Practice ECGStrips

7/28/2019 Practice ECGStrips

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Copyright 2006 by Mosby I

Rhythm IdentificationRhythm Identification


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Ventricular rate/rhythmVentricular rate/rhythm 68 bpm/regular68 bpm/regular

Atrial rate/rhythmAtrial rate/rhythm 68 bpm/regular68 bpm/regular

PR intervalPR interval 0.24 sec0.24 sec

QRS durationQRS duration 0.06 to 0.08 sec0.06 to 0.08 sec

IdentificationIdentification Sinus rhythm with first-degreeSinus rhythm with first-degreeAV block, ST-segment elevationAV block, ST-segment elevation


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Ventricular rate/rhythmVentricular rate/rhythm 83/min (sinus beats)/83/min (sinus beats)/Regular except for the eventRegular except for the event

Atrial rate/rhythmAtrial rate/rhythm 83/min (sinus beats)/83/min (sinus beats)/

Regular except for the eventRegular except for the event



IdentificationIdentification Sinus rhythm with two PJCs,Sinus rhythm with two PJCs,

ST-segment elevationST-segment elevation


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This rhythm strip is from an 83-year-oldThis rhythm strip is from an 83-year-old

woman with syncope.woman with syncope.


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Ventricular rate/rhythmVentricular rate/rhythm 38 to 75 bpm/irregular38 to 75 bpm/irregular


PR intervalPR interval LengtheningLengthening


IdentificationIdentification Second-degree AV block, type ISecond-degree AV block, type I


7/300Copyright 2006 by Mosby I


This rhythm strip is from an 82-year-old manThis rhythm strip is from an 82-year-old man

complaining of back pain.complaining of back pain.

Top = lead II, bottom = MCL1Top = lead II, bottom = MCL1




Atrial rate/rhythmAtrial rate/rhythm 56 to 125 bpm/irregular56 to 125 bpm/irregular

PR intervalPR interval 0.20 sec0.20 secQRS durationQRS duration 0.12 sec0.12 sec

IdentificationIdentification Sinus rhythm with a nonconducted PACSinus rhythm with a nonconducted PAC





woman who experienced a cardiopulmonarywoman who experienced a cardiopulmonary

arrest. The initial rhythm was asystole. Thearrest. The initial rhythm was asystole. The

following rhythm resulted after IVfollowing rhythm resulted after IVadministration of epinephrine and atropine.administration of epinephrine and atropine.




Atrial rate/rhythmAtrial rate/rhythm NoneNone

PR intervalPR interval NoneNone

QRS durationQRS duration 0.18 sec0.18 sec

IdentificationIdentification Idioventricular rhythm (IVR)Idioventricular rhythm (IVR)(ventricular escape rhythm)(ventricular escape rhythm)




This rhythm strip is from a 69-year-old manThis rhythm strip is from a 69-year-old man

complaining of shortness of breath. Lungcomplaining of shortness of breath. Lung

sounds reveal bilateral rales. Blood pressure:sounds reveal bilateral rales. Blood pressure:

160/58.160/58.



Ventricular rate/rhythmVentricular rate/rhythm 107 bpm (sinus beats)/107 bpm (sinus beats)/

Regular except for the eventsRegular except for the events

Atrial rate/rhythmAtrial rate/rhythm 107 bpm (sinus beats)/107 bpm (sinus beats)/


PR intervalPR interval 0.20 sec (sinus beats)0.20 sec (sinus beats)

QRS durationQRS duration 0.08 sec (sinus beats)0.08 sec (sinus beats)

IdentificationIdentification Sinus tachycardia with uniform PVCsSinus tachycardia with uniform PVCs






QRS durationQRS duration 0.06 sec0.06 secIdentificationIdentification Sinus rhythm with first-degree AVSinus rhythm with first-degree AV

block, ST-segment depressionblock, ST-segment depression


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Atrial rate/rhythmAtrial rate/rhythm Unable to determineUnable to determine

PR intervalPR interval Unable to determineUnable to determine


IdentificationIdentification Monomorphic ventricular tachycardiaMonomorphic ventricular tachycardia


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Ventricular rate/rhythmVentricular rate/rhythm 214 bpm (VT) to 71 bpm (atrial fib)/214 bpm (VT) to 71 bpm (atrial fib)/IrregularIrregular



QRS durationQRS duration 0.12 to 0.16 sec (VT) to0.12 to 0.16 sec (VT) to 0.06 sec0.06 sec(atrial fib)(atrial fib)

IdentificationIdentification Monomorphic VT to atrial fibrillationMonomorphic VT to atrial fibrillation


