Mosby Inc. All rights reserved. Rhythm Recognition - Part 1

Slide 70 of 250 Next Back Close Copyright © 2011 by Mosby Inc. All rights reserved. Ventricular rate/rhythm None Atrial rate/rhythm None PR interval None QRS duration None IdentificationAsystole

Slide 71 of 250 Next Back Close Copyright © 2011 by Mosby Inc. All rights reserved. Rhythm Recognition - Part 1

Slide 72 of 250 Next Back Close Copyright © 2011 by Mosby Inc. All rights reserved. Atrial paced activity? No Ventricular paced activity? Yes Paced interval rate 65 Identification 100% ventricular paced rhythm

Slide 73 of 250 Next Back Close Copyright © 2011 by Mosby Inc. All rights reserved. Rhythm Recognition - Part 1  These rhythm strips are from a 46-year-old woman complaining of abdominal pain.

Slide 74 of 250 Next Back Close Copyright © 2011 by Mosby Inc. All rights reserved. Ventricular rate/rhythm 107 bpm (sinus beats)/ Regular except for the events Atrial rate/rhythm 107 bpm (sinus beats)/ Regular except for the events PR interval 0.14 sec (sinus beats) QRS duration 0.06 sec (sinus beats) Identification Sinus tachycardia with uniform PVCs

Slide 75 of 250 Next Back Close Copyright © 2011 by Mosby Inc. All rights reserved. Rhythm Recognition - Part 1  This rhythm strip is from a 61-year-old man with a history of heart failure.

Slide 76 of 250 Next Back Close Copyright © 2011 by Mosby Inc. All rights reserved. Ventricular rate/rhythm 65 to 75 bpm (sinus beats)/Irregular Atrial rate/rhythm 65 to 75 bpm (sinus beats)/Irregular PR interval 0.32 sec (sinus beats) QRS duration 0.18 sec (sinus beats) Identification Sinus rhythm with first-degree AV block, wide QRS (bundle branch block), multiform PVCs, and ST- segment elevation

Slide 77 of 250 Next Back Close Copyright © 2011 by Mosby Inc. All rights reserved. Rhythm Recognition - Part 1  This rhythm strip is from a 1-month-old infant after a 3-minute seizure.

Slide 78 of 250 Next Back Close Copyright © 2011 by Mosby Inc. All rights reserved. Ventricular rate/rhythm 130 bpm/regular Atrial rate/rhythm 130 bpm/regular PR interval 0.14 to 0.16 sec QRS duration 0.06 to 0.08 sec Identification Sinus tachycardia

Slide 79 of 250 Next Back Close Copyright © 2011 by Mosby Inc. All rights reserved. Rhythm Recognition - Part 1

Slide 80 of 250 Next Back Close Copyright © 2011 by Mosby Inc. All rights reserved. Ventricular rate/rhythm 45 bpm/regular Atrial rate/rhythm 115 bpm/regular PR interval Varies QRS duration 0.16 sec Identification Complete (third-degree) AV block

Slide 81 of 250 Next Back Close Copyright © 2011 by Mosby Inc. All rights reserved. Rhythm Recognition - Part 1  This rhythm strip is from a 72-year-old man complaining of chest pain.

Slide 82 of 250 Next Back Close Copyright © 2011 by Mosby Inc. All rights reserved. Atrial paced activity? No Ventricular paced activity? Yes Paced interval rate 60 Identification 100% ventricular paced rhythm

Slide 83 of 250 Next Back Close Copyright © 2011 by Mosby Inc. All rights reserved. Rhythm Recognition - Part 1  This rhythm strip is from a 77-year-old woman with a congested cough.

Slide 84 of 250 Next Back Close Copyright © 2011 by Mosby Inc. All rights reserved. Ventricular rate/rhythm 107 to 200 bpm/irregular Atrial rate/rhythm Unable to determine PR interval Unable to determine QRS duration 0.06 to 0.08 sec Identification Atrial fibrillation (uncontrolled)

Slide 85 of 250 Next Back Close Copyright © 2011 by Mosby Inc. All rights reserved. Rhythm Recognition - Part 1

Slide 86 of 250 Next Back Close Copyright © 2011 by Mosby Inc. All rights reserved. Ventricular rate/rhythm 30 bpm (junctional beats) to 56 bpm (sinus beats)/ Irregular (junctional beats) to regular (sinus beats) Atrial rate/rhythm None (junctional beats) to 56 bpm (sinus beats)/ None (junctional beats) to regular (sinus beats) PR interval None (junctional beats) to 0.18 (sinus beats) QRS duration 0.04 sec (junctional beats) to 0.08 (sinus beats) Identification Junctional bradycardia to sinus bradycardia

Slide 87 of 250 Next Back Close Copyright © 2011 by Mosby Inc. All rights reserved. Rhythm Recognition - Part 1

Slide 88 of 250 Next Back Close Copyright © 2011 by Mosby Inc. All rights reserved. Ventricular rate/rhythm 83 bpm (sinus beats)/regular Atrial rate/rhythm 83 bpm (sinus beats)/regular PR interval 0.20 sec (sinus beats) QRS duration 0.06 to 0.08 sec (sinus beats) Identification Atrial flutter to sinus rhythm

Slide 89 of 250 Next Back Close Copyright © 2011 by Mosby Inc. All rights reserved. Rhythm Recognition - Part 1

Slide 90 of 250 Next Back Close Copyright © 2011 by Mosby Inc. All rights reserved. Ventricular rate/rhythm 96 bpm (sinus beats)/ Regular except for the event Atrial rate/rhythm 96 bpm (sinus beats)/ Regular except for the event PR interval 0.12 sec (sinus beats) QRS duration 0.08 to 0.10 sec (sinus beats) Identification Sinus rhythm with uniform PVCs

Slide 91 of 250 Next Back Close Copyright © 2011 by Mosby Inc. All rights reserved. Rhythm Recognition - Part 1  This rhythm strip is from a 54-year-old man who had a syncopal episode.

