copyright © 2006 by mosby inc. all rights reserved. rhythm identification

Copyright © 2006 by Mosby Inc. All rights reserved.

Rhythm IdentificationRhythm Identification


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-degree Sinus rhythm with first-degree AV block, ST-segment elevationAV block, ST-segment elevation


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)/




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

ST-segment elevationST-segment elevation



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


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



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


QRS durationQRS duration 0.12 sec0.12 sec

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



This rhythm strip is from an 86-year-old This rhythm strip is from an 86-year-old woman who experienced a cardiopulmonary woman who experienced a cardiopulmonary arrest. The initial rhythm was asystole. The arrest. The initial rhythm was asystole. The following rhythm resulted after IV following rhythm resulted after IV administration of epinephrine and atropine. administration of epinephrine and atropine.



Atrial rate/rhythmAtrial rate/rhythm NoneNone

PR intervalPR interval NoneNone


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



This rhythm strip is from a 69-year-old man This rhythm strip is from a 69-year-old man complaining of shortness of breath. Lung complaining 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






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



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

PR intervalPR interval Unable to determineUnable to determine


IdentificationIdentification Monomorphic ventricular tachycardiaMonomorphic ventricular tachycardia


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) to 0.12 to 0.16 sec (VT) to 0.06 sec 0.06 sec (atrial fib)(atrial fib)

IdentificationIdentification Monomorphic VT to atrial fibrillationMonomorphic VT to atrial fibrillation






IdentificationIdentification Atrial flutter with ST-segment Atrial flutter with ST-segment depressiondepression




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



IdentificationIdentification Junctional bradycardia with ST-Junctional bradycardia with ST-segment depression to sinus segment depression to sinus bradycardia, inverted T wavesbradycardia, inverted T waves




PR intervalPR interval VariesVaries


IdentificationIdentification Complete (third-degree) AV block Complete (third-degree) AV block with inverted T waveswith inverted T waves



This rhythm strip is from a 52-year-old man This rhythm strip is from a 52-year-old man found unresponsive, apneic, and pulseless. found unresponsive, apneic, and pulseless.






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



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





IdentificationIdentification Sinus rhythm with first-degree AV Sinus rhythm with first-degree AV block and PACsblock and PACs






IdentificationIdentification Second-degree AV block type II Second-degree AV block type II with ST-segment depressionwith ST-segment depression


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



These rhythm strips are from a 78-year-old These rhythm strips are from a 78-year-old man complaining of shortness of breath. He man complaining of shortness of breath. He has a history of COPD, coronary artery has a history of COPD, coronary artery disease, and hypertension. disease, and hypertension.






IdentificationIdentification Atrial fibrillation (controlled)Atrial fibrillation (controlled)



This rhythm strip is from a 97-year-old This rhythm strip is from a 97-year-old woman after a fall. woman after a fall.






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



This rhythm strip is from a 70-year-old man This rhythm strip is from a 70-year-old man complaining of a sharp pain across his complaining of a sharp pain across his shoulders. Blood pressure: 218/86. shoulders. Blood pressure: 218/86.


Ventricular rate/rhythmVentricular rate/rhythm 115/min (sinus beats)/115/min (sinus beats)/


Atrial rate/rhythmAtrial rate/rhythm 115/min (sinus beats)/115/min (sinus beats)/







This rhythm strip is from a 76-year-old man This rhythm strip is from a 76-year-old man complaining of indigestion. complaining of indigestion.






IdentificationIdentification Junctional bradycardia with Junctional bradycardia with ST-segment depression and ST-segment depression and inverted T wavesinverted T waves



This rhythm strip is from an 80-year-old This rhythm strip is from an 80-year-old woman complaining of weakness. woman complaining of weakness.


Atrial paced activity?Atrial paced activity? NoNo



IdentificationIdentification 100% ventricular paced rhythm100% ventricular paced rhythm


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

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

Atrial rate/rhythmAtrial rate/rhythm 55/min (sinus beats)/ 55/min (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 ventricular Sinus bradycardia with ventricular bigeminybigeminy



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






IdentificationIdentification Sinus rhythm with Sinus rhythm with ST-segment depressionST-segment depression



This rhythm strip is from an 86-year-old This rhythm strip is from an 86-year-old woman complaining of chest pain that she woman complaining of chest pain that she rates a 4 on a scale of 0 to 10. Blood rates a 4 on a scale of 0 to 10. Blood pressure: 142/72. pressure: 142/72.






