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

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

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

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

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

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

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.

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)

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.

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

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

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

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

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

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

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

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)

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

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

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

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.

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)

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

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.

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

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

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

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.

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

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.

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

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

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

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.

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

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.

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)

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.

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

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

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

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

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)

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

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

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

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)

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

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

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

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

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

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

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.

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

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)

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

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

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.

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.

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)

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

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

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

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.

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

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.

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

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.

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

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.

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)

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.

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

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

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.

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

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

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.

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

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

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.

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

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

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

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)

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

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

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)

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.

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

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

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.

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

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.

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)

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

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.

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

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.

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)

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.

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.

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.

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)

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

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

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)

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

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

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

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.

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

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

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

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

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.

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

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.

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

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

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

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.

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

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)

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.

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

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)

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

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)

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

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

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

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

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

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

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.

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

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

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.

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

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

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

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

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.

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

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

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.

of 250 Next Back Close Copyright © 2011 by Mosby Inc. All rights reserved. Ventricular rate/rhythm 55-94 bpm/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

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

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.

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

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

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

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