Slide 92 of 250 Next Back Close Copyright © 2011 by Mosby Inc. All rights reserved. Ventricular rate/rhythm 58 bpm/regular Atrial rate/rhythm 58 bpm/regular PR interval 0.20 sec QRS duration 0.08 sec Identification Sinus bradycardia

Slide 93 of 250 Next Back Close Copyright © 2011 by Mosby Inc. All rights reserved. Rhythm Recognition - Part 1  This rhythm strip is from a 66-year-old man complaining of chest pain. Blood pressure: 170/96.

Slide 94 of 250 Next Back Close Copyright © 2011 by Mosby Inc. All rights reserved. Ventricular rate/rhythm 107 bpm/regular Atrial rate/rhythm 107 bpm/regular PR interval 0.24 sec QRS duration 0.08 sec Identification Sinus tachycardia with first-degree AV block

Slide 95 of 250 Next Back Close Copyright © 2011 by Mosby Inc. All rights reserved. Rhythm Recognition - Part 1  This rhythm strip is from a 43-year-old woman complaining of palpitations.

Slide 96 of 250 Next Back Close Copyright © 2011 by Mosby Inc. All rights reserved. Ventricular rate/rhythm 214 bpm/regular Atrial rate/rhythm Unable to determine PR interval Unable to determine QRS duration 0.08 sec Identification Narrow-QRS tachycardia

Slide 97 of 250 Next Back Close Copyright © 2011 by Mosby Inc. All rights reserved. Rhythm Recognition - Part 1  A 43-year-old woman is complaining of palpitations. The patient has a history of SVT and states she cannot tolerate adenosine. The following rhythm is observed on the cardiac monitor after diltiazem administration.

Slide 98 of 250 Next Back Close Copyright © 2011 by Mosby Inc. All rights reserved. Ventricular rate/rhythm 187 bpm (atrial beats)/ Regular (atrial beats) Atrial rate/rhythm Unable to determine PR interval Unable to determine QRS duration 0.08 sec (atrial beats) Identification Junctional to sinus to narrow-QRS tachycardia

Slide 99 of 250 Next Back Close Copyright © 2011 by Mosby Inc. All rights reserved. Rhythm Recognition - Part 1

Slide 100 of 250 Next Back Close Copyright © 2011 by Mosby Inc. All rights reserved. Ventricular rate/rhythm Unable to determine Atrial rate/rhythm Unable to determine PR interval Unable to determine QRS duration Unable to determine Identification Ventricular fibrillation (coarse)

Slide 101 of 250 Next Back Close Copyright © 2011 by Mosby Inc. All rights reserved. Rhythm Recognition - Part 1

Slide 102 of 250 Next Back Close Copyright © 2011 by Mosby Inc. All rights reserved. Ventricular rate/rhythm 37 bpm/regular Atrial rate/rhythm 75 bpm/regular PR interval 0.28 sec QRS duration 0.06 sec Identification 2:1 AV block, probably type I

Slide 103 of 250 Next Back Close Copyright © 2011 by Mosby Inc. All rights reserved. Rhythm Recognition - Part 1

Slide 104 of 250 Next Back Close Copyright © 2011 by Mosby Inc. All rights reserved. Ventricular rate/rhythm 27 bpm/regular Atrial rate/rhythm 27 bpm/regular PR interval 0.22 sec QRS duration 0.12 sec Identification Sinus bradycardia with first-degree AV block, wide-QRS (probable bundle branch block), ST-segment depression

Slide 105 of 250 Next Back Close Copyright © 2011 by Mosby Inc. All rights reserved. Rhythm Recognition - Part 1  This rhythm strip is from a 76-year-old woman complaining of back pain. Her medical history includes a myocardial infarction 2 years ago.

Slide 106 of 250 Next Back Close Copyright © 2011 by Mosby Inc. All rights reserved. Atrial paced activity? No Ventricular paced activity? Yes Paced interval rate 65 Identification 100% ventricular paced rhythm

Slide 107 of 250 Next Back Close Copyright © 2011 by Mosby Inc. All rights reserved. Rhythm Recognition - Part 1  This rhythm strip is from an 80-year-old man found sitting in a chair. He is unresponsive, apneic, and pulseless.

Slide 108 of 250 Next Back Close Copyright © 2011 by Mosby Inc. All rights reserved. Ventricular rate/rhythm None Atrial rate/rhythm None PR interval None QRS duration None Identification Asystole – the electrical activity shown is caused by pacemaker spikes from the patient’s permanent pacemaker (no capture)

Slide 109 of 250 Next Back Close Copyright © 2011 by Mosby Inc. All rights reserved. Rhythm Recognition - Part 1  This rhythm strip is from an 88-year-old woman complaining of hip pain after a fall injury.

Slide 110 of 250 Next Back Close Copyright © 2011 by Mosby Inc. All rights reserved. Ventricular rate/rhythm 68 to 125 bpm/irregular Atrial rate/rhythm Unable to determine PR interval Unable to determine QRS duration 0.08 sec Identification Atrial fibrillation

Slide 111 of 250 Next Back Close Copyright © 2011 by Mosby Inc. All rights reserved. Rhythm Recognition - Part 1

Slide 112 of 250 Next Back Close Copyright © 2011 by Mosby Inc. All rights reserved. Ventricular rate/rhythm 42 to 68 bpm/irregular Atrial rate/rhythm 68 bpm/regular PR interval Lengthens QRS duration 0.10 sec Identification Second-degree AV block type I with a ventricular complex

Slide 113 of 250 Next Back Close Copyright © 2011 by Mosby Inc. All rights reserved. Rhythm Recognition - Part 1

Slide 114 of 250 Next Back Close Copyright © 2011 by Mosby Inc. All rights reserved. Ventricular rate/rhythm 48 bpm (junctional beats)/regular Atrial rate/rhythm Unable to determine (junctional beats) PR interval Unable to determine (junctional beats) QRS duration 0.06 to 0.08 sec Identification Sinus bradycardia with a first-degree AV block to junctional escape rhythm

Slide 115 of 250 Next Back Close Copyright © 2011 by Mosby Inc. All rights reserved. Rhythm Recognition - Part 1  This rhythm strip is from a 67-year-old woman found unresponsive on the side of the road. Outdoor temperature is 112°F. Blood pressure: 238/110, respiratory rate: 60/min.