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IdentificationIdentification Atrial flutter with ST-segmentAtrial flutter with ST-segmentdepressiondepression


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None (junctional beats) to regularNone (junctional beats) to regular(sinus beats)(sinus beats)


QRS durationQRS duration 0.04 to 0.06 sec0.04 to 0.06 secIdentificationIdentification Junctional bradycardia with ST-Junctional bradycardia with ST-

segment depression to sinussegment depression to sinusbradycardia, inverted T wavesbradycardia, inverted T waves


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PR intervalPR interval VariesVaries

QRS durationQRS duration 0.12 sec0.12 secIdentificationIdentification Complete (third-degree) AV blockComplete (third-degree) AV block

with inverted T waveswith inverted T waves


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found unresponsive, apneic, and pulseless.found unresponsive, apneic, and pulseless.


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IdentificationIdentification Accelerated idioventricular rhythmAccelerated idioventricular rhythm(AIVR)(AIVR)


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QRS durationQRS duration 0.12 sec0.12 secIdentificationIdentification Second-degree AV block type IISecond-degree AV block type II

with ST-segment depressionwith ST-segment depression


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Atrial paced activity?Atrial paced activity? YesYes

Ventricular paced activity?Ventricular paced activity? YesYes

Paced interval ratePaced interval rate 7171

IdentificationIdentification 100% paced rhythm 100% paced rhythm AV sequential pacemakerAV sequential pacemaker


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These rhythm strips are from a 78-year-oldThese rhythm strips are from a 78-year-old

man complaining of shortness of breath. Heman complaining of shortness of breath. He

has a history of COPD, coronary arteryhas a history of COPD, coronary artery

disease, and hypertension.disease, and hypertension.


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IdentificationIdentification Atrial fibrillation (controlled)Atrial fibrillation (controlled)


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This rhythm strip is from a 97-year-oldThis rhythm strip is from a 97-year-old

woman after a fall.woman after a fall.


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IdentificationIdentification Sinus rhythm with first-degree AVSinus rhythm with first-degree AVblock, ST-segment depressionblock, ST-segment depression


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complaining of a sharp pain across hiscomplaining of a sharp pain across his

shoulders. Blood pressure: 218/86.shoulders. Blood pressure: 218/86.


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Ventricular rate/rhythmVentricular rate/rhythm 115/min (sinus beats)/115/min (sinus beats)/Regular except for the eventsRegular except for the events



PR intervalPR interval 0.18 sec (sinus beats)0.18 sec (sinus beats)QRS durationQRS duration 0.06 sec (sinus beats)0.06 sec (sinus beats)



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complaining of indigestion.complaining of indigestion.


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IdentificationIdentification Junctional bradycardia withJunctional bradycardia withST-segment depression andST-segment depression andinverted T wavesinverted T waves


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woman complaining of weakness.woman complaining of weakness.


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Atrial paced activity?Atrial paced activity? NoNo



IdentificationIdentification 100% ventricular paced rhythm100% ventricular paced rhythm


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Ventricular rate/rhythmVentricular rate/rhythm 55/min (sinus beats)/55/min (sinus beats)/

Regular except for the event (everyRegular except for the event (every

other beat is an ectopic beat)other beat is an ectopic beat)


Regular except for the event (everyRegular except for the event (everyother beat is an ectopic beat)other beat is an ectopic beat)

PR intervalPR interval 0.12 sec (sinus beats)0.12 sec (sinus beats)QRS durationQRS duration 0.08 to 0.10 sec (sinus beats)0.08 to 0.10 sec (sinus beats)

IdentificationIdentification Sinus bradycardia with ventricularSinus bradycardia with ventricularbigeminybigeminy


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This rhythm strip is from a 90-year-old womanThis rhythm strip is from a 90-year-old woman

complaining of hip pain after a fall.complaining of hip pain after a fall.


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QRS durationQRS duration 0.08 to 0.10 sec0.08 to 0.10 secIdentificationIdentification Sinus rhythm withSinus rhythm with

ST-segment depressionST-segment depression


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woman complaining of chest pain that shewoman complaining of chest pain that she

rates a 4 on a scale of 0 to 10. Bloodrates a 4 on a scale of 0 to 10. Blood

pressure: 142/72.pressure: 142/72.


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complaining of palpitations. Note the point atcomplaining of palpitations. Note the point at

which the patient was defibrillated.which the patient was defibrillated.


