Practice ECGStrips

Rhythm Identification
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


Ventricular rate/rhythm 83/min (sinus beats)/
Regular except for the event
Atrial rate/rhythm 83/min (sinus beats)/
Identification Sinus rhythm with two PJCs,
ST-segment elevation

 This rhythm strip is from an 83-year-old
woman with syncope.

Ventricular rate/rhythm 38 to 75 bpm/irregular
PR interval Lengthening
Identification Second-degree AV block, type I

 This rhythm strip is from an 82-year-old man
complaining of back pain.
 Top = lead II, bottom = MCL1

Atrial rate/rhythm 56 to 125 bpm/irregular
QRS duration 0.12 sec
Identification Sinus rhythm with a nonconducted PAC

woman who experienced a cardiopulmonary
arrest. The initial rhythm was asystole. The
following rhythm resulted after IV
administration of epinephrine and atropine.

Atrial rate/rhythm None
PR interval None
Identification Idioventricular rhythm (IVR)
(ventricular escape rhythm)

 This rhythm strip is from a 69-year-old man
complaining of shortness of breath. Lung
sounds reveal bilateral rales. Blood pressure:
160/58.

Ventricular rate/rhythm 107 bpm (sinus beats)/
Regular except for the events
Atrial rate/rhythm 107 bpm (sinus beats)/
PR interval 0.20 sec (sinus beats)
QRS duration 0.08 sec (sinus beats)
Identification Sinus tachycardia with uniform PVCs


Identification Sinus rhythm with first-degree AV
block, ST-segment depression


Atrial rate/rhythm Unable to determine
PR interval Unable to determine
Identification Monomorphic ventricular tachycardia


Ventricular rate/rhythm 214 bpm (VT) to 71 bpm (atrial fib)/
Irregular
QRS duration 0.12 to 0.16 sec (VT) to 0.06 sec
(atrial fib)
Identification Monomorphic VT to atrial fibrillation


Identification Atrial flutter with ST-segment
depression


None (junctional beats) to regular
(sinus beats)
Identification Junctional bradycardia with ST-
segment depression to sinus
bradycardia, inverted T waves


PR interval Varies
Identification Complete (third-degree) AV block
with inverted T waves

found unresponsive, apneic, and pulseless.

PR interval None
Identification Accelerated idioventricular rhythm
(AIVR)


Regular except for the event(s)
block and PACs


Identification Second-degree AV block type II
with ST-segment depression


Atrial paced activity? Yes
Ventricular paced activity? Yes
Paced interval rate 71
Identification 100% paced rhythm –
AV sequential pacemaker

 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.

Identification Atrial fibrillation (controlled)

complaining of indigestion.

PR interval None
Identification Junctional bradycardia with
ST-segment depression and
inverted T waves

woman complaining of weakness.

Atrial paced activity? No
Identification 100% ventricular paced rhythm


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)/
QRS duration 0.08 to 0.10 sec (sinus beats)
Identification Sinus bradycardia with ventricular
bigeminy

 This rhythm strip is from a 90-year-old woman
complaining of hip pain after a fall.

Identification Sinus rhythm with
ST-segment depression

woman complaining of chest pain that she
rates a 4 on a scale of 0 to 10. Blood
pressure: 142/72.

Identification Sinus rhythm

complaining of palpitations. Note the point at
which the patient was defibrillated.

Ventricular rate/rhythm 63 to 79 bpm (sinus beats)/
Irregular (sinus beats)
Atrial rate/rhythm 63 to 79 bpm (sinus beats)/
Irregular (sinus beats)
Identification Monomorphic ventricular
tachycardia – shock – ventricular
beats – sinus arrhythmia


Identification Sinus rhythm with uniform PVCs


Identification Sinus tachycardia with PACs

 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.

PR interval 0.12 to 0.16 sec
Identification Sinus tachycardia with an
interpolated PVC

complaining of chest pain. He had a new
pacemaker implanted 5 days ago. His blood
pressure is 148/60.


with substernal chest pain. He has a history
of COPD and mitral valve regurgitation. Blood
pressure: 140/78.

Identification Sinus rhythm with ST-segment
depression


Identification 2:1 AV block, probably type I


PR interval Lengthens
Identification Second-degree AV block, type I


PR interval None
Identification Accelerated junctional rhythm




Ventricular rate/rhythm None
PR interval None
QRS duration None
Identification Asystole



woman complaining of abdominal pain.

Identification Sinus tachycardia with uniform PVCs

with a history of heart failure.

Ventricular rate/rhythm 65 to 75 bpm (sinus beats)/Irregular
Atrial rate/rhythm 65 to 75 bpm (sinus beats)/Irregular
block, wide QRS (bundle branch
block), multiform PVCs, and ST-
segment elevation

 This rhythm strip is from a 1-month-old infant
after a 3-minute seizure.

Identification Sinus tachycardia


PR interval Varies

complaining of chest pain.


with a congested cough.