Slide 116 of 250 Next Back Close Copyright © 2011 by Mosby Inc. All rights reserved. Ventricular rate/rhythm 136 bpm/regular Atrial rate/rhythm 136 bpm/regular PR interval 0.16 sec QRS duration 0.08 sec Identification Sinus tachycardia with ST-segment depression

Slide 117 of 250 Next Back Close Copyright © 2011 by Mosby Inc. All rights reserved. Rhythm Recognition - Part 1  This rhythm strip is from an 84-year-old man complaining of dizziness. He had a triple bypass 4 days ago.

Slide 118 of 250 Next Back Close Copyright © 2011 by Mosby Inc. All rights reserved. Ventricular rate/rhythm 60 bpm (sinus beats)/ Regular except for the event (every other beat is an ectopic beat) Atrial rate/rhythm 60 bpm (sinus beats)/ Regular except for the event PR interval 0.16 sec (sinus beats) QRS duration 0.08 sec (sinus beats) Identification Sinus rhythm with ventricular bigeminy, ST-segment depression

Slide 119 of 250 Next Back Close Copyright © 2011 by Mosby Inc. All rights reserved. Rhythm Recognition - Part 1  This rhythm strip is from an 81-year-old woman with an altered level of responsiveness. Blood pressure: 160/70, blood sugar: 114.

Slide 120 of 250 Next Back Close Copyright © 2011 by Mosby Inc. All rights reserved. Ventricular rate/rhythm 56 bpm/regular Atrial rate/rhythm 56 bpm/regular PR interval 0.24 sec QRS duration 0.06 sec Identification Sinus bradycardia with first-degree AV block

Slide 121 of 250 Next Back Close Copyright © 2011 by Mosby Inc. All rights reserved. Rhythm Recognition - Part 1  This rhythm strip is from a 80-year-old woman who was playing Bingo when she felt dizzy and slumped over in her chair. Bystanders state she was unresponsive for approximately 5 minutes. A pulse is present.

Slide 122 of 250 Next Back Close Copyright © 2011 by Mosby Inc. All rights reserved. Ventricular rate/rhythm 75 to 94 bpm/irregular Atrial rate/rhythm Unable to determine PR interval Unable to determine QRS duration 0.08 sec Identification Atrial fibrillation (controlled)

Slide 123 of 250 Next Back Close Copyright © 2011 by Mosby Inc. All rights reserved. Rhythm Recognition - Part 1  This rhythm strip is from a 91-year-old woman complaining of chest pain and difficulty breathing.

Slide 124 of 250 Next Back Close Copyright © 2011 by Mosby Inc. All rights reserved. Ventricular rate/rhythm 94 to 108 bpm/irregular Atrial rate/rhythm Unable to determine PR interval Unable to determine QRS duration 0.10 sec Identification Atrial fibrillation with ST-segment elevation

Slide 125 of 250 Next Back Close Copyright © 2011 by Mosby Inc. All rights reserved. Rhythm Recognition - Part 1  This rhythm strip is from an 85-year-old woman complaining of numbness in her legs.

Slide 126 of 250 Next Back Close Copyright © 2011 by Mosby Inc. All rights reserved. Ventricular rate/rhythm 48 bpm/regular Atrial rate/rhythm 48 bpm/regular PR interval 0.16 sec QRS duration 0.08 sec Identification Sinus bradycardia

Slide 127 of 250 Next Back Close Copyright © 2011 by Mosby Inc. All rights reserved. Rhythm Recognition - Part 1  This rhythm strip is from a 59-year-old woman who complained of sudden weakness in her legs and fell to the floor in her kitchen.

Slide 128 of 250 Next Back Close Copyright © 2011 by Mosby Inc. All rights reserved. Ventricular rate/rhythm 50 to 79 bpm/irregular Atrial rate/rhythm Unable to determine PR interval Unable to determine QRS duration 0.12 sec Identification Atrial fibrillation (controlled) with ST-segment elevation

Slide 129 of 250 Next Back Close Copyright © 2011 by Mosby Inc. All rights reserved. Rhythm Recognition - Part 1  This rhythm strip is from an 82-year-old woman with vomiting x 2 days.

Slide 130 of 250 Next Back Close Copyright © 2011 by Mosby Inc. All rights reserved. Ventricular rate/rhythm 115 bpm/regular Atrial rate/rhythm 115 bpm/regular PR interval 0.18 sec QRS duration 0.06 sec Identification Sinus tachycardia

Slide 131 of 250 Next Back Close Copyright © 2011 by Mosby Inc. All rights reserved. Rhythm Recognition - Part 1  This rhythm strip is from a 62-year-old woman complaining of chest pain. Her blood pressure is 146/104, respirations are 20. Breath sounds are clear.

Slide 132 of 250 Next Back Close Copyright © 2011 by Mosby Inc. All rights reserved. Ventricular rate/rhythm 167 bpm/regular Atrial rate/rhythm Unable to determine PR interval Unable to determine QRS duration 0.06 sec Identification Narrow-QRS tachycardia (SVT) with ST-segment depression

Slide 133 of 250 Next Back Close Copyright © 2011 by Mosby Inc. All rights reserved. Rhythm Recognition - Part 1  This rhythm strip is from a 6-year-old boy immediately after a seizure.

Slide 134 of 250 Next Back Close Copyright © 2011 by Mosby Inc. All rights reserved. Ventricular rate/rhythm 68 to 88 bpm/irregular Atrial rate/rhythm 68 to 88 bpm/irregular PR interval 0.12 sec QRS duration 0.08 sec Identification Sinus arrhythmia

Slide 135 of 250 Next Back Close Copyright © 2011 by Mosby Inc. All rights reserved. Rhythm Recognition - Part 1  This rhythm strip is from a 76-year-old man who was playing golf and experienced a syncopal episode.