IdentificationIdentification Sinus rhythmSinus rhythm



This rhythm strip is from a 78-year-old man This rhythm strip is from a 78-year-old man complaining of palpitations. Note the point at complaining of palpitations. Note the point at which the patient was defibrillated. which the patient was defibrillated.


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)



IdentificationIdentification Monomorphic ventricular Monomorphic ventricular tachycardia – shock – ventricular tachycardia – shock – ventricular beats – sinus arrhythmiabeats – sinus arrhythmia








IdentificationIdentification Sinus rhythm with uniform PVCsSinus rhythm with uniform PVCs








IdentificationIdentification Sinus tachycardia with PACsSinus tachycardia with PACs



This rhythm strip is from a 3-month-old This rhythm strip is from a 3-month-old infant who had an altered level of infant who had an altered level of responsiveness. She was limp with a responsiveness. She was limp with a respiratory rate of 4 breaths/min. Blood respiratory rate of 4 breaths/min. Blood sugar was 174. sugar was 174.




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


IdentificationIdentification Sinus tachycardia with an Sinus tachycardia with an interpolated PVCinterpolated PVC



This rhythm strip is from an 83-year-old man This rhythm strip is from an 83-year-old man complaining of chest pain. He had a new complaining of chest pain. He had a new pacemaker implanted 5 days ago. His blood pacemaker implanted 5 days ago. His blood pressure is 148/60. pressure is 148/60.



This rhythm strip is from a 52-year-old man This rhythm strip is from a 52-year-old man with substernal chest pain. He has a history with substernal chest pain. He has a history of COPD and mitral valve regurgitation. Blood of COPD and mitral valve regurgitation. Blood pressure: 140/78. pressure: 140/78.






IdentificationIdentification Sinus rhythm with ST-segment Sinus rhythm with ST-segment depressiondepression






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




PR intervalPR interval LengthensLengthens


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






IdentificationIdentification Accelerated junctional rhythmAccelerated junctional rhythm


Ventricular rate/rhythmVentricular rate/rhythm NoneNone



QRS durationQRS duration NoneNone

IdentificationIdentification AsystoleAsystole



These rhythm strips are from a 46-year-old These rhythm strips are from a 46-year-old woman complaining of abdominal pain. woman complaining of abdominal pain.



This rhythm strip is from a 61-year-old man This rhythm strip is from a 61-year-old man with a history of heart failure. with a history of heart failure.


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

Atrial rate/rhythmAtrial rate/rhythm 65 to 75 bpm (sinus beats)/Irregular65 to 75 bpm (sinus beats)/Irregular



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



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






IdentificationIdentification Sinus tachycardiaSinus tachycardia






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



This rhythm strip is from a 72-year-old man This rhythm strip is from a 72-year-old man complaining of chest pain. complaining of chest pain.



This rhythm strip is from a 77-year-old woman This rhythm strip is from a 77-year-old woman with a congested cough. with a congested cough.






IdentificationIdentification Atrial fibrillation (uncontrolled)Atrial fibrillation (uncontrolled)


Ventricular Ventricular 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


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



This rhythm strip is from a 54-year-old man This rhythm strip is from a 54-year-old man who had a syncopal episode. who had a syncopal episode.






IdentificationIdentification Sinus bradycardiaSinus bradycardia



This rhythm strip is from a 66-year-old man This rhythm strip is from a 66-year-old man complaining of chest pain. Blood pressure: complaining of chest pain. Blood pressure: 170/96. 170/96.






IdentificationIdentification Sinus tachycardia with Sinus tachycardia with

first-degree AV blockfirst-degree AV block



This rhythm strip is from a 43-year-old woman This rhythm strip is from a 43-year-old woman complaining of palpitations. complaining of palpitations.