Identification Atrial fibrillation (uncontrolled)


Ventricular 30 bpm (junctional beats) to 56 bpm (sinus beats)/
rate/rhythm 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


Ventricular rate/rhythm 83 bpm (sinus beats)/regular
Atrial rate/rhythm 83 bpm (sinus beats)/regular
Identification Atrial flutter to sinus rhythm



who had a syncopal episode.

Identification Sinus bradycardia

complaining of chest pain. Blood pressure:
170/96.

Identification Sinus tachycardia with
first-degree AV block

complaining of palpitations.

Identification Narrow-QRS tachycardia

 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.

Ventricular rate/rhythm 187 bpm (atrial beats)/
Regular (atrial beats)
QRS duration 0.08 sec (atrial beats)
Identification Junctional to sinus
to narrow-QRS tachycardia


Ventricular rate/rhythm Unable to determine
QRS duration Unable to determine
Identification Ventricular fibrillation (coarse)




Identification Sinus bradycardia with first-degree
AV block, wide-QRS (probable
bundle branch block),

complaining of back pain. Her medical history
includes a myocardial infarction 2 years ago.


found sitting in a chair. He is unresponsive,
apneic, and pulseless.

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)

woman complaining of hip pain after a fall
injury.

Identification Atrial fibrillation


PR interval Lengthens
Identification Second-degree AV block type I
with a ventricular complex


Ventricular rate/rhythm 48 bpm (junctional beats)/ regular
Atrial rate/rhythm Unable to determine (junctional beats)
PR interval Unable to determine (junctional beats)
Identification Sinus bradycardia with a first-degree
AV block to junctional escape rhythm

found unresponsive on the side of the road.
Outdoor temperature is 112°F. Blood
pressure: 238/110, respiratory rate: 60/min.

Identification Sinus tachycardia with

complaining of dizziness. He had a triple
bypass 4 days ago.

Identification Sinus rhythm with ventricular
bigeminy, ST-segment depression

woman with an altered level of
responsiveness. blood pressure: 160/70,
blood sugar: 114.

Identification Sinus bradycardia with
first-degree AV block

 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.


complaining of chest pain and difficulty
breathing.

Identification Atrial fibrillation with

woman complaining of numbness in her legs.


who complained of sudden weakness in her
legs and fell to the floor in her kitchen.

with ST-segment elevation

woman with vomiting x 2 days.


complaining of chest pain. Her blood
pressure is 146/104, respirations are 20.
Breath sounds are clear.

Identification Narrow-QRS tachycardia (SVT)

 This rhythm strip is from a 6-year-old boy
immediately after a seizure.

Identification Sinus arrhythmia

who was playing golf and experienced a
syncopal episode.

Identification Sinus rhythm with ST-segment
elevation

woman complaining of chest pain.

PR interval None
tachycardia


PR interval Varies

woman complaining of chest pain.

PR interval None
(AIVR)

complaining of weakness.

Identification Ventricular demand pacemaker


Identification Atrial flutter


ventricular bigeminy


PR interval None
(AIVR)

 These rhythm strips are from a 63-year-old woman
who experienced a syncopal episode. Blood
pressure is 200/90, blood sugar is 98.


woman with a nosebleed. Blood pressure:
250/74.

Identification Sinus rhythm

complaining of palpitations. His initial blood
pressure was 112/84. His second blood
pressure, 8 minutes after the first, was 78/P.

Identification Narrow-QRS tachycardia (SVT)



complaining of weakness and dizziness.
Blood pressure is 160/98, blood sugar is 88.



Identification Second-degree AV block type II

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.

Identification Sinus rhythm with uniform PVCs,

complaining of palpitations and shortness of
breath.

Ventricular rate/rhythm 130 to 214 bpm/ irregular
Identification Atrial fibrillation with a rapid
ventricular response (RVR)

breath after administration of adenosine 6 mg
IV.


breath 1 minute after administration of
adenosine 12 mg IV.


breath two minutes after administration of
adenosine 6 mg IV.

Identification Atrial fibrillation with a rapid
ventricular response (RVR)


Ventricular rate/rhythm 30 bpm (junctional beats)/irregular
Atrial rate/rhythm None (junctional beats)/irregular
Identification Sinus beat, two junctional beats,
sinus beat; ST-segment depression

with shortness of breath.



PR interval 0.16 to 0.18 sec (sinus beats)


Ventricular rate/rhythm 100 bpm (sinus beats) to 150 bpm
(VT)/Regular
Regular to unable to determine
block to monomorphic ventricular
tachycardia (VT)


PR interval Varies




PR interval None
QRS duration None
Identification P-wave asystole

with chest pain. Blood pressure: 192/90. She
rates her pain as a 9 on a scale of 0 to 10.



Ventricular rate/rhythm 91 bpm/
Atrial rate/rhythm 91 bpm/
Identification Sinus rhythm with a nonconducted PAC


Note U waves are present
(they follow the T waves)

with chest pain.

Atrial paced activity? Yes
Identification AV sequential pacemaker with
failure to capture

woman with an altered level of
responsiveness. Blood pressure: 136/78,
blood sugar is 96.