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Ventricular rate/rhythmVentricular rate/rhythm 63 to 79 bpm (sinus beats)/63 to 79 bpm (sinus beats)/

Irregular (sinus beats)Irregular (sinus beats)Atrial rate/rhythmAtrial rate/rhythm 63 to 79 bpm (sinus beats)/63 to 79 bpm (sinus beats)/

Irregular (sinus beats)Irregular (sinus beats)


QRS durationQRS duration 0.04 to 0.06 sec (sinus beats)0.04 to 0.06 sec (sinus beats)

IdentificationIdentification Monomorphic ventricularMonomorphic ventriculartachycardia shock ventriculartachycardia shock ventricularbeats sinus arrhythmiabeats sinus arrhythmia


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IdentificationIdentification Sinus rhythm with uniform PVCsSinus rhythm with uniform PVCs


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IdentificationIdentification Sinus tachycardia with PACsSinus tachycardia with PACs


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This rhythm strip is from a 3-month-oldThis rhythm strip is from a 3-month-old

infant who had an altered level ofinfant who had an altered level of

responsiveness. She was limp with aresponsiveness. She was limp with a

respiratory rate of 4 breaths/min. Bloodrespiratory rate of 4 breaths/min. Bloodsugar was 174.sugar was 174.


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PR intervalPR interval 0.12 to 0.16 sec0.12 to 0.16 sec


IdentificationIdentification Sinus tachycardia with anSinus tachycardia with aninterpolated PVCinterpolated PVC


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with substernal chest pain. He has a historywith substernal chest pain. He has a history

of COPD and mitral valve regurgitation. Bloodof COPD and mitral valve regurgitation. Blood

pressure: 140/78.pressure: 140/78.


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IdentificationIdentification Sinus rhythm with ST-segmentSinus rhythm with ST-segmentdepressiondepression


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Ventricular rate/rhythmVentricular rate/rhythm 34 bpm/regular34 bpm/regularAtrial rate/rhythmAtrial rate/rhythm 68 bpm/regular68 bpm/regular



IdentificationIdentification 2:1 AV block, probably type I2:1 AV block, probably type I


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PR intervalPR interval LengthensLengthens


IdentificationIdentification Second-degree AV block, type ISecond-degree AV block, type I


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IdentificationIdentification Accelerated junctional rhythmAccelerated junctional rhythm


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QRS durationQRS duration 0.08 sec0.08 secIdentificationIdentification Atrial fibrillation (controlled)Atrial fibrillation (controlled)


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Ventricular rate/rhythmVentricular rate/rhythm NoneNone



QRS durationQRS duration NoneNone

IdentificationIdentification AsystoleAsystole


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These rhythm strips are from a 46-year-oldThese rhythm strips are from a 46-year-old

woman complaining of abdominal pain.woman complaining of abdominal pain.


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Ventricular rate/rhythmVentricular rate/rhythm 65 to 75 bpm (sinus beats)/Irregular65 to 75 bpm (sinus beats)/IrregularAtrial rate/rhythmAtrial rate/rhythm 65 to 75 bpm (sinus beats)/Irregular65 to 75 bpm (sinus beats)/Irregular



IdentificationIdentification Sinus rhythm with first-degree AVSinus rhythm with first-degree AVblock, wide QRS (bundle branchblock, wide QRS (bundle branchblock), multiform PVCs, and ST-block), multiform PVCs, and ST-segment elevationsegment elevation


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This rhythm strip is from a 1-month-old infantThis rhythm strip is from a 1-month-old infant

after a 3-minute seizure.after a 3-minute seizure.


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QRS durationQRS duration 0.06 to 0.08 sec0.06 to 0.08 secIdentificationIdentification Sinus tachycardiaSinus tachycardia

f


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IdentificationIdentification Complete (third-degree) AV blockComplete (third-degree) AV block

Rh th Id tifi ti


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complaining of chest pain.complaining of chest pain.


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Rh h Id ifi iRh th Id tifi ti


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with a congested cough.with a congested cough.


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IdentificationIdentification Atrial fibrillation (uncontrolled)Atrial fibrillation (uncontrolled)

Rh th Id tifi tiRh th Id tifi ti


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VentricularVentricular

rate/rhythmrate/rhythm

30 bpm (junctional beats) to 56 bpm (sinus beats)/30 bpm (junctional beats) to 56 bpm (sinus beats)/

Irregular (junctional beats) to regular (sinus beats)Irregular (junctional beats) to regular (sinus beats)

Atrial rate/rhythmAtrial rate/rhythm None (junctional beats) to 56 bpm (sinus beats)/None (junctional beats) to 56 bpm (sinus beats)/

None (junctional beats) to regular (sinus beats)None (junctional beats) to regular (sinus beats)

PR intervalPR interval None (junctional beats) to 0.18 (sinus beats)None (junctional beats) to 0.18 (sinus beats)