IdentificationIdentification Narrow-QRS tachycardiaNarrow-QRS tachycardia



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 she The patient has a history of SVT and states she cannot tolerate adenosine. The following rhythm is cannot tolerate adenosine. The following rhythm is observed on the cardiac monitor after diltiazem observed on the cardiac monitor after diltiazem

administration.administration.


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 sinus Junctional to sinus to narrow-QRS tachycardiato narrow-QRS tachycardia


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



QRS durationQRS duration Unable to determineUnable to determine

IdentificationIdentification Ventricular fibrillation (coarse)Ventricular fibrillation (coarse)






IdentificationIdentification Sinus bradycardia with first-degree Sinus bradycardia with first-degree AV block, wide-QRS (probable AV block, wide-QRS (probable bundle branch block), bundle branch block), ST-segment depressionST-segment depression



This rhythm strip is from a 76-year-old woman This rhythm strip is from a 76-year-old woman complaining of back pain. Her medical history complaining of back pain. Her medical history includes a myocardial infarction 2 years ago. includes a myocardial infarction 2 years ago.



This rhythm strip is from an 80-year-old man This rhythm strip is from an 80-year-old man found sitting in a chair. He is unresponsive, found sitting in a chair. He is unresponsive, apneic, and pulseless. apneic, and pulseless.






IdentificationIdentification Asystole – the electrical activity Asystole – the electrical activity shown is caused by pacemaker shown is caused by pacemaker spikes from the patient’s spikes from the patient’s permanent pacemaker (no permanent pacemaker (no capture)capture)



This rhythm strip is from an 88-year-old This rhythm strip is from an 88-year-old woman complaining of hip pain after a fall woman complaining of hip pain after a fall injury. injury.






IdentificationIdentification Atrial fibrillationAtrial fibrillation






IdentificationIdentification Second-degree AV block type I Second-degree AV block type I with a ventricular complexwith a ventricular complex


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-degree Sinus bradycardia with a first-degree AV block to junctional escape rhythmAV block to junctional escape rhythm



This rhythm strip is from a 67-year-old woman This rhythm strip is from a 67-year-old woman found unresponsive on the side of the road. found unresponsive on the side of the road. Outdoor temperature is 112°F. Blood Outdoor temperature is 112°F. Blood pressure: 238/110, respiratory rate: 60/min. pressure: 238/110, respiratory rate: 60/min.






IdentificationIdentification Sinus tachycardia with Sinus tachycardia with

ST-segment depressionST-segment depression



This rhythm strip is from an 84-year-old man This rhythm strip is from an 84-year-old man complaining of dizziness. He had a triple complaining of dizziness. He had a triple bypass 4 days ago. bypass 4 days ago.








IdentificationIdentification Sinus rhythm with ventricular Sinus rhythm with ventricular bigeminy, ST-segment depressionbigeminy, ST-segment depression



This rhythm strip is from an 81-year-old This rhythm strip is from an 81-year-old woman with an altered level of woman with an altered level of responsiveness. blood pressure: 160/70, responsiveness. blood pressure: 160/70, blood sugar: 114. blood sugar: 114.






IdentificationIdentification Sinus bradycardia with Sinus bradycardia with

first-degree AV blockfirst-degree AV block



This rhythm strip is from a 80-year-old woman who This rhythm strip is from a 80-year-old woman who was playing Bingo when she felt dizzy and slumped was playing Bingo when she felt dizzy and slumped over in her chair. Bystanders state she was over in her chair. Bystanders state she was unresponsive for approximately 5 minutes. A pulse is unresponsive for approximately 5 minutes. A pulse is present. present.



This rhythm strip is from a 91-year-old woman This rhythm strip is from a 91-year-old woman complaining of chest pain and difficulty complaining of chest pain and difficulty breathing. breathing.






IdentificationIdentification Atrial fibrillation with Atrial fibrillation with




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



This rhythm strip is from a 59-year-old woman This rhythm strip is from a 59-year-old woman who complained of sudden weakness in her who complained of sudden weakness in her legs and fell to the floor in her kitchen. legs and fell to the floor in her kitchen.