Slide 136 of 250 Next Back Close Copyright © 2011 by Mosby Inc. All rights reserved. Ventricular rate/rhythm 65 bpm/regular Atrial rate/rhythm 65 bpm/regular PR interval 0.16 sec QRS duration 0.08 sec Identification Sinus rhythm with ST-segment elevation

Slide 137 of 250 Next Back Close Copyright © 2011 by Mosby Inc. All rights reserved. Rhythm Recognition - Part 1  These rhythm strips are from a 44-year-old woman complaining of chest pain.

Slide 138 of 250 Next Back Close Copyright © 2011 by Mosby Inc. All rights reserved. Ventricular rate/rhythm 176 bpm/regular Atrial rate/rhythm None PR interval None QRS duration 0.12 to 0.14 sec Identification Monomorphic ventricular tachycardia

Slide 139 of 250 Next Back Close Copyright © 2011 by Mosby Inc. All rights reserved. Rhythm Recognition - Part 1

Slide 140 of 250 Next Back Close Copyright © 2011 by Mosby Inc. All rights reserved. Ventricular rate/rhythm 29 bpm/regular Atrial rate/rhythm 71 bpm/regular PR interval Varies QRS duration 0.16 sec Identification Complete (third-degree) AV block with ST-segment elevation

Slide 141 of 250 Next Back Close Copyright © 2011 by Mosby Inc. All rights reserved. Rhythm Recognition - Part 1  This rhythm strip is from an 81-year-old woman complaining of chest pain.

Slide 142 of 250 Next Back Close Copyright © 2011 by Mosby Inc. All rights reserved. Ventricular rate/rhythm 76 bpm/regular Atrial rate/rhythm None PR interval None QRS duration 0.12 to 0.14 sec Identification Accelerated idioventricular rhythm (AIVR)

Slide 143 of 250 Next Back Close Copyright © 2011 by Mosby Inc. All rights reserved. Rhythm Recognition - Part 1  This rhythm strip is from a 74-year-old woman complaining of weakness.

Slide 144 of 250 Next Back Close Copyright © 2011 by Mosby Inc. All rights reserved. Atrial paced activity? No Ventricular paced activity? Yes Paced interval rate 68 Identification Ventricular demand pacemaker

Slide 145 of 250 Next Back Close Copyright © 2011 by Mosby Inc. All rights reserved. Rhythm Recognition - Part 1

Slide 146 of 250 Next Back Close Copyright © 2011 by Mosby Inc. All rights reserved. Ventricular rate/rhythm 75 to 150 bpm/irregular Atrial rate/rhythm Unable to determine PR interval Unable to determine QRS duration 0.08 sec Identification Atrial flutter

Slide 147 of 250 Next Back Close Copyright © 2011 by Mosby Inc. All rights reserved. Rhythm Recognition - Part 1

Slide 148 of 250 Next Back Close Copyright © 2011 by Mosby Inc. All rights reserved. Ventricular rate/rhythm 42 bpm (sinus beats)/ Regular except for the event (every other beat is an ectopic beat) Atrial rate/rhythm 42 bpm (sinus beats)/ Regular except for the event PR interval 0.12 sec (sinus beats) QRS duration 0.08 to 0.10 sec (sinus beats) Identification Sinus bradycardia with ventricular bigeminy

Slide 149 of 250 Next Back Close Copyright © 2011 by Mosby Inc. All rights reserved. Rhythm Recognition - Part 1

Slide 150 of 250 Next Back Close Copyright © 2011 by Mosby Inc. All rights reserved. Ventricular rate/rhythm 42 bpm/regular Atrial rate/rhythm None PR interval None QRS duration 0.24 sec Identification Accelerated idioventricular rhythm (AIVR)

Slide 151 of 250 Next Back Close Copyright © 2011 by Mosby Inc. All rights reserved. Rhythm Recognition - Part 1  These rhythm strips are from a 63-year-old woman who experienced a syncopal episode. Blood pressure is 200/90, blood sugar is 98.

Slide 152 of 250 Next Back Close Copyright © 2011 by Mosby Inc. All rights reserved. Ventricular rate/rhythm 44 bpm/regular Atrial rate/rhythm 88 bpm/regular PR interval 0.20 sec QRS duration 0.10 sec Identification 2:1 AV block, probably type I

Slide 153 of 250 Next Back Close Copyright © 2011 by Mosby Inc. All rights reserved. Rhythm Recognition - Part 1  This rhythm strip is from an 84-year-old woman with a nosebleed. Blood pressure: 250/74.

Slide 154 of 250 Next Back Close Copyright © 2011 by Mosby Inc. All rights reserved. Ventricular rate/rhythm 68 bpm/regular Atrial rate/rhythm 68 bpm/regular PR interval 0.16 sec QRS duration 0.08 sec Identification Sinus rhythm

Slide 155 of 250 Next Back Close Copyright © 2011 by Mosby Inc. All rights reserved. Rhythm Recognition - Part 1  This rhythm strip is from a 79-year-old man complaining of palpitations. His initial blood pressure was 112/84. His second blood pressure, 8 minutes after the first, was 78/P.

Slide 156 of 250 Next Back Close Copyright © 2011 by Mosby Inc. All rights reserved. Ventricular rate/rhythm 147 bpm/regular Atrial rate/rhythm Unable to determine PR interval Unable to determine QRS duration 0.06 to 0.08 sec Identification Narrow-QRS tachycardia (SVT) with ST-segment depression

Slide 157 of 250 Next Back Close Copyright © 2011 by Mosby Inc. All rights reserved. Rhythm Recognition - Part 1

Slide 158 of 250 Next Back Close Copyright © 2011 by Mosby Inc. All rights reserved. Atrial paced activity? No Ventricular paced activity? Yes Paced interval rate 60 Identification 100% ventricular paced rhythm

Slide 159 of 250 Next Back Close Copyright © 2011 by Mosby Inc. All rights reserved. Rhythm Recognition - Part 1  This rhythm strip is from an 80-year-old man complaining of weakness and dizziness. Blood pressure is 160/98, blood sugar is 88.