QRS durationQRS duration 0.04 sec (junctional beats) to 0.08 (sinus beats)0.04 sec (junctional beats) to 0.08 (sinus beats)

IdentificationIdentification Junctional bradycardia to sinus bradycardiaJunctional bradycardia to sinus bradycardia



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Ventricular rate/rhythmVentricular rate/rhythm 83 bpm (sinus beats)/regular83 bpm (sinus beats)/regular

Atrial rate/rhythmAtrial rate/rhythm 83 bpm (sinus beats)/regular83 bpm (sinus beats)/regular



IdentificationIdentification Atrial flutter to sinus rhythmAtrial flutter to sinus rhythm



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Rh th Id tifi tiRh thm Identification


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who had a syncopal episode.who had a syncopal episode.


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QRS durationQRS duration 0.08 sec0.08 secIdentificationIdentification Sinus bradycardiaSinus bradycardia

Rh th Id tifi tiRhythm Identification


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complaining of chest pain. Blood pressure:complaining of chest pain. Blood pressure:

170/96.170/96.


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IdentificationIdentification Sinus tachycardia withSinus tachycardia withfirst-degree AV blockfirst-degree AV block



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complaining of palpitations.complaining of palpitations.


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IdentificationIdentification Narrow-QRS tachycardiaNarrow-QRS tachycardia



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A 43-year-old woman is complaining of palpitations.A 43-year-old woman is complaining of palpitations.The patient has a history of SVT and states sheThe patient has a history of SVT and states she

cannot tolerate adenosine. The following rhythm iscannot tolerate adenosine. The following rhythm is

observed on the cardiac monitor after diltiazemobserved on the cardiac monitor after diltiazem

administration.administration.


98/300


Ventricular rate/rhythmVentricular rate/rhythm 187 bpm (atrial beats)/187 bpm (atrial beats)/

Regular (atrial beats)Regular (atrial beats)



QRS durationQRS duration 0.08 sec (atrial beats)0.08 sec (atrial beats)

IdentificationIdentification Junctional to sinusJunctional to sinusto narrow-QRS tachycardiato narrow-QRS tachycardia



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Ventricular rate/rhythmVentricular rate/rhythm Unable to determineUnable to determine



QRS durationQRS duration Unable to determineUnable to determineIdentificationIdentification Ventricular fibrillation (coarse)Ventricular fibrillation (coarse)



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IdentificationIdentification Sinus bradycardia with first-degreeSinus bradycardia with first-degreeAV block, wide-QRS (probableAV block, wide-QRS (probablebundle branch block),bundle branch block),ST-segment depressionST-segment depression



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This rhythm strip is from a 76-year-old womanThis rhythm strip is from a 76-year-old womancomplaining of back pain. Her medical historycomplaining of back pain. Her medical history

includes a myocardial infarction 2 years ago.includes a myocardial infarction 2 years ago.


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107/300



This rhythm strip is from an 80-year-old manThis rhythm strip is from an 80-year-old manfound sitting in a chair. He is unresponsive,found sitting in a chair. He is unresponsive,

apneic, and pulseless.apneic, and pulseless.


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Atrial rate/rhythmAtrial rate/rhythm NoneNonePR intervalPR interval NoneNone


IdentificationIdentification Asystole the electrical activityAsystole the electrical activity

shown is caused by pacemakershown is caused by pacemakerspikes from the patientsspikes from the patientspermanent pacemaker (nopermanent pacemaker (nocapture)capture)



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This rhythm strip is from an 88-year-oldThis rhythm strip is from an 88-year-oldwoman complaining of hip pain after a fallwoman complaining of hip pain after a fall

injury.injury.


110/300






IdentificationIdentification Atrial fibrillationAtrial fibrillation


111/300


112/300





QRS durationQRS duration

0.10 sec0.10 sec

IdentificationIdentification Second-degree AV block type ISecond-degree AV block type Iwith a ventricular complexwith a ventricular complex



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Ventricular rate/rhythmVentricular rate/rhythm 48 bpm (junctional beats)/ regular48 bpm (junctional beats)/ regular

Atrial rate/rhythmAtrial rate/rhythm Unable to determine (junctional beats)Unable to determine (junctional beats)

PR intervalPR interval Unable to determine (junctional beats)Unable to determine (junctional beats)


IdentificationIdentification Sinus bradycardia with a first-degreeSinus bradycardia with a first-degree

AV block to junctional escape rhythmAV block to junctional escape rhythm



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This rhythm strip is from a 67-year-old womanThis rhythm strip is from a 67-year-old womanfound unresponsive on the side of the road.found unresponsive on the side of the road.