Identification Sinus tachycardia with a PVC and
a ventricular couplet

complaining of chest pain that he rates as a 6
on a scale of 0 to 10. Blood pressure: 170/80.

Identification Sinus tachycardia with PACs


Ventricular rate/rhythm 29 bpm/essentially regular
PR interval None
Identification Junctional bradycardia


block; ST-segment elevation

 This rhythm strip is from a 44-year-old construction
worker with a sudden onset of chest pressure.


Identification Sinus arrhythmia at 52 to 94 bpm


Atrial pacing? No
Ventricular pacing? Yes
Paced interval 80
Identification Ventricular-paced rhythm with
pacemaker malfunction
(failure to capture)

complaining of back pain.
 Top = lead II, bottom = MCL1.

QRS duration 0.12
Identification Sinus rhythm at 41 to 73 bpm
with a nonconducted PAC


Ventricular rate/rhythm 78/min/regular except for the event
Atrial rate/rhythm 78/min/regular except for the event
Identification Sinus rhythm at 78 bpm with a PAC


Identification Junctional rhythm; ST-segment
elevation


Ventricular rate/rhythm 115 bpm (sinus beats)/regular
except for the event
Atrial rate/rhythm 115 bpm (sinus beats)/regular
except for the event
Identification Sinus tachycardia with a PJC

complaining of chest pain.

PR interval None
tachycardia


Ventricular rate/rhythm 21 bpm/irregular
Atrial rate/rhythm 21 bpm/irregular
junctional escape beats


Identification Second-degree AV block type II;


Atrial rate/rhythm Unable to determine/irregular
PR interval Varies
Identification Multifocal atrial tachycardia



PR interval Varies
Identification Third-degree AV block;

 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.

Identification Sinus tachycardia at 215 bpm

 This rhythm strip is from an 81-year-old woman
complaining of weakness. BP: 122/59, R: 12. Blood
sugar is 109 mg/dL.



Identification Accelerated junctional rhythm;

 This rhythm strip is from a 26-year-old man after a
seizure.

Identification Sinus arrhythmia at 64 to 94 bpm

 This rhythm strip is from an 18-year-old man with a
gunshot wound to his chest.

Ventricular rate/rhythm Unable to determine
PR interval None
QRS duration None
Identification Coarse ventricular
fibrillation


Atrial pacing? Yes
Paced interval 71
Identification 100% paced rhythm
– AV sequential pacemaker


Ventricular rate/rhythm 88/min/regular
Identification Atrial flutter at 88 bpm

 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.

Identification 2:1 AV block, probably type II;

 This rhythm strip is from a 57-year-old man with no cardiac
history.

Ventricular rate/rhythm 111 bpm/regular except for event
Atrial rate/rhythm 111 bpm/regular except for event
Identification Sinus tachycardia at 111 bpm with a
nonconducted PAC


Ventricular rate/rhythm Two ventricular complexes to none
PR interval None
QRS duration 0.14 sec to none
Identification Agonal rhythm/asystole


Ventricular rate/rhythm 30 bpm (sinus beats)/regular except for events
Atrial rate/rhythm 30 bpm (sinus beats)/regular except for events
Identification Sinus bradycardia with ventricular bigeminy,
inverted T waves, horizontal ST-segments

 These rhythm strips are from a 52-year-old man with
syncope.

Atrial pacing? Yes
Ventricular pacing? No
Paced interval 79
Identification Atrial pacemaker

 This rhythm strip is from a 79-year-old woman with a nosebleed.
Blood pressure is 222/118.

Identification Sinus tachycardia at 130 bpm with a
wide-QRS and ST-segment depression


PR interval None
Identification Sinus beat to junctional escape
rhythm with inverted T waves


Ventricular rate/rhythm 54 bpm/regular (sinus beats)
Atrial rate/rhythm 54 bpm/regular (sinus beats)
QRS duration 0.06-0.08 sec (sinus beats)
ventricular bigeminy


Identification 2:1 AV block, probably type I;


Identification 2:1 AV block, probably type 1


Identification Sinus tachycardia at 167 bpm

 This rhythm strip is from an 83-year-old woman with syncope.



Ventricular rate/rhythm 150 bpm/essentially regular
Identification Monomorphic VT


Atrial pacing? No
Paced interval 79
Identification 100% ventricular-paced rhythm


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)
Identification Sinus rhythm with PJCs


Ventricular rate/rhythm 180/min/regular
Identification AVNRT at 180 bpm, ST-segment elevation

 This rhythm strip is from a 61-year-old woman complaining
of shortness of breath. Blood pressure 176/110.

Ventricular rate/rhythm 125 bpm/essentially regular except for
events
Atrial rate/rhythm 125 bpm/essentially regular except for
events
Identification Sinus tachycardia with multiform PVCs


Identification Sinus tachycardia with first-degree
AV block


(AIVR) with ST-segment elevation

Practice ECGStrips

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Rhythm Identification

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 Top = lead II, bottom = MCL1

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