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

2. Copyright © 2006 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

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

4. Copyright © 2006 by Mosby Inc. All rights reserved. Ventricular rate/rhythm 83/min (sinus beats)/ Regular except for the event Atrial rate/rhythm 83/min (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

5. Copyright © 2006 by Mosby Inc. All rights reserved. Rhythm Identification  This rhythm strip is from an 83-year-old woman with syncope.

6. 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

7. Copyright © 2006 by Mosby Inc. All rights reserved. Rhythm Identification  This rhythm strip is from an 82-year-old man complaining of back pain.  Top = lead II, bottom = MCL1

8. Copyright © 2006 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

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

10. Copyright © 2006 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)

11. Copyright © 2006 by Mosby Inc. All rights reserved. Rhythm Identification  This rhythm strip is from a 69-year-old man complaining of shortness of breath. Lung sounds reveal bilateral rales. Blood pressure: 160/58.

12. Copyright © 2006 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

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

14. Copyright © 2006 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

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

16. Copyright © 2006 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

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

18. 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 Unable to determine QRS duration 0.12 to 0.16 sec (VT) to 0.06 sec (atrial fib) Identification Monomorphic VT to atrial fibrillation

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

20. Copyright © 2006 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

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

22. Copyright © 2006 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

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

24. Copyright © 2006 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

25. Copyright © 2006 by Mosby Inc. All rights reserved. Rhythm Identification  This rhythm strip is from a 52-year-old man found unresponsive, apneic, and pulseless.

26. Copyright © 2006 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)

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

28. Copyright © 2006 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

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

30. Copyright © 2006 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

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

32. Copyright © 2006 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

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

34. Copyright © 2006 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)

35. Copyright © 2006 by Mosby Inc. All rights reserved. Rhythm Identification  This rhythm strip is from a 97-year-old woman after a fall.

36. Copyright © 2006 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

37. Copyright © 2006 by Mosby Inc. All rights reserved. Rhythm Identification  This rhythm strip is from a 70-year-old man complaining of a sharp pain across his shoulders. Blood pressure: 218/86.

38. Copyright © 2006 by Mosby Inc. All rights reserved. Ventricular rate/rhythm 115/min (sinus beats)/ Regular except for the events Atrial rate/rhythm 115/min (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

39. Copyright © 2006 by Mosby Inc. All rights reserved. Rhythm Identification  This rhythm strip is from a 76-year-old man complaining of indigestion.

40. Copyright © 2006 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

41. Copyright © 2006 by Mosby Inc. All rights reserved. Rhythm Identification  This rhythm strip is from an 80-year-old woman complaining of weakness.

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

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

44. Copyright © 2006 by Mosby Inc. All rights reserved. Ventricular rate/rhythm 55/min (sinus beats)/ Regular except for the event (every other beat is an ectopic beat) Atrial rate/rhythm 55/min (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

45. Copyright © 2006 by Mosby Inc. All rights reserved. Rhythm Identification  This rhythm strip is from a 90-year-old woman complaining of hip pain after a fall.

46. Copyright © 2006 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

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

48. Copyright © 2006 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

49. Copyright © 2006 by Mosby Inc. All rights reserved. Rhythm Identification  This rhythm strip is from a 78-year-old man complaining of palpitations. Note the point at which the patient was defibrillated.

50. Copyright © 2006 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

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

52. Copyright © 2006 by Mosby Inc. All rights reserved. Ventricular rate/rhythm 68 bpm (sinus beats)/ Regular except for the event Atrial rate/rhythm 68 bpm (sinus beats)/ 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

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

54. Copyright © 2006 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 to 0.10 sec Identification Sinus tachycardia with PACs

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

56. Copyright © 2006 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

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

58. Copyright © 2006 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)

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

60. Copyright © 2006 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

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

62. Copyright © 2006 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

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

64. Copyright © 2006 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

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

66. Copyright © 2006 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

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

68. Copyright © 2006 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)

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

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

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

72. Copyright © 2006 by Mosby Inc. All rights reserved. Atrial paced activity? No Ventricular paced activity? Yes Paced interval rate 65 Identification 100% ventricular paced rhythm

73. Copyright © 2006 by Mosby Inc. All rights reserved. Rhythm Identification  These rhythm strips are from a 46-year-old woman complaining of abdominal pain.