Outdoor temperature is 112F. BloodOutdoor temperature is 112F. Blood

pressure: 238/110, respiratory rate: 60/min.pressure: 238/110, respiratory rate: 60/min.


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IdentificationIdentification Sinus tachycardia withSinus tachycardia withST-segment depressionST-segment depression



117/300



This rhythm strip is from an 84-year-old manThis rhythm strip is from an 84-year-old mancomplaining of dizziness. He had a triplecomplaining of dizziness. He had a triple

bypass 4 days ago.bypass 4 days ago.


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Regular except for the event (everyRegular except for the event (everyother beat is an ectopic beat)other beat is an ectopic beat)





IdentificationIdentification Sinus rhythm with ventricularSinus rhythm with ventricularbigeminy, ST-segment depressionbigeminy, ST-segment depression



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This rhythm strip is from an 81-year-oldThis rhythm strip is from an 81-year-oldwoman with an altered level ofwoman with an altered level of

responsiveness. blood pressure: 160/70,responsiveness. blood pressure: 160/70,

blood sugar: 114.blood sugar: 114.


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IdentificationIdentification Sinus bradycardia withSinus bradycardia withfirst-degree AV blockfirst-degree AV block



121/300



This rhythm strip is from a 80-year-old woman whoThis rhythm strip is from a 80-year-old woman whowas playing Bingo when she felt dizzy and slumpedwas playing Bingo when she felt dizzy and slumped

over in her chair. Bystanders state she wasover in her chair. Bystanders state she was

unresponsive for approximately 5 minutes. A pulse isunresponsive for approximately 5 minutes. A pulse is

present.present.


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This rhythm strip is from a 91-year-old womanThis rhythm strip is from a 91-year-old womancomplaining of chest pain and difficultycomplaining of chest pain and difficulty

breathing.breathing.


124/300






IdentificationIdentification Atrial fibrillation withAtrial fibrillation with

ST-segment elevationST-segment elevation



125/300



This rhythm strip is from an 85-year-oldThis rhythm strip is from an 85-year-oldwoman complaining of numbness in her legs.woman complaining of numbness in her legs.


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IdentificationIdentification Sinus bradycardiaSinus bradycardia



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Rhythm Identificationy

This rhythm strip is from a 59-year-old womanThis rhythm strip is from a 59-year-old womanwho complained of sudden weakness in herwho complained of sudden weakness in her

legs and fell to the floor in her kitchen.legs and fell to the floor in her kitchen.


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129/300


yy

This rhythm strip is from an 82-year-oldThis rhythm strip is from an 82-year-oldwoman with vomiting x 2 days.woman with vomiting x 2 days.


130/300






IdentificationIdentification Sinus tachycardiaSinus tachycardia



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yy

This rhythm strip is from a 62-year-old womanThis rhythm strip is from a 62-year-old womancomplaining of chest pain. Her blood pressurecomplaining of chest pain. Her blood pressure

is 146/104, respirations are 20. Breathis 146/104, respirations are 20. Breath

sounds are clear.sounds are clear.


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IdentificationIdentification Narrow-QRS tachycardia (SVT)Narrow-QRS tachycardia (SVT)with ST-segment depressionwith ST-segment depression



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yy

This rhythm strip is from a 6-year-old boyThis rhythm strip is from a 6-year-old boyimmediately after a seizure.immediately after a seizure.


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QRS durationQRS duration 0.08 sec0.08 secIdentificationIdentification Sinus arrhythmiaSinus arrhythmia


135/300


136/300





IdentificationIdentification Sinus rhythm with ST-segmentSinus rhythm with ST-segmentelevationelevation



137/300


yy

These rhythm strips are from a 44-year-oldThese rhythm strips are from a 44-year-oldwoman complaining of chest pain.woman complaining of chest pain.


138/300






IdentificationIdentification Monomorphic ventricularMonomorphic ventriculartachycardiatachycardia



139/300


y


140/300





IdentificationIdentification Complete (third-degree) AV blockComplete (third-degree) AV blockwith ST-segment elevationwith ST-segment elevation



141/300


y

This rhythm strip is from an 81-year-oldThis rhythm strip is from an 81-year-oldwoman complaining of chest pain.woman complaining of chest pain.


142/300









143/300


This rhythm strip is from a 74-year-old womanThis rhythm strip is from a 74-year-old womancomplaining of weakness.complaining of weakness.