IdentificationIdentification Atrial fibrillation (controlled) Atrial fibrillation (controlled) with ST-segment elevationwith ST-segment elevation



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



This rhythm strip is from a 62-year-old woman This rhythm strip is from a 62-year-old woman complaining of chest pain. Her blood pressure complaining of chest pain. Her blood pressure is 146/104, respirations are 20. Breath is 146/104, respirations are 20. Breath sounds are clear. sounds are clear.






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



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






IdentificationIdentification Sinus arrhythmiaSinus arrhythmia



This rhythm strip is from a 76-year-old man This rhythm strip is from a 76-year-old man who was playing golf and experienced a who was playing golf and experienced a syncopal episode. syncopal episode.






IdentificationIdentification Sinus rhythm with ST-segment Sinus rhythm with ST-segment elevationelevation



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






IdentificationIdentification Monomorphic ventricular Monomorphic ventricular tachycardiatachycardia






IdentificationIdentification Complete (third-degree) AV block Complete (third-degree) AV block with ST-segment elevationwith ST-segment elevation



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



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





IdentificationIdentification Ventricular demand pacemakerVentricular demand pacemaker






IdentificationIdentification Atrial flutterAtrial flutter









ventricular bigeminyventricular bigeminy



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



This rhythm strip is from an 84-year-old This rhythm strip is from an 84-year-old woman with a nosebleed. Blood pressure: woman with a nosebleed. Blood pressure: 250/74. 250/74.






IdentificationIdentification Sinus rhythmSinus rhythm



This rhythm strip is from a 79-year-old man This rhythm strip is from a 79-year-old man complaining of palpitations. His initial blood complaining of palpitations. His initial blood pressure was 112/84. His second blood pressure was 112/84. His second blood pressure, 8 minutes after the first, was 78/P. pressure, 8 minutes after the first, was 78/P.






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



This rhythm strip is from an 80-year-old man This rhythm strip is from an 80-year-old man complaining 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.






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



This rhythm strip is from a 58-year-old man This rhythm strip is from a 58-year-old man with chest pain that he rates as a 2 on a scale with chest pain that he rates as a 2 on a scale of 0 to 10. He states he recently began taking of 0 to 10. He states he recently began taking pills for weight control. pills for weight control.








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



This rhythm strip is from a 60-year-old woman This rhythm strip is from a 60-year-old woman complaining of palpitations and shortness of complaining of palpitations and shortness of breath. breath.


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




IdentificationIdentification Atrial fibrillation with a rapid Atrial fibrillation with a rapid ventricular response (RVR)ventricular response (RVR)



This rhythm strip is from a 60-year-old woman This rhythm strip is from a 60-year-old woman complaining of palpitations and shortness of complaining of palpitations and shortness of breath after administration of adenosine 6 mg breath after administration of adenosine 6 mg IV. IV.



This rhythm strip is from a 60-year-old woman This rhythm strip is from a 60-year-old woman complaining of palpitations and shortness of complaining of palpitations and shortness of breath 1 minute after administration of breath 1 minute after administration of adenosine 12 mg IV. adenosine 12 mg IV.



This rhythm strip is from a 60-year-old woman This rhythm strip is from a 60-year-old woman complaining of palpitations and shortness of complaining of palpitations and shortness of breath two minutes after administration of breath two minutes after administration of adenosine 6 mg IV. adenosine 6 mg IV.






IdentificationIdentification Atrial fibrillation with a rapid Atrial fibrillation with a rapid ventricular response (RVR)ventricular response (RVR)


Ventricular rate/rhythmVentricular rate/rhythm 30 bpm (junctional beats)/irregular30 bpm (junctional beats)/irregular

Atrial 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



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






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




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

Atrial rate/rhythmAtrial rate/rhythm 100 bpm (sinus beats)/100 bpm (sinus beats)/

Regular to unable to determineRegular to unable to determine



IdentificationIdentification Sinus rhythm with first-degree AV Sinus rhythm with first-degree AV block to monomorphic ventricular block to monomorphic ventricular tachycardia (VT)tachycardia (VT)






IdentificationIdentification Complete (third-degree) AV block Complete (third-degree) AV block with ST-segment elevationwith ST-segment elevation






