Rhythm Identification

Rhythm Identification
Copyright © 2006 by Mosby Inc. All rights reserved.

Ventricular rate/rhythm 68 bpm/regular
Atrial rate/rhythm PR interval 0.24 sec QRS duration 0.06 to 0.08 sec Identification Sinus rhythm with first-degree AV block, ST-segment elevation Copyright © 2006 by Mosby Inc. All rights reserved.

Ventricular rate/rhythm 83/min (sinus beats)/
Regular except for the event Atrial rate/rhythm PR interval 0.20 sec QRS duration 0.08 to 0.10 sec Identification Sinus rhythm with two PJCs, ST-segment elevation Copyright © 2006 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 Copyright © 2006 by Mosby Inc. All rights reserved.

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. Copyright © 2006 by Mosby Inc. All rights reserved.

Ventricular rate/rhythm 107 bpm (sinus beats)/
Regular except for the events Atrial rate/rhythm PR interval 0.20 sec (sinus beats) QRS duration 0.08 sec (sinus beats) Identification Sinus tachycardia with uniform PVCs Copyright © 2006 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 QRS duration 0.12 to 0.16 sec (VT) to sec (atrial fib) Identification Monomorphic VT to atrial fibrillation Copyright © 2006 by Mosby Inc. All rights reserved.

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 Copyright © 2006 by Mosby Inc. All rights reserved.

Regular except for the event(s) Atrial rate/rhythm PR interval 0.24 sec (sinus beats) QRS duration 0.08 sec (sinus beats) Identification Sinus rhythm with first-degree AV block and PACs Copyright © 2006 by Mosby Inc. All rights reserved.

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 Copyright © 2006 by Mosby Inc. All rights reserved.

Ventricular paced activity?
Atrial paced activity? Yes Ventricular paced activity? Paced interval rate 71 Identification 100% paced rhythm – AV sequential pacemaker Copyright © 2006 by Mosby Inc. All rights reserved.

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. Copyright © 2006 by Mosby Inc. All rights reserved.

Ventricular paced activity? Yes
Atrial paced activity? No Ventricular paced activity? Yes Paced interval rate 83 Identification 100% ventricular paced rhythm Copyright © 2006 by Mosby Inc. All rights reserved.

Regular except for the event (every other beat is an ectopic beat) Atrial rate/rhythm PR interval 0.12 sec (sinus beats) QRS duration 0.08 to 0.10 sec (sinus beats) Identification Sinus bradycardia with ventricular bigeminy Copyright © 2006 by Mosby Inc. All rights reserved.

Ventricular rate/rhythm
63 to 79 bpm (sinus beats)/ Irregular (sinus beats) Atrial rate/rhythm 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 Copyright © 2006 by Mosby Inc. All rights reserved.

Regular except for the event Atrial rate/rhythm PR interval 0.18 sec (sinus beats) QRS duration 0.06 sec (sinus beats) Identification Sinus rhythm with uniform PVCs Copyright © 2006 by Mosby Inc. All rights reserved.

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. Copyright © 2006 by Mosby Inc. All rights reserved.

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. Copyright © 2006 by Mosby Inc. All rights reserved.

Ventricular rate/rhythm None
Atrial rate/rhythm PR interval QRS duration Identification Asystole Copyright © 2006 by Mosby Inc. All rights reserved.

Ventricular rate/rhythm 65 to 75 bpm (sinus beats)/Irregular
Atrial rate/rhythm 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 Copyright © 2006 by Mosby Inc. All rights reserved.

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 Copyright © 2006 by Mosby Inc. All rights reserved.

Ventricular rate/rhythm 83 bpm (sinus beats)/regular
Atrial rate/rhythm PR interval 0.20 sec (sinus beats) QRS duration 0.06 to 0.08 sec (sinus beats) Identification Atrial flutter to sinus rhythm Copyright © 2006 by Mosby Inc. All rights reserved.

Regular except for the event Atrial rate/rhythm PR interval 0.12 sec (sinus beats) QRS duration 0.08 to 0.10 sec (sinus beats) Identification Sinus rhythm with uniform PVCs Copyright © 2006 by Mosby Inc. All rights reserved.

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. Copyright © 2006 by Mosby Inc. All rights reserved.

Ventricular rate/rhythm 187 bpm (atrial beats)/ Regular (atrial beats)
Atrial rate/rhythm Unable to determine PR interval QRS duration 0.08 sec (atrial beats) Identification Junctional to sinus to narrow-QRS tachycardia Copyright © 2006 by Mosby Inc. All rights reserved.

Ventricular rate/rhythm Unable to determine
Atrial rate/rhythm PR interval QRS duration Identification Ventricular fibrillation (coarse) Copyright © 2006 by Mosby Inc. All rights reserved.