74. Copyright © 2006 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

75. Copyright © 2006 by Mosby Inc. All rights reserved. Rhythm Identification  This rhythm strip is from a 61-year-old man with a history of heart failure.

76. Copyright © 2006 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

77. Copyright © 2006 by Mosby Inc. All rights reserved. Rhythm Identification  This rhythm strip is from a 1-month-old infant after a 3-minute seizure.

78. Copyright © 2006 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

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

80. Copyright © 2006 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

81. Copyright © 2006 by Mosby Inc. All rights reserved. Rhythm Identification  This rhythm strip is from a 72-year-old man complaining of chest pain.

82. Copyright © 2006 by Mosby Inc. All rights reserved. Atrial paced activity? No Ventricular paced activity? Yes Paced interval rate 60 Identification 100% ventricular paced rhythm

83. Copyright © 2006 by Mosby Inc. All rights reserved. Rhythm Identification  This rhythm strip is from a 77-year-old woman with a congested cough.

84. Copyright © 2006 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)

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

86. Copyright © 2006 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

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

88. Copyright © 2006 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

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

90. Copyright © 2006 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

91. Copyright © 2006 by Mosby Inc. All rights reserved. Rhythm Identification  This rhythm strip is from a 54-year-old man who had a syncopal episode.

92. Copyright © 2006 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

93. Copyright © 2006 by Mosby Inc. All rights reserved. Rhythm Identification  This rhythm strip is from a 66-year-old man complaining of chest pain. Blood pressure: 170/96.

94. Copyright © 2006 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

95. Copyright © 2006 by Mosby Inc. All rights reserved. Rhythm Identification  This rhythm strip is from a 43-year-old woman complaining of palpitations.

96. Copyright © 2006 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

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

98. 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 Unable to determine QRS duration 0.08 sec (atrial beats) Identification Junctional to sinus to narrow-QRS tachycardia

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

100. Copyright © 2006 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)

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

102. Copyright © 2006 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

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

104. Copyright © 2006 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

105. Copyright © 2006 by Mosby Inc. All rights reserved. Rhythm Identification  This rhythm strip is from a 76-year-old woman complaining of back pain. Her medical history includes a myocardial infarction 2 years ago.

106. Copyright © 2006 by Mosby Inc. All rights reserved. Atrial paced activity? No Ventricular paced activity? Yes Paced interval rate 65 Identification 100% ventricular paced rhythm

107. Copyright © 2006 by Mosby Inc. All rights reserved. Rhythm Identification  This rhythm strip is from an 80-year-old man found sitting in a chair. He is unresponsive, apneic, and pulseless.

108. Copyright © 2006 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)

109. Copyright © 2006 by Mosby Inc. All rights reserved. Rhythm Identification  This rhythm strip is from an 88-year-old woman complaining of hip pain after a fall injury.

110. Copyright © 2006 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

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

112. Copyright © 2006 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

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

114. 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 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

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

116. Copyright © 2006 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

117. Copyright © 2006 by Mosby Inc. All rights reserved. Rhythm Identification  This rhythm strip is from an 84-year-old man complaining of dizziness. He had a triple bypass 4 days ago.

118. Copyright © 2006 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

119. Copyright © 2006 by Mosby Inc. All rights reserved. Rhythm Identification  This rhythm strip is from an 81-year-old woman with an altered level of responsiveness. blood pressure: 160/70, blood sugar: 114.

120. Copyright © 2006 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

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

122. Copyright © 2006 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)

123. Copyright © 2006 by Mosby Inc. All rights reserved. Rhythm Identification  This rhythm strip is from a 91-year-old woman complaining of chest pain and difficulty breathing.

124. Copyright © 2006 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

125. Copyright © 2006 by Mosby Inc. All rights reserved. Rhythm Identification  This rhythm strip is from an 85-year-old woman complaining of numbness in her legs.

126. Copyright © 2006 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

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

128. Copyright © 2006 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

129. Copyright © 2006 by Mosby Inc. All rights reserved. Rhythm Identification  This rhythm strip is from an 82-year-old woman with vomiting x 2 days.