IdentificationIdentification P-wave asystoleP-wave asystole



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


Ventricular rate/rhythmVentricular rate/rhythm 91 bpm/91 bpm/


Atrial rate/rhythmAtrial rate/rhythm 91 bpm/91 bpm/




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






NoteNote U waves are present U waves are present

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





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


Atrial paced activity?Atrial paced activity? YesYes



IdentificationIdentification AV sequential pacemaker with AV sequential pacemaker with failure to capturefailure to capture



This rhythm strip is from an 85-year-old This rhythm strip is from an 85-year-old woman with an altered level of woman with an altered level of responsiveness. Blood pressure: 136/78, responsiveness. Blood pressure: 136/78, blood sugar is 96. blood sugar is 96.








IdentificationIdentification Sinus tachycardia with a PVC and Sinus tachycardia with a PVC and a ventricular coupleta ventricular couplet



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








IdentificationIdentification Sinus tachycardia with PACsSinus tachycardia with PACs


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




IdentificationIdentification Junctional bradycardia Junctional bradycardia with ST-segment depressionwith ST-segment depression


Ventricular rate/rhythmVentricular rate/rhythm 88 bpm/regular 88 bpm/regular

Atrial rate/rhythmAtrial rate/rhythm 88 bpm/regular 88 bpm/regular

PR intervalPR interval 0.28 sec 0.28 sec

QRS durationQRS duration 0.08 sec 0.08 sec

IdentificationIdentification Sinus rhythm with first-degree AV Sinus rhythm with first-degree AV block; ST-segment elevation block; ST-segment elevation


Rhythm IdentificationRhythm Identification This rhythm strip is from a 44-year-old construction This 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.






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


Atrial pacing?Atrial pacing? NoNo

Ventricular pacing?Ventricular pacing? YesYes

Paced intervalPaced interval 8080

IdentificationIdentification Ventricular-paced rhythm with Ventricular-paced rhythm with pacemaker malfunction pacemaker malfunction

(failure to capture)(failure to capture)


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

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





QRS durationQRS duration 0.120.12

IdentificationIdentification Sinus rhythm at 41 to 73 bpm Sinus rhythm at 41 to 73 bpm with a nonconducted PACwith a nonconducted PAC


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

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



IdentificationIdentification Sinus rhythm at 78 bpm with a PACSinus rhythm at 78 bpm with a PAC






IdentificationIdentification Junctional rhythm; ST-segment Junctional rhythm; ST-segment elevationelevation


Ventricular rate/rhythmVentricular rate/rhythm 115 bpm (sinus beats)/regular 115 bpm (sinus beats)/regular except for the event except for the event

Atrial rate/rhythmAtrial rate/rhythm 115 bpm (sinus beats)/regular 115 bpm (sinus beats)/regular except for the event except for the event



IdentificationIdentification Sinus tachycardia with a PJC Sinus tachycardia with a PJC


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

complaining of chest pain.complaining of chest pain.






IdentificationIdentification Monomorphic ventricular Monomorphic ventricular tachycardiatachycardia


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

Atrial rate/rhythmAtrial rate/rhythm 21 bpm/irregular21 bpm/irregular



IdentificationIdentification Sinus bradycardia with Sinus bradycardia with junctional escape beatsjunctional escape beats



48 to 83 bpm/irregular48 to 83 bpm/irregular




IdentificationIdentification Second-degree AV block type II; Second-degree AV block type II; ST-segment depressionST-segment depression



Atrial rate/rhythmAtrial rate/rhythm Unable to determine/irregularUnable to determine/irregular



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


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

Atrial 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,




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

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

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

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

IdentificationIdentification Sinus rhythm with an episode of Sinus rhythm with an episode of couplets and a run of VT couplets 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, albuterol, and Lotensin.






IdentificationIdentification Sinus bradycardia at 44 bpm, ST-segment Sinus bradycardia at 44 bpm, ST-segment depression. Note the upright U waves depression. Note the upright U waves following each T wave. following each T wave.