Atrial rate/rhythm 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 Copyright © 2006 by Mosby Inc. All rights reserved.

Atrial rate/rhythm PR interval QRS duration Identification Asystole – the electrical activity shown is caused by pacemaker spikes from the patient’s permanent pacemaker (no capture) Copyright © 2006 by Mosby Inc. All rights reserved.

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 Copyright © 2006 by Mosby Inc. All rights reserved.

Ventricular rate/rhythm 48 bpm (junctional beats)/ regular
Atrial rate/rhythm Unable to determine (junctional beats) PR interval QRS duration 0.06 to 0.08 sec Identification Sinus bradycardia with a first-degree AV block to junctional escape rhythm Copyright © 2006 by Mosby Inc. All rights reserved.

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. Copyright © 2006 by Mosby Inc. All rights reserved.

Regular except for the event (every other beat is an ectopic beat) Atrial rate/rhythm 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 Copyright © 2006 by Mosby Inc. All rights reserved.

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. Copyright © 2006 by Mosby Inc. All rights reserved.

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. Copyright © 2006 by Mosby Inc. All rights reserved.

Regular except for the event (every other beat is an ectopic beat) Atrial rate/rhythm 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 Copyright © 2006 by Mosby Inc. All rights reserved.

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. Copyright © 2006 by Mosby Inc. All rights reserved.

Atrial rate/rhythm Unable to determine PR interval QRS duration 0.06 to 0.08 sec Identification Narrow-QRS tachycardia (SVT) with ST-segment depression Copyright © 2006 by Mosby Inc. All rights reserved.

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. Copyright © 2006 by Mosby Inc. All rights reserved.

Regular except for the event(s) Atrial rate/rhythm PR interval 0.20 sec (sinus beats) QRS duration 0.06 sec (sinus beats) Identification Sinus rhythm with uniform PVCs, ST-segment depression Copyright © 2006 by Mosby Inc. All rights reserved.

Ventricular rate/rhythm 130 to 214 bpm/ irregular
Atrial rate/rhythm Unable to determine PR interval QRS duration 0.08 sec Identification Atrial fibrillation with a rapid ventricular response (RVR) Copyright © 2006 by Mosby Inc. All rights reserved.

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. Copyright © 2006 by Mosby Inc. All rights reserved.

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. Copyright © 2006 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 Copyright © 2006 by Mosby Inc. All rights reserved.

Regular except for the event(s) Atrial rate/rhythm 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 Copyright © 2006 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) Copyright © 2006 by Mosby Inc. All rights reserved.

Atrial rate/rhythm 115 bpm/regular PR interval Varies QRS duration 0.08 sec Identification Complete (third-degree) AV block with ST-segment elevation Copyright © 2006 by Mosby Inc. All rights reserved.

Ventricular rate/rhythm 91 bpm/ Regular except for the event
Atrial rate/rhythm PR interval 0.16 sec QRS duration 0.06 sec Identification Sinus rhythm with a nonconducted PAC Copyright © 2006 by Mosby Inc. All rights reserved.

Atrial rate/rhythm 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 Copyright © 2006 by Mosby Inc. All rights reserved.

Ventricular paced activity?
Atrial paced activity? Yes Ventricular paced activity? Paced interval rate 60 Identification AV sequential pacemaker with failure to capture Copyright © 2006 by Mosby Inc. All rights reserved.

Regular except for the event Atrial rate/rhythm 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 Copyright © 2006 by Mosby Inc. All rights reserved.

Ventricular rate/rhythm 29 bpm/essentially regular
Atrial rate/rhythm None PR interval QRS duration 0.04 to 0.06 sec Identification Junctional bradycardia with ST-segment depression Copyright © 2006 by Mosby Inc. All rights reserved.

Ventricular-paced rhythm with pacemaker malfunction
Atrial pacing? No Ventricular pacing? Yes Paced interval 80 Identification Ventricular-paced rhythm with pacemaker malfunction (failure to capture) Copyright © 2006 by Mosby Inc. All rights reserved.

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 Copyright © 2006 by Mosby Inc. All rights reserved.

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

115 bpm (sinus beats)/regular except for the event Atrial rate/rhythm PR interval 0.16 sec (sinus beats) QRS duration 0.06 sec (sinus beats) Identification Sinus tachycardia with a PJC Copyright © 2006 by Mosby Inc. All rights reserved.

Ventricular rate/rhythm 21 bpm/irregular
Atrial rate/rhythm PR interval 0.36 sec QRS duration 0.08 to 0.10 sec Identification Sinus bradycardia with junctional escape beats Copyright © 2006 by Mosby Inc. All rights reserved.