144/300





IdentificationIdentification Ventricular demand pacemakerVentricular demand pacemaker



145/300



146/300






IdentificationIdentification Atrial flutterAtrial flutter



147/300



148/300



Regular except for the event (everyRegular except for the event (every

other beat is an ectopic beat)other beat is an ectopic beat)




QRS durationQRS duration 0.08 to 0.10 sec (sinus beats)0.08 to 0.10 sec (sinus beats)IdentificationIdentification Sinus bradycardia withSinus bradycardia with

ventricular bigeminyventricular bigeminy



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150/300









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These rhythm strips are from a 63-year-old womanThese rhythm strips are from a 63-year-old womanwho experienced a syncopal episode. Bloodwho experienced a syncopal episode. Blood

pressure is 200/90, blood sugar is 98.pressure is 200/90, blood sugar is 98.


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153/300


This rhythm strip is from an 84-year-oldThis rhythm strip is from an 84-year-oldwoman with a nosebleed. Blood pressure:woman with a nosebleed. Blood pressure:

250/74.250/74.


154/300






IdentificationIdentification Sinus rhythmSinus rhythm



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This rhythm strip is from a 79-year-old manThis rhythm strip is from a 79-year-old mancomplaining of palpitations. His initial bloodcomplaining of palpitations. His initial blood

pressure was 112/84. His second bloodpressure was 112/84. His second blood

pressure, 8 minutes after the first, was 78/P.pressure, 8 minutes after the first, was 78/P.


156/300



157/300



158/300



Ventricular paced activity?Ventricular paced activity? YesYesPaced interval ratePaced interval rate 6060




159/300


This rhythm strip is from an 80-year-old manThis rhythm strip is from an 80-year-old mancomplaining of weakness and dizziness.complaining of weakness and dizziness.

Blood pressure is 160/98, blood sugar is 88.Blood pressure is 160/98, blood sugar is 88.


160/300









161/300



162/300






IdentificationIdentification Second-degree AV block type IISecond-degree AV block type II



163/300


This rhythm strip is from a 58-year-old manThis rhythm strip is from a 58-year-old manwith chest pain that he rates as a 2 on a scalewith chest pain that he rates as a 2 on a scale

of 0 to 10. He states he recently began takingof 0 to 10. He states he recently began taking

pills for weight control.pills for weight control.


164/300



Regular except for the event(s)Regular except for the event(s)





IdentificationIdentification Sinus rhythm with uniform PVCs,Sinus rhythm with uniform PVCs,ST-segment depressionST-segment depression



165/300


This rhythm strip is from a 60-year-old womanThis rhythm strip is from a 60-year-old womancomplaining of palpitations and shortness ofcomplaining of palpitations and shortness of

breath.breath.


166/300


Ventricular rate/rhythmVentricular rate/rhythm 130 to 214 bpm/ irregular130 to 214 bpm/ irregular




IdentificationIdentification Atrial fibrillation with a rapidAtrial fibrillation with a rapidventricular response (RVR)ventricular response (RVR)



167/300



breath after administration of adenosine 6 mgbreath after administration of adenosine 6 mg

IV.IV.


168/300





QRS durationQRS duration 0.08 sec0.08 secIdentificationIdentification Atrial fibrillationAtrial fibrillation



169/300



breath 1 minute after administration ofbreath 1 minute after administration of

adenosine 12 mg IV.adenosine 12 mg IV.


170/300









171/300



breath two minutes after administration ofbreath two minutes after administration of

adenosine 6 mg IV.adenosine 6 mg IV.


172/300






IdentificationIdentification Atrial fibrillation with a rapidAtrial fibrillation with a rapidventricular response (RVR)ventricular response (RVR)



173/300



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Ventricular rate/rhythmVentricular rate/rhythm 30 bpm (junctional beats)/irregular30 bpm (junctional beats)/irregularAtrial rate/rhythmAtrial rate/rhythm None (junctional beats)/irregularNone (junctional beats)/irregular



IdentificationIdentification Sinus beat, two junctional beats,Sinus beat, two junctional beats,sinus beat; ST-segment depressionsinus beat; ST-segment depression



175/300


This rhythm strip is from a 90-year-old womanThis rhythm strip is from a 90-year-old womanwith shortness of breath.with shortness of breath.