U wave



60 to 98 bpm/irregular60 to 98 bpm/irregular




IdentificationIdentification Second-degree AV block type I; Second-degree AV block type I; ST-segment depressionST-segment depression


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

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






IdentificationIdentification Sinus rhythm at 79 bpmSinus rhythm at 79 bpm


Rhythm IdentificationRhythm Identification This rhythm strip is from a 35-year-old woman This rhythm strip is from a 35-year-old woman

complaining of chest pain and palpitations. complaining of chest pain and palpitations.


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


PR intervalPR interval Unable to determine Unable to determine


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


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

Atrial rate/rhythmAtrial rate/rhythm 64 bpm (sinus beats)/regular except for 64 bpm (sinus beats)/regular except for the event the event



IdentificationIdentification Sinus rhythm with an episode of sinus Sinus rhythm with an episode of sinus arrest and a junctional escape beatarrest and a junctional escape beat


Rhythm IdentificationRhythm Identification This rhythm strip is from an 82-year-old man complaining of back pain.

Lead II

Lead MCL1


Ventricular rate/rhythmVentricular rate/rhythm 75/min/regular except for event 75/min/regular except for event

Atrial rate/rhythmAtrial rate/rhythm 75/min/regular except for event 75/min/regular except for event



IdentificationIdentification Sinus rhythm at 75 bpm with a wide QRS Sinus rhythm at 75 bpm with a wide QRS and a nonconducted PACand a nonconducted PAC

Lead II

Lead MCL1


Rhythm IdentificationRhythm Identification This rhythm strip is from a 51-year-old man This rhythm strip is from a 51-year-old man

complaining of dull chest pain that began about 2 complaining of dull chest pain that began about 2 hours ago. He rates his discomfort as a 6 on a scale 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, of 1 to 10. BP: 70/48, R: 24. His skin is cool, pale, and diaphoretic.and diaphoretic.



Atrial rate/rhythmAtrial rate/rhythm 71 bpm/slightly irregular71 bpm/slightly irregular



IdentificationIdentification Complete AV block with Complete AV block with ST-segment elevationST-segment elevation



250 to 333 bpm/irregular 250 to 333 bpm/irregular

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



IdentificationIdentification Polymorphic VTPolymorphic VT



Ventricular Ventricular pacing?pacing?

YesYes


IdentificationIdentification 100% ventricular paced rhythm 100% ventricular paced rhythm


Rhythm IdentificationRhythm Identification These rhythm strips are from a 78-year-old man complaining of shortness of breath. He has a history of COPD, coronary artery disease, and hypertension.



55-94/min/irregular55-94/min/irregular




IdentificationIdentification Controlled atrial fibrillation at 55-94 bpm Controlled atrial fibrillation at 55-94 bpm



50 bpm/regular 50 bpm/regular




IdentificationIdentification Third-degree AV block; Third-degree AV block;

ST-segment elevation ST-segment elevation


Rhythm IdentificationRhythm Identification This rhythm strip is from a 1-year-old girl. Mom says This rhythm strip is from a 1-year-old girl. Mom says

the infant suddenly went limp and her limbs began the infant suddenly went limp and her limbs began shaking. The episode lasted about 45 sec. Her shaking. The episode lasted about 45 sec. Her temperature is normal. temperature is normal.






IdentificationIdentification Sinus tachycardia at 215 bpmSinus tachycardia at 215 bpm


Rhythm IdentificationRhythm Identification This rhythm strip is from an 81-year-old woman This rhythm strip is from an 81-year-old woman

complaining of weakness. BP: 122/59, R: 12. Blood complaining of weakness. BP: 122/59, R: 12. Blood sugar is 109 mg/dL.sugar is 109 mg/dL.






IdentificationIdentification Accelerated junctional rhythm; Accelerated junctional rhythm;



Rhythm IdentificationRhythm Identification This rhythm strip is from a 26-year-old man after a seizure.






IdentificationIdentification Sinus arrhythmia at 64 to 94 bpm Sinus arrhythmia at 64 to 94 bpm


Rhythm IdentificationRhythm Identification This rhythm strip is from an 18-year-old man with a This rhythm strip is from an 18-year-old man with a

gunshot wound to his chest.gunshot wound to his chest.