Slide 160 of 250 Next Back Close Copyright © 2011 by Mosby Inc. All rights reserved. Ventricular rate/rhythm 63 to 100 bpm/irregular Atrial rate/rhythm Unable to determine PR interval Unable to determine QRS duration 0.08 to 0.10 sec Identification Atrial fibrillation (controlled)

Slide 161 of 250 Next Back Close Copyright © 2011 by Mosby Inc. All rights reserved. Rhythm Recognition - Part 1

Slide 162 of 250 Next Back Close Copyright © 2011 by Mosby Inc. All rights reserved. Ventricular rate/rhythm 42 to 71 bpm/irregular Atrial rate/rhythm 125 bpm/regular PR interval 0.24 sec QRS duration 0.10 to 0.12 sec Identification Second-degree AV block type II

Slide 163 of 250 Next Back Close Copyright © 2011 by Mosby Inc. All rights reserved. Rhythm Recognition - Part 1  This rhythm strip is from a 58-year-old man with chest pain that he rates as a 2 on a scale of 0 to 10. He states he recently began taking pills for weight control.

Slide 164 of 250 Next Back Close Copyright © 2011 by Mosby Inc. All rights reserved. Ventricular rate/rhythm 91 bpm (sinus beats)/ Regular except for the event(s) Atrial rate/rhythm 91 bpm (sinus beats)/ Regular except for the event(s) PR interval 0.20 sec (sinus beats) QRS duration 0.06 sec (sinus beats) Identification Sinus rhythm with uniform PVCs, ST-segment depression

Slide 165 of 250 Next Back Close Copyright © 2011 by Mosby Inc. All rights reserved. Rhythm Recognition - Part 1  This rhythm strip is from a 60-year-old woman complaining of palpitations and shortness of breath.

Slide 166 of 250 Next Back Close Copyright © 2011 by Mosby Inc. All rights reserved. Ventricular rate/rhythm 130 to 214 bpm/irregular Atrial rate/rhythm Unable to determine PR interval Unable to determine QRS duration 0.08 sec Identification Atrial fibrillation with a rapid ventricular response (RVR)

Slide 167 of 250 Next Back Close Copyright © 2011 by Mosby Inc. All rights reserved. Rhythm Recognition - Part 1  This rhythm strip is from a 60-year-old woman complaining of palpitations and shortness of breath after administration of adenosine 6 mg IV.

Slide 168 of 250 Next Back Close Copyright © 2011 by Mosby Inc. All rights reserved. Ventricular rate/rhythm 28 to 63 bpm/irregular Atrial rate/rhythm Unable to determine PR interval Unable to determine QRS duration 0.08 sec Identification Atrial fibrillation

Slide 169 of 250 Next Back Close Copyright © 2011 by Mosby Inc. All rights reserved. Rhythm Recognition - Part 1  This rhythm strip is from a 60-year-old woman complaining of palpitations and shortness of breath 1 minute after administration of adenosine 12 mg IV.

Slide 170 of 250 Next Back Close Copyright © 2011 by Mosby Inc. All rights reserved. Ventricular rate/rhythm 18 to 21 bpm/irregular Atrial rate/rhythm Unable to determine PR interval Unable to determine QRS duration 0.08 sec Identification Atrial fibrillation

Slide 171 of 250 Next Back Close Copyright © 2011 by Mosby Inc. All rights reserved. Rhythm Recognition - Part 1  This rhythm strip is from a 60-year-old woman complaining of palpitations and shortness of breath two minutes after administration of adenosine 6 mg IV.

Slide 172 of 250 Next Back Close Copyright © 2011 by Mosby Inc. All rights reserved. Ventricular rate/rhythm 115 to 250 bpm/irregular Atrial rate/rhythm Unable to determine PR interval Unable to determine QRS duration 0.08 sec Identification Atrial fibrillation with a rapid ventricular response (RVR)

Slide 173 of 250 Next Back Close Copyright © 2011 by Mosby Inc. All rights reserved. Rhythm Recognition - Part 1

Slide 174 of 250 Next Back Close Copyright © 2011 by Mosby Inc. All rights reserved. Ventricular rate/rhythm 30 bpm (junctional beats)/irregular Atrial rate/rhythm None (junctional beats)/irregular PR interval 0.16 sec (sinus beats) QRS duration 0.06 sec Identification Sinus beat - two junctional beats - sinus beat; ST-segment depression

Slide 175 of 250 Next Back Close Copyright © 2011 by Mosby Inc. All rights reserved. Rhythm Recognition - Part 1  This rhythm strip is from a 90-year-old woman with shortness of breath.

Slide 176 of 250 Next Back Close Copyright © 2011 by Mosby Inc. All rights reserved. Atrial paced activity? No Ventricular paced activity? Yes Paced interval rate 60 Identification 100% ventricular paced rhythm

Slide 177 of 250 Next Back Close Copyright © 2011 by Mosby Inc. All rights reserved. Rhythm Recognition - Part 1

Slide 178 of 250 Next Back Close Copyright © 2011 by Mosby Inc. All rights reserved. Ventricular rate/rhythm 75 bpm (sinus beats)/ Regular except for the event(s) Atrial rate/rhythm 75 bpm (sinus beats)/ Regular except for the event(s) PR interval 0.16 to 0.18 sec (sinus beats) QRS duration 0.04 to 0.06 sec (sinus beats) Identification Sinus rhythm with uniform PVCs

Slide 179 of 250 Next Back Close Copyright © 2011 by Mosby Inc. All rights reserved. Rhythm Recognition - Part 1

Slide 180 of 250 Next Back Close Copyright © 2011 by Mosby Inc. All rights reserved. Ventricular rate/rhythm 100 bpm (sinus beats) to 150 bpm (VT)/Regular Atrial rate/rhythm 100 bpm (sinus beats)/ Regular to unable to determine PR interval 0.24 sec (sinus beats) QRS duration 0.08 sec (sinus beats) Identification Sinus rhythm with first-degree AV block to monomorphic ventricular tachycardia (VT)