130. Copyright © 2006 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

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

132. Copyright © 2006 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

133. Copyright © 2006 by Mosby Inc. All rights reserved. Rhythm Identification  This rhythm strip is from a 6-year-old boy immediately after a seizure.

134. Copyright © 2006 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

135. Copyright © 2006 by Mosby Inc. All rights reserved. Rhythm Identification  This rhythm strip is from a 76-year-old man who was playing golf and experienced a syncopal episode.

136. Copyright © 2006 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

137. Copyright © 2006 by Mosby Inc. All rights reserved. Rhythm Identification  These rhythm strips are from a 44-year-old woman complaining of chest pain.

138. Copyright © 2006 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

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

140. Copyright © 2006 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

141. Copyright © 2006 by Mosby Inc. All rights reserved. Rhythm Identification  This rhythm strip is from an 81-year-old woman complaining of chest pain.

142. Copyright © 2006 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)

143. Copyright © 2006 by Mosby Inc. All rights reserved. Rhythm Identification  This rhythm strip is from a 74-year-old woman complaining of weakness.

144. Copyright © 2006 by Mosby Inc. All rights reserved. Atrial paced activity? No Ventricular paced activity? Yes Paced interval rate 68 Identification Ventricular demand pacemaker

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

146. Copyright © 2006 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

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

148. Copyright © 2006 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

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

150. Copyright © 2006 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)

151. Copyright © 2006 by Mosby Inc. All rights reserved. Rhythm Identification  These rhythm strips are from a 63-year-old woman who experienced a syncopal episode. Blood pressure is 200/90, blood sugar is 98.

152. Copyright © 2006 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

153. Copyright © 2006 by Mosby Inc. All rights reserved. Rhythm Identification  This rhythm strip is from an 84-year-old woman with a nosebleed. Blood pressure: 250/74.

154. Copyright © 2006 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

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

156. Copyright © 2006 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

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

158. Copyright © 2006 by Mosby Inc. All rights reserved. Atrial paced activity? No Ventricular paced activity? Yes Paced interval rate 60 Identification 100% ventricular paced rhythm

159. Copyright © 2006 by Mosby Inc. All rights reserved. Rhythm Identification  This rhythm strip is from an 80-year-old man complaining of weakness and dizziness. Blood pressure is 160/98, blood sugar is 88.

160. Copyright © 2006 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)

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

162. Copyright © 2006 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

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

164. Copyright © 2006 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

165. Copyright © 2006 by Mosby Inc. All rights reserved. Rhythm Identification  This rhythm strip is from a 60-year-old woman complaining of palpitations and shortness of breath.

166. Copyright © 2006 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)

167. Copyright © 2006 by Mosby Inc. All rights reserved. Rhythm Identification  This rhythm strip is from a 60-year-old woman complaining of palpitations and shortness of breath after administration of adenosine 6 mg IV.

168. Copyright © 2006 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

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

170. Copyright © 2006 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

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

172. Copyright © 2006 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)

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

174. 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

175. Copyright © 2006 by Mosby Inc. All rights reserved. Rhythm Identification  This rhythm strip is from a 90-year-old woman with shortness of breath.

176. Copyright © 2006 by Mosby Inc. All rights reserved. Atrial paced activity? No Ventricular paced activity? Yes Paced interval rate 60 Identification 100% ventricular paced rhythm

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

178. Copyright © 2006 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

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

180. 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)

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

182. Copyright © 2006 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

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

184. Copyright © 2006 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

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

186. Copyright © 2006 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

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

188. Copyright © 2006 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

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

190. Copyright © 2006 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

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

192. Copyright © 2006 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

193. Copyright © 2006 by Mosby Inc. All rights reserved. Rhythm Identification  This rhythm strip is from a 97-year-old man with chest pain.

194. Copyright © 2006 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

195. Copyright © 2006 by Mosby Inc. All rights reserved. Rhythm Identification  This rhythm strip is from an 85-year-old woman with an altered level of responsiveness. Blood pressure: 136/78, blood sugar is 96.