Atrial rate/rhythm Unable to determine/irregular PR interval Varies QRS duration 0.04 to 0.06 sec Identification Multifocal atrial tachycardia with ST-segment depression Copyright © 2006 by Mosby Inc. All rights reserved.

Ventricular rate/rhythm 71/min, regular
Atrial rate/rhythm 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 Copyright © 2006 by Mosby Inc. All rights reserved.

Ventricular rate/rhythm 94 (sinus beats)/irregular
Atrial rate/rhythm 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 Copyright © 2006 by Mosby Inc. All rights reserved.

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. Copyright © 2006 by Mosby Inc. All rights reserved.

U wave Ventricular rate/rhythm 44 bpm/regular Atrial rate/rhythm 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. Copyright © 2006 by Mosby Inc. All rights reserved.

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. Copyright © 2006 by Mosby Inc. All rights reserved.

Ventricular rate/rhythm 188/min/regular
Atrial rate/rhythm Unable to determine PR interval QRS duration 0.06 sec Identification Narrow-QRS tachycardia (AVNRT) with ST-segment depression Copyright © 2006 by Mosby Inc. All rights reserved.

64 bpm (sinus beats)/regular except for the event Atrial rate/rhythm 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 Copyright © 2006 by Mosby Inc. All rights reserved.

Ventricular rate/rhythm 75/min/regular except for event
Lead II Lead MCL1 Ventricular rate/rhythm 75/min/regular except for event Atrial rate/rhythm PR interval 0.20 sec QRS duration 0.12 sec Identification Sinus rhythm at 75 bpm with a wide QRS and a nonconducted PAC Copyright © 2006 by Mosby Inc. All rights reserved.

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. Copyright © 2006 by Mosby Inc. All rights reserved.

Atrial rate/rhythm 71 bpm/slightly irregular PR interval Varies QRS duration 0.08 to 0.10 sec Identification Complete AV block with ST-segment elevation Copyright © 2006 by Mosby Inc. All rights reserved.

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. Copyright © 2006 by Mosby Inc. All rights reserved.

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

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. Copyright © 2006 by Mosby Inc. All rights reserved.

This rhythm strip is from a 77-year-old woman who states that she feels fine. She stopped at a blood pressure machine in Wal-Mart and the machine would not read her pulse rate. She later went to her physician’s office and then to the emergency department. Copyright © 2006 by Mosby Inc. All rights reserved.

Ventricular rate/rhythm 111 bpm/regular except for event
Atrial rate/rhythm PR interval 0.18 sec QRS duration 0.08 sec Identification Sinus tachycardia at 111 bpm with a nonconducted PAC Copyright © 2006 by Mosby Inc. All rights reserved.

Ventricular rate/rhythm Two ventricular complexes to none
Atrial rate/rhythm None PR interval QRS duration 0.14 sec to none Identification Agonal rhythm/asystole Copyright © 2006 by Mosby Inc. All rights reserved.

Ventricular rate/rhythm 30 bpm (sinus beats)/regular except for events
Atrial rate/rhythm PR interval 0.12 to 0.16 sec (sinus beats) QRS duration 0.06 sec (sinus beats) Identification Sinus bradycardia with ventricular bigeminy, inverted T waves, horizontal ST-segments Copyright © 2006 by Mosby Inc. All rights reserved.

Ventricular rate/rhythm 54 bpm/regular (sinus beats)
Atrial rate/rhythm PR interval 0.12 sec (sinus beats) QRS duration sec (sinus beats) Identification Sinus bradycardia with ventricular bigeminy Copyright © 2006 by Mosby Inc. All rights reserved.

Ventricular rate/rhythm 150 bpm/essentially regular
Atrial rate/rhythm Unable to determine PR interval QRS duration 0.12 to 0.16 sec Identification Monomorphic VT Copyright © 2006 by Mosby Inc. All rights reserved.

63 bpm (sinus beats)/regular except for the event (every third beat is a PJC) Atrial rate/rhythm PR interval 0.12 to 0.16 sec (sinus beats) QRS duration 0.06 sec (sinus beats) Identification Sinus rhythm with PJCs Copyright © 2006 by Mosby Inc. All rights reserved.

Ventricular rate/rhythm 125 bpm/essentially regular except for events
Atrial rate/rhythm PR interval 0.12 sec (sinus beats) QRS duration 0.06 sec (sinus beats) Identification Sinus tachycardia with multiform PVCs Copyright © 2006 by Mosby Inc. All rights reserved.

Atrial rate/rhythm Unable to determine PR interval QRS duration 0.12 sec Identification Accelerated idioventricular rhythm (AIVR) with ST-segment elevation Copyright © 2006 by Mosby Inc. All rights reserved.

Rhythm Identification

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