Slide 181 of 250 Next Back Close Copyright © 2011 by Mosby Inc. All rights reserved. Rhythm Recognition - Part 1

Slide 182 of 250 Next Back Close Copyright © 2011 by Mosby Inc. All rights reserved. Ventricular rate/rhythm 47 bpm/regular Atrial rate/rhythm 115 bpm/regular PR interval Varies QRS duration 0.08 sec Identification Complete (third-degree) AV block with ST-segment elevation

Slide 183 of 250 Next Back Close Copyright © 2011 by Mosby Inc. All rights reserved. Rhythm Recognition - Part 1

Slide 184 of 250 Next Back Close Copyright © 2011 by Mosby Inc. All rights reserved. Ventricular rate/rhythm 88 to 167 bpm/irregular Atrial rate/rhythm Unable to determine PR interval Unable to determine QRS duration 0.06 to 0.08 sec Identification Atrial fibrillation

Slide 185 of 250 Next Back Close Copyright © 2011 by Mosby Inc. All rights reserved. Rhythm Recognition - Part 1

Slide 186 of 250 Next Back Close Copyright © 2011 by Mosby Inc. All rights reserved. Ventricular rate/rhythm None Atrial rate/rhythm 94 bpm/regular PR interval None QRS duration None Identification P-wave asystole

Slide 187 of 250 Next Back Close Copyright © 2011 by Mosby Inc. All rights reserved. Rhythm Recognition - Part 1  This rhythm strip is from a 74-year-old woman with chest pain. Blood pressure: 192/90. She rates her pain as a 9 on a scale of 0 to 10.

Slide 188 of 250 Next Back Close Copyright © 2011 by Mosby Inc. All rights reserved. Ventricular rate/rhythm 136 bpm/regular Atrial rate/rhythm 136 bpm/regular PR interval 0.14 sec QRS duration 0.08 sec Identification Sinus tachycardia

Slide 189 of 250 Next Back Close Copyright © 2011 by Mosby Inc. All rights reserved. Rhythm Recognition - Part 1

Slide 190 of 250 Next Back Close Copyright © 2011 by Mosby Inc. All rights reserved. Ventricular rate/rhythm 91 bpm/ Regular except for the event Atrial rate/rhythm 91 bpm/ Regular except for the event PR interval 0.16 sec QRS duration 0.06 sec Identification Sinus rhythm with a nonconducted PAC

Slide 191 of 250 Next Back Close Copyright © 2011 by Mosby Inc. All rights reserved. Rhythm Recognition - Part 1

Slide 192 of 250 Next Back Close Copyright © 2011 by Mosby Inc. All rights reserved. Ventricular rate/rhythm 35 bpm/regular Atrial rate/rhythm 35 bpm/regular PR interval 0.16 sec QRS duration 0.06 sec Note U waves are present (they follow the T waves) Identification Sinus bradycardia with ST-segment depression

Slide 193 of 250 Next Back Close Copyright © 2011 by Mosby Inc. All rights reserved. Rhythm Recognition - Part 1  This rhythm strip is from a 97-year-old man with chest pain.

Slide 194 of 250 Next Back Close Copyright © 2011 by Mosby Inc. All rights reserved. Atrial paced activity? Yes Ventricular paced activity? Yes Paced interval rate 60 Identification AV sequential pacemaker with failure to capture

Slide 195 of 250 Next Back Close Copyright © 2011 by Mosby Inc. All rights reserved. Rhythm Recognition - Part 1  This rhythm strip is from an 85-year-old woman with an altered level of responsiveness. Blood pressure: 136/78, blood sugar is 96.

Slide 196 of 250 Next Back Close Copyright © 2011 by Mosby Inc. All rights reserved. Ventricular rate/rhythm 115 bpm (sinus beats)/ Regular except for the event Atrial rate/rhythm 115 bpm (sinus beats)/ Regular except for the event PR interval 0.20 sec (sinus beats) QRS duration 0.08 to 0.10 sec (sinus beats) Identification Sinus tachycardia with a PVC and a ventricular couplet

Slide 197 of 250 Next Back Close Copyright © 2011 by Mosby Inc. All rights reserved. Rhythm Recognition - Part 1  This rhythm strip is from an 88-year-old man complaining of chest pain that he rates as a 6 on a scale of 0 to 10. Blood pressure: 170/80.

Slide 198 of 250 Next Back Close Copyright © 2011 by Mosby Inc. All rights reserved. Ventricular rate/rhythm 115 bpm (sinus beats)/ Regular except for the event Atrial rate/rhythm 115 bpm (sinus beats)/ Regular except for the event PR interval 0.16 sec QRS duration 0.08 sec Identification Sinus tachycardia with PACs

Slide 199 of 250 Next Back Close Copyright © 2011 by Mosby Inc. All rights reserved. Rhythm Recognition - Part 1

Slide 200 of 250 Next Back Close Copyright © 2011 by Mosby Inc. All rights reserved. Ventricular rate/rhythm 29 bpm/essentially regular Atrial rate/rhythm None PR interval None QRS duration 0.04 to 0.06 sec Identification Junctional bradycardia with ST-segment depression

Slide 201 of 250 Next Back Close Copyright © 2011 by Mosby Inc. All rights reserved. Rhythm Recognition - Part 1

Slide 202 of 250 Next Back Close Copyright © 2011 by Mosby Inc. All rights reserved. Ventricular rate/rhythm 88 bpm/regular Atrial rate/rhythm 88 bpm/regular PR interval 0.28 sec QRS duration 0.08 sec Identification Sinus rhythm at 88 bpm with first- degree AV block; ST-segment elevation

Slide 203 of 250 Next Back Close Copyright © 2011 by Mosby Inc. All rights reserved. Rhythm Recognition - Part 1  This rhythm strip is from a 44-year-old construction worker with a sudden onset of chest pressure.