196. Copyright © 2006 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

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

198. Copyright © 2006 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

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

200. Copyright © 2006 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

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

202. Copyright © 2006 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 with first-degree AV block; ST-segment elevation

203. Copyright © 2006 by Mosby Inc. All rights reserved. Rhythm Identification  This rhythm strip is from a 44-year-old construction worker with a sudden onset of chest pressure.

204. Copyright © 2006 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

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

206. Copyright © 2006 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)

207. Copyright © 2006 by Mosby Inc. All rights reserved. Rhythm Identification  This rhythm strip is from an 82-year-old man complaining of back pain.  Top = lead II, bottom = MCL1.

208. Copyright © 2006 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

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

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

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

212. Copyright © 2006 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; ST-segment elevation

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

214. Copyright © 2006 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 with a PJC

215. Copyright © 2006 by Mosby Inc. All rights reserved. Rhythm Identification  This rhythm strip is from an 82-year-old man complaining of chest pain.

216. Copyright © 2006 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

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

218. Copyright © 2006 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 with junctional escape beats

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

220. Copyright © 2006 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; ST-segment depression

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

222. Copyright © 2006 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 with ST-segment depression

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

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

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

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

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

228. Copyright © 2006 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

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

230. Copyright © 2006 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; ST-segment depression

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

232. Copyright © 2006 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

233. Copyright © 2006 by Mosby Inc. All rights reserved. Rhythm Identification  This rhythm strip is from a 35-year-old woman complaining of chest pain and palpitations.

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

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

236. Copyright © 2006 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

237. Copyright © 2006 by Mosby Inc. All rights reserved. Rhythm Identification   This rhythm strip is from an 82-year-old man complaining of back pain. Lead II Lead MCL 1

238. Copyright © 2006 by Mosby Inc. All rights reserved. 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 Lead II Lead MCL 1

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

240. Copyright © 2006 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 with ST-segment elevation

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

242. Copyright © 2006 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

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

244. Copyright © 2006 by Mosby Inc. All rights reserved. Atrial pacing? No Ventricular pacing? Yes Paced interval 74 Identification 100% ventricular paced rhythm

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

246. Copyright © 2006 by Mosby Inc. All rights reserved. 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 55-94 bpm

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

248. Copyright © 2006 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; ST-segment elevation

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

250. Copyright © 2006 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

251. Copyright © 2006 by Mosby Inc. All rights reserved. Rhythm Identification  This rhythm strip is from an 81-year-old woman complaining of weakness. BP: 122/59, R: 12. Blood sugar is 109 mg/dL.

252. Copyright © 2006 by Mosby Inc. All rights reserved. Ventricular rate/rhythm 52 bpm/regular Atrial rate/rhythm 52 bpm/regular PR interval 0.16 to 0.20 sec QRS duration 0.06 sec Identification Sinus bradycardia

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

254. Copyright © 2006 by Mosby Inc. All rights reserved. Ventricular rate/rhythm 71 bpm/regular Atrial rate/rhythm 71 bpm/regular PR interval 0.14 sec QRS duration 0.08 sec Identification Accelerated junctional rhythm; ST-segment elevation

255. Copyright © 2006 by Mosby Inc. All rights reserved. Rhythm Identification   This rhythm strip is from a 26-year-old man after a seizure.

256. Copyright © 2006 by Mosby Inc. All rights reserved. Ventricular rate/rhythm 64 to 94 bpm/irregular Atrial rate/rhythm 64 to 94 bpm/irregular PR interval 0.16 sec QRS duration 0.06 to 0.08 sec Identification Sinus arrhythmia at 64 to 94 bpm

257. Copyright © 2006 by Mosby Inc. All rights reserved. Rhythm Identification  This rhythm strip is from an 18-year-old man with a gunshot wound to his chest.

258. Copyright © 2006 by Mosby Inc. All rights reserved. Ventricular rate/rhythm Unable to determine Atrial rate/rhythm None PR interval None QRS duration None Identification Coarse ventricular fibrillation

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

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

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

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

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

264. Copyright © 2006 by Mosby Inc. All rights reserved. Ventricular rate/rhythm 30 bpm/regular Atrial rate/rhythm 68 bpm/regular PR interval 0.28 sec QRS duration 0.16 sec Identification 2:1 AV block, probably type II; ST-segment elevation

265. Copyright © 2006 by Mosby Inc. All rights reserved. Rhythm Identification   This rhythm strip is from a 57-year-old man with no cardiac history.