176/300








177/300



178/300






PR intervalPR interval 0.16 to 0.18 sec (sinus beats)0.16 to 0.18 sec (sinus beats)





179/300



180/300


Ventricular rate/rhythmVentricular rate/rhythm 100 bpm (sinus beats) to 150 bpm100 bpm (sinus beats) to 150 bpm(VT)/Regular(VT)/Regular


Regular to unable to determineRegular to unable to determine



IdentificationIdentification Sinus rhythm with first-degree AVSinus rhythm with first-degree AVblock to monomorphic ventricularblock to monomorphic ventriculartachycardia (VT)tachycardia (VT)



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IdentificationIdentification Complete (third-degree) AV blockComplete (third-degree) AV blockwith ST-segment elevationwith ST-segment elevation



183/300



184/300






0.06 to 0.08 sec0.06 to 0.08 sec




185/300



186/300






IdentificationIdentification P-wave asystoleP-wave asystole



187/300


This rhythm strip is from a 74-year-old womanThis rhythm strip is from a 74-year-old womanwith chest pain. Blood pressure: 192/90. Shewith chest pain. Blood pressure: 192/90. She

rates her pain as a 9 on a scale of 0 to 10.rates her pain as a 9 on a scale of 0 to 10.


188/300






IdentificationIdentification Sinus tachycardiaSinus tachycardia



189/300



190/300



191/300



192/300



Atrial rate/rhythmAtrial rate/rhythm 35 bpm/regular35 bpm/regularPR intervalPR interval 0.16 sec0.16 sec


NoteNote U waves are presentU waves are present

(they follow the T waves)(they follow the T waves)

IdentificationIdentification Sinus bradycardia withSinus bradycardia with




193/300


This rhythm strip is from a 97-year-old manThis rhythm strip is from a 97-year-old manwith chest pain.with chest pain.


194/300


Atrial paced activity?Atrial paced activity? YesYes



IdentificationIdentification AV sequential pacemaker withAV sequential pacemaker with

failure to capturefailure to capture



195/300


This rhythm strip is from an 85-year-oldThis rhythm strip is from an 85-year-oldwoman with an altered level ofwoman with an altered level of

responsiveness. Blood pressure: 136/78,responsiveness. Blood pressure: 136/78,

blood sugar is 96.blood sugar is 96.


196/300



Regular except for the eventRegular except for the eventAtrial rate/rhythmAtrial rate/rhythm 115 bpm (sinus beats)/115 bpm (sinus beats)/



QRS durationQRS duration 0.08 to 0.10 sec (sinus beats)0.08 to 0.10 sec (sinus beats)IdentificationIdentification Sinus tachycardia with a PVC andSinus tachycardia with a PVC and

a ventricular coupleta ventricular couplet



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This rhythm strip is from an 88-year-old manThis rhythm strip is from an 88-year-old mancomplaining of chest pain that he rates as a 6complaining of chest pain that he rates as a 6

on a scale of 0 to 10. Blood pressure: 170/80.on a scale of 0 to 10. Blood pressure: 170/80.


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IdentificationIdentification Sinus tachycardia with PACsSinus tachycardia with PACs



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Ventricular rate/rhythmVentricular rate/rhythm 29 bpm/essentially regular29 bpm/essentially regular




IdentificationIdentification Junctional bradycardiaJunctional bradycardiawith ST-segment depressionwith ST-segment depression



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0.08 sec0.08 sec

IdentificationIdentification Sinus rhythm with first-degree AVSinus rhythm with first-degree AVblock; ST-segment elevationblock; ST-segment elevation


This rhythm strip is from a 44 year old constructionThis rhythm strip is from a 44 year old construction


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This rhythm strip is from a 44-year-old constructionThis rhythm strip is from a 44-year-old construction

worker with a sudden onset of chest pressure.worker with a sudden onset of chest pressure.


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IdentificationIdentification Sinus arrhythmia at 52 to 94 bpmSinus arrhythmia at 52 to 94 bpm



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Atrial pacing?Atrial pacing? NoNo

Ventricular pacing?Ventricular pacing? YesYes

Paced intervalPaced interval 8080

IdentificationIdentification Ventricular-paced rhythm withVentricular-paced rhythm with

pacemaker malfunctionpacemaker malfunction(failure to capture)(failure to capture)

Rhythm IdentificationRhythm Identification This rhythm strip is from an 82-year-old manThis rhythm strip is from an 82-year-old man

complaining of back paincomplaining of back pain


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complaining of back pain.complaining of back pain.

Top = lead II, bottom = MCL1.Top = lead II, bottom = MCL1.