Slide 204 of 250 Next Back Close Copyright © 2011 by Mosby Inc. All rights reserved. Ventricular rate/rhythm 52 to 94 bpm/irregular Atrial rate/rhythm 52 to 94 bpm/irregular PR interval 0.12 sec QRS duration 0.08 sec Identification Sinus arrhythmia at 52 to 94 bpm

Slide 205 of 250 Next Back Close Copyright © 2011 by Mosby Inc. All rights reserved. Rhythm Recognition - Part 1

Slide 206 of 250 Next Back Close Copyright © 2011 by Mosby Inc. All rights reserved. Atrial pacing? No Ventricular pacing? Yes Paced interval 80 Identification Ventricular-paced rhythm with pacemaker malfunction (failure to capture)

Slide 207 of 250 Next Back Close Copyright © 2011 by Mosby Inc. All rights reserved. Rhythm Recognition - Part 1  This rhythm strip is from an 82-year-old man complaining of back pain.  Top = lead II, bottom = MCL1.

Slide 208 of 250 Next Back Close Copyright © 2011 by Mosby Inc. All rights reserved. Ventricular rate/rhythm 41 to 73 bpm/irregular Atrial rate/rhythm 56 to 125 bpm/irregular PR interval 0.20 sec QRS duration 0.12 Identification Sinus rhythm at 41 to 73 bpm with a nonconducted PAC

Slide 209 of 250 Next Back Close Copyright © 2011 by Mosby Inc. All rights reserved. Rhythm Recognition - Part 1

Slide 210 of 250 Next Back Close Copyright © 2011 by Mosby Inc. All rights reserved. Ventricular rate/rhythm 78 bpm/regular except for the event Atrial rate/rhythm 78 bpm/regular except for the event PR interval 0.16 sec QRS duration 0.06 sec Identification Sinus rhythm at 78 bpm with a PAC, ST- segment elevation (PAC is the third complex from left)

Slide 211 of 250 Next Back Close Copyright © 2011 by Mosby Inc. All rights reserved. Rhythm Recognition - Part 1

Slide 212 of 250 Next Back Close Copyright © 2011 by Mosby Inc. All rights reserved. Ventricular rate/rhythm 44 bpm/regular Atrial rate/rhythm 44 bpm/regular PR interval 0.14 sec QRS duration 0.08 sec Identification Junctional rhythm at 44 bpm; ST- segment elevation

Slide 213 of 250 Next Back Close Copyright © 2011 by Mosby Inc. All rights reserved. Rhythm Recognition - Part 1

Slide 214 of 250 Next Back Close Copyright © 2011 by Mosby Inc. All rights reserved. Ventricular rate/rhythm 115 bpm (sinus beats)/regular except for the event Atrial rate/rhythm 115 bpm (sinus beats)/regular except for the event PR interval 0.16 sec (sinus beats) QRS duration 0.06 sec (sinus beats) Identification Sinus tachycardia at 115 bpm with a PJC (fifth beat is the PJC)

Slide 215 of 250 Next Back Close Copyright © 2011 by Mosby Inc. All rights reserved. Rhythm Recognition - Part 1  This rhythm strip is from an 82-year-old man complaining of chest pain.

Slide 216 of 250 Next Back Close Copyright © 2011 by Mosby Inc. All rights reserved. Ventricular rate/rhythm 245 bpm/regular Atrial rate/rhythm 245 bpm/regular PR interval None QRS duration 0.28 sec Identification Monomorphic ventricular tachycardia at 245 bpm

Slide 217 of 250 Next Back Close Copyright © 2011 by Mosby Inc. All rights reserved. Rhythm Recognition - Part 1

Slide 218 of 250 Next Back Close Copyright © 2011 by Mosby Inc. All rights reserved. Ventricular rate/rhythm 21 bpm/irregular Atrial rate/rhythm 21 bpm/irregular PR interval 0.36 sec QRS duration 0.08 to 0.10 sec Identification Sinus bradycardia at 21 bpm with junctional escape

Slide 219 of 250 Next Back Close Copyright © 2011 by Mosby Inc. All rights reserved. Rhythm Recognition - Part 1

Slide 220 of 250 Next Back Close Copyright © 2011 by Mosby Inc. All rights reserved. Ventricular rate/rhythm 48 to 83 bpm/irregular Atrial rate/rhythm 167 bpm/regular PR interval 0.24 sec QRS duration 0.12 sec Identification Second-degree AV block type II at 48 to 83 bpm; ST-segment depression

Slide 221 of 250 Next Back Close Copyright © 2011 by Mosby Inc. All rights reserved. Rhythm Recognition - Part 1

Slide 222 of 250 Next Back Close Copyright © 2011 by Mosby Inc. All rights reserved. Ventricular rate/rhythm 115 to 215 bpm/irregular Atrial rate/rhythm Unable to determine/irregular PR interval Varies QRS duration 0.04 to 0.06 sec Identification Multifocal atrial tachycardia at 115 to 215 bpm with ST- segment depression

Slide 223 of 250 Next Back Close Copyright © 2011 by Mosby Inc. All rights reserved. Rhythm Recognition - Part 1

Slide 224 of 250 Next Back Close Copyright © 2011 by Mosby Inc. All rights reserved. Ventricular rate/rhythm 71 bpm, regular Atrial rate/rhythm 71 bpm, regular PR interval 0.16 to 0.20 sec QRS duration 0.12 to 0.14 sec Identification Sinus rhythm at 71 bpm with a wide QRS, ST-segment depression

Slide 225 of 250 Next Back Close Copyright © 2011 by Mosby Inc. All rights reserved. Rhythm Recognition - Part 1

Slide 226 of 250 Next Back Close Copyright © 2011 by Mosby Inc. All rights reserved. Ventricular rate/rhythm 94 bpm (sinus beats)/irregular Atrial rate/rhythm 94 bpm (sinus beats)/irregular PR interval 0.16 sec (sinus beats) QRS duration 0.08 sec (sinus beats) Identification Sinus rhythm with an episode of couplets and a run of VT

Slide 227 of 250 Next Back Close Copyright © 2011 by Mosby Inc. All rights reserved. Rhythm 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.