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

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

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

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

270. Copyright © 2006 by Mosby Inc. All rights reserved. Ventricular rate/rhythm 30 bpm (sinus beats)/regular except for events Atrial rate/rhythm 30 bpm (sinus beats)/regular except for events 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

271. Copyright © 2006 by Mosby Inc. All rights reserved. Rhythm Identification  These rhythm strips are from a 52-year-old man with syncope.

272. Copyright © 2006 by Mosby Inc. All rights reserved. Atrial pacing? Yes Ventricular pacing? No Paced interval 79 Identification Atrial pacemaker

273. Copyright © 2006 by Mosby Inc. All rights reserved. Rhythm Identification   This rhythm strip is from a 79-year-old woman with a nosebleed. Blood pressure is 222/118.

274. Copyright © 2006 by Mosby Inc. All rights reserved. Ventricular rate/rhythm 130 bpm/regular Atrial rate/rhythm 130 bpm/regular PR interval 0.16 sec QRS duration 0.12 sec Identification Sinus tachycardia at 130 bpm with a wide-QRS and ST-segment depression

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

276. Copyright © 2006 by Mosby Inc. All rights reserved. Ventricular rate/rhythm 52 bpm/regular Atrial rate/rhythm None PR interval None QRS duration 0.06 sec Identification Sinus beat to junctional escape rhythm with inverted T waves

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

278. Copyright © 2006 by Mosby Inc. All rights reserved. Ventricular rate/rhythm 54 bpm/regular (sinus beats) Atrial rate/rhythm 54 bpm/regular (sinus beats) PR interval 0.12 sec (sinus beats) QRS duration 0.06-0.08 sec (sinus beats) Identification Sinus bradycardia with ventricular bigeminy

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

280. Copyright © 2006 by Mosby Inc. All rights reserved. Ventricular rate/rhythm 40 bpm/regular Atrial rate/rhythm 83 bpm/regular PR interval 0.24 sec QRS duration 0.10 sec Identification 2:1 AV block, probably type I; ST-segment depression

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

282. Copyright © 2006 by Mosby Inc. All rights reserved. Ventricular rate/rhythm 36 bpm/regular Atrial rate/rhythm 72 bpm/regular PR interval 0.32 sec QRS duration 0.10 sec Identification 2:1 AV block, probably type 1

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

284. Copyright © 2006 by Mosby Inc. All rights reserved. Ventricular rate/rhythm 167 bpm/regular Atrial rate/rhythm 167 bpm/regular PR interval 0.12 sec QRS duration 0.06 sec Identification Sinus tachycardia at 167 bpm

285. Copyright © 2006 by Mosby Inc. All rights reserved. Rhythm Identification  This rhythm strip is from an 83-year-old woman with syncope.

286. Copyright © 2006 by Mosby Inc. All rights reserved. Ventricular rate/rhythm 36 bpm/regular Atrial rate/rhythm 72 bpm/regular PR interval 0.20 to 0.22 sec QRS duration 0.06 to 0.08 sec Identification 2:1 AV block, probably type I

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

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

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

290. Copyright © 2006 by Mosby Inc. All rights reserved. Atrial pacing? No Ventricular pacing? Yes Paced interval 79 Identification 100% ventricular-paced rhythm

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

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

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

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

295. Copyright © 2006 by Mosby Inc. All rights reserved. Rhythm Identification  This rhythm strip is from a 61-year-old woman complaining of shortness of breath. Blood pressure 176/110.

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

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

298. Copyright © 2006 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

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

300. Copyright © 2006 by Mosby Inc. All rights reserved. Ventricular rate/rhythm 71 bpm/regular Atrial rate/rhythm Unable to determine PR interval Unable to determine QRS duration 0.12 sec Identification Accelerated idioventricular rhythm (AIVR) with ST-segment elevation