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QRS durationQRS duration 0.120.12

IdentificationIdentification Sinus rhythm at 41 to 73 bpmSinus rhythm at 41 to 73 bpmwith a nonconducted PACwith a nonconducted PAC



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Ventricular rate/rhythmVentricular rate/rhythm 78/min/regular except for the event78/min/regular except for the event

Atrial rate/rhythmAtrial rate/rhythm 78/min/regular except for the event78/min/regular except for the event


QRS durationQRS duration 0.06 sec0.06 secIdentificationIdentification Sinus rhythm at 78 bpm with a PACSinus rhythm at 78 bpm with a PAC



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IdentificationIdentification Junctional rhythm; ST-segmentJunctional rhythm; ST-segmentelevationelevation



213/300



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Ventricular rate/rhythmVentricular rate/rhythm 115 bpm (sinus beats)/regular115 bpm (sinus beats)/regularexcept for the eventexcept for the event

Atrial rate/rhythmAtrial rate/rhythm 115 bpm (sinus beats)/regular115 bpm (sinus beats)/regularexcept for the eventexcept for the event



IdentificationIdentification Sinus tachycardia with a PJCSinus tachycardia with a PJC

Rhythm IdentificationRhythm Identification This rhythm strip is from an 82-year-old manThis rhythm strip is from an 82-year-old man


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complaining of chest pain.complaining of chest pain.


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IdentificationIdentification Monomorphic ventricularMonomorphic ventriculartachycardiatachycardia



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Ventricular rate/rhythmVentricular rate/rhythm 21 bpm/irregular21 bpm/irregular

Atrial rate/rhythmAtrial rate/rhythm 21 bpm/irregular21 bpm/irregularPR intervalPR interval 0.36 sec0.36 sec


IdentificationIdentification Sinus bradycardia withSinus bradycardia withjunctional escape beatsjunctional escape beats



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VentricularVentricularrate/rhythmrate/rhythm

48 to 83 bpm/irregular48 to 83 bpm/irregular



QRS durationQRS duration 0.12 sec0.12 secIdentificationIdentification Second-degree AV block type II;Second-degree AV block type II;




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Ventricular rate/rhythmVentricular rate/rhythm 115 to 215 bpm/irregular115 to 215 bpm/irregularAtrial rate/rhythmAtrial rate/rhythm Unable to determine/irregularUnable to determine/irregular



IdentificationIdentification Multifocal atrial tachycardiaMultifocal atrial tachycardiawith ST-segment depressionwith ST-segment depression



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Ventricular rate/rhythmVentricular rate/rhythm 71/min, regular71/min, regularAtrial rate/rhythmAtrial rate/rhythm 71/min, regular71/min, regular



IdentificationIdentification Sinus rhythm at 71 bpm with a wide QRS,Sinus rhythm at 71 bpm with a wide QRS,




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94 (sinus beats)/irregular94 (sinus beats)/irregular

Atrial rate/rhythmAtrial rate/rhythm 94 (sinus beats)/irregular94 (sinus beats)/irregular



IdentificationIdentification Sinus rhythm with an episode ofSinus rhythm with an episode ofcouplets and a run of VTcouplets and a run of VT

Rhythm IdentificationRhythm Identification This rhythm strip is from a 73-year-old man complaining of chest pain.

History of hypertension and lung disease. Medications include aspirin,


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albuterol, and Lotensin.

U wave


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IdentificationIdentification Sinus bradycardia at 44 bpm, ST-segmentSinus bradycardia at 44 bpm, ST-segmentdepression. Note the upright U wavesdepression. Note the upright U wavesfollowing each T wave.following each T wave.



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60 to 98 bpm/irregular60 to 98 bpm/irregular



QRS durationQRS duration 0.08 sec0.08 secIdentificationIdentification Second-degree AV block type I;Second-degree AV block type I;


Rhythm IdentificationRhythm Identification This rhythm strip is from a 69-year-old man who isThis rhythm strip is from a 69-year-old man who is

disoriented. He knows his name but has no ideadisoriented. He knows his name but has no idea


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where he is or how he got there. BP: 172/98, R: 20.where he is or how he got there. BP: 172/98, R: 20.

Blood sugar: 127 mg/dL.Blood sugar: 127 mg/dL.


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IdentificationIdentification Sinus rhythm at 79 bpmSinus rhythm at 79 bpm


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Ventricular rate/rhythmVentricular rate/rhythm 188/min/regular188/min/regular




IdentificationIdentification Narrow-QRS tachycardia (AVNRT)Narrow-QRS tachycardia (AVNRT)with ST-segment depressionwith ST-segment depression



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Ventricular rate/rhythmVentricular rate/rhythm 64 bpm (sinus beats)/regular except for64 bpm (sinus beats)/regular except for

the eventthe eventAtrial rate/rhythmAtrial rate/rhythm 64 bpm (sinus beats)/regular except for64 bpm (sinus beats)/regular except for

the eventthe event



IdentificationIdentification Sinus rhythm with an episode of sinusSinus rhythm with an episode of sinusarrest and a junctional escape beatarrest and a junctional escape beat

Rhythm IdentificationRhythm IdentificationThis rhythm strip is from an 82-year-old man complaining of

back pain.


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Lead II

Lead MCL1


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