Slide 228 of 250 Next Back Close Copyright © 2011 by Mosby Inc. All rights reserved. Ventricular rate/rhythm 44 bpm/regular Atrial rate/rhythm 44 bpm/regular PR interval 0.16 sec QRS duration 0.06 sec Identification Sinus bradycardia at 44 bpm, ST-segment depression. Note the upright U waves following each T wave. U wave

Slide 229 of 250 Next Back Close Copyright © 2011 by Mosby Inc. All rights reserved. Rhythm Recognition - Part 1

Slide 230 of 250 Next Back Close Copyright © 2011 by Mosby Inc. All rights reserved. Ventricular rate/rhythm 60 to 98 bpm/irregular Atrial rate/rhythm 111 bpm/regular PR interval Lengthens QRS duration 0.08 sec Identification Second-degree AV block type I at 68 to 90 bpm; ST-segment depression

Slide 231 of 250 Next Back Close Copyright © 2011 by Mosby Inc. All rights reserved. Rhythm Recognition - Part 1  This rhythm strip is from a 69-year-old man who is disoriented. He knows his name but has no idea where he is or how he got there. BP: 172/98, R: 20. Blood sugar: 127 mg/dL.

Slide 232 of 250 Next Back Close Copyright © 2011 by Mosby Inc. All rights reserved. Ventricular rate/rhythm 79 bpm/regular Atrial rate/rhythm 79 bpm/regular PR interval 0.18 sec QRS duration 0.06 to 0.08 sec Identification Sinus rhythm at 79 bpm

Slide 233 of 250 Next Back Close Copyright © 2011 by Mosby Inc. All rights reserved. Rhythm Recognition - Part 1  This rhythm strip is from a 35-year-old woman complaining of chest pain and palpitations.

Slide 234 of 250 Next Back Close Copyright © 2011 by Mosby Inc. All rights reserved. Ventricular rate/rhythm 188 bpm/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

Slide 235 of 250 Next Back Close Copyright © 2011 by Mosby Inc. All rights reserved. Rhythm Recognition - Part 1

Slide 236 of 250 Next Back Close Copyright © 2011 by Mosby Inc. All rights reserved. Ventricular rate/rhythm 64 bpm (sinus beats)/regular except for the event Atrial rate/rhythm 64 bpm (sinus beats)/regular except for the event PR interval 0.16 to 0.18 sec QRS duration 0.08 sec Identification Sinus rhythm with an episode of sinus arrest and a junctional escape beat

Slide 237 of 250 Next Back Close Copyright © 2011 by Mosby Inc. All rights reserved. Rhythm Recognition - Part 1   This rhythm strip is from an 82-year-old man complaining of back pain. Lead II Lead MCL 1

Slide 238 of 250 Next Back Close Copyright © 2011 by Mosby Inc. All rights reserved. Ventricular rate/rhythm 75 bpm/regular except for event Atrial rate/rhythm 75 bpm/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 Lead II Lead MCL 1

Slide 239 of 250 Next Back Close Copyright © 2011 by Mosby Inc. All rights reserved. Rhythm Recognition - Part 1  This rhythm strip is from a 51-year-old man complaining of dull chest pain that began about 2 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, and diaphoretic.

Slide 240 of 250 Next Back Close Copyright © 2011 by Mosby Inc. All rights reserved. Ventricular rate/rhythm 48 bpm/regular Atrial rate/rhythm 71 bpm/slightly irregular PR interval Varies QRS duration 0.08 to 0.10 sec Identification Complete AV block at 48 bpm with ST-segment elevation

Slide 241 of 250 Next Back Close Copyright © 2011 by Mosby Inc. All rights reserved. Rhythm Recognition - Part 1

Slide 242 of 250 Next Back Close Copyright © 2011 by Mosby Inc. All rights reserved. Ventricular rate/rhythm 250 to 333 bpm/irregular Atrial rate/rhythm Unable to determine PR interval Unable to determine QRS duration 0.16 sec Identification Polymorphic VT at 250 to 333 bpm

Slide 243 of 250 Next Back Close Copyright © 2011 by Mosby Inc. All rights reserved. Rhythm Recognition - Part 1

Slide 244 of 250 Next Back Close Copyright © 2011 by Mosby Inc. All rights reserved. Atrial pacing? No Ventricular pacing? Yes Paced interval 74 Identification 100% ventricular paced rhythm

Slide 245 of 250 Next Back Close Copyright © 2011 by Mosby Inc. All rights reserved. Rhythm 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.

Slide 246 of 250 Next Back Close Copyright © 2011 by Mosby Inc. All rights reserved. Ventricular rate/rhythm bpm/irregular Atrial rate/rhythm Unable to determine PR interval Unable to determine QRS duration 0.10 sec Identification Controlled atrial fibrillation at bpm

Slide 247 of 250 Next Back Close Copyright © 2011 by Mosby Inc. All rights reserved. Rhythm Recognition - Part 1

Slide 248 of 250 Next Back Close Copyright © 2011 by Mosby Inc. All rights reserved. Ventricular rate/rhythm 50 bpm/regular Atrial rate/rhythm 167 bpm/regular PR interval Varies QRS duration 0.06 sec Identification Third-degree AV block at 50 bpm; ST-segment elevation

Slide 249 of 250 Next Back Close Copyright © 2011 by Mosby Inc. All rights reserved. Rhythm Recognition - Part 1  This rhythm strip is from a 1-year-old girl. Mom says the infant suddenly went limp and her limbs began shaking. The episode lasted about 45 sec. Her temperature is normal.

Slide 250 of 250 Next Back Close Copyright © 2011 by Mosby Inc. All rights reserved. Ventricular rate/rhythm 215 bpm/regular Atrial rate/rhythm 215 bpm/regular PR interval 0.10 sec QRS duration 0.08 sec Identification Sinus tachycardia at 215 bpm