Unable to determineUnable to determine




IdentificationIdentification Coarse ventricular Coarse ventricular fibrillationfibrillation


Atrial pacing?Atrial pacing? YesYes



IdentificationIdentification 100% paced rhythm 100% paced rhythm

– – AV sequential AV sequential pacemakerpacemaker


Ventricular rate/rhythmVentricular rate/rhythm 88/min/regular88/min/regular




IdentificationIdentification Atrial flutter at 88 bpm Atrial flutter at 88 bpm

with ST-segment depressionwith ST-segment depression


Rhythm IdentificationRhythm Identification This rhythm strip is from a 77-year-old woman who states that 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-she feels fine. She stopped at a blood pressure machine in Wal-Mart and the machine would not read her pulse rate. She later Mart and the machine would not read her pulse rate. She later went to her physician’s office and then to the emergency went to her physician’s office and then to the emergency department.department.






IdentificationIdentification 2:1 AV block, probably type II; 2:1 AV block, probably type II; ST-segment elevation ST-segment elevation


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



111 bpm/regular except for event111 bpm/regular except for event

Atrial rate/rhythmAtrial rate/rhythm 111 bpm/regular except for event111 bpm/regular except for event



IdentificationIdentification Sinus tachycardia at 111 bpm with a Sinus tachycardia at 111 bpm with a nonconducted PACnonconducted PAC


Ventricular rate/rhythmVentricular rate/rhythm Two ventricular complexes to noneTwo ventricular complexes to none



QRS durationQRS duration 0.14 sec to none0.14 sec to none

IdentificationIdentification Agonal rhythm/asystole Agonal rhythm/asystole


Ventricular rate/rhythmVentricular rate/rhythm 30 bpm (sinus beats)/regular except for events 30 bpm (sinus beats)/regular except for events

Atrial rate/rhythmAtrial rate/rhythm 30 bpm (sinus beats)/regular except for events 30 bpm (sinus beats)/regular except for events

PR intervalPR interval 0.12 to 0.16 sec (sinus beats) 0.12 to 0.16 sec (sinus beats)

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

IdentificationIdentification Sinus bradycardia with ventricular bigeminy, Sinus bradycardia with ventricular bigeminy, inverted T waves, horizontal ST-segments inverted T waves, horizontal ST-segments


Rhythm IdentificationRhythm Identification These rhythm strips are from a 52-year-old man with These rhythm strips are from a 52-year-old man with

syncope. syncope.


Atrial pacing?Atrial pacing? YesYes

Ventricular Ventricular pacing?pacing?

NoNo


IdentificationIdentification Atrial pacemakerAtrial pacemaker


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






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



52 bpm/regular52 bpm/regular




IdentificationIdentification Sinus beat to junctional escape Sinus beat to junctional escape rhythm with inverted T wavesrhythm with inverted T waves



54 bpm/regular (sinus beats) 54 bpm/regular (sinus beats)

Atrial rate/rhythmAtrial rate/rhythm 54 bpm/regular (sinus beats) 54 bpm/regular (sinus beats)


QRS durationQRS duration 0.06-0.08 sec (sinus beats) 0.06-0.08 sec (sinus beats)

IdentificationIdentification Sinus bradycardia with Sinus bradycardia with ventricular bigeminyventricular bigeminy







IdentificationIdentification 2:1 AV block, probably type I; 2:1 AV block, probably type I; ST-segment depression ST-segment depression







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






IdentificationIdentification Sinus tachycardia at 167 bpm Sinus tachycardia at 167 bpm



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






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


Ventricular rate/rhythmVentricular rate/rhythm 150 bpm/essentially regular150 bpm/essentially regular




IdentificationIdentification Monomorphic VTMonomorphic VT





IdentificationIdentification 100% ventricular-paced rhythm 100% ventricular-paced rhythm



63 bpm (sinus beats)/regular except for 63 bpm (sinus beats)/regular except for the event (every third beat is a PJC)the event (every third beat is a PJC)

Atrial rate/rhythmAtrial rate/rhythm 63 bpm (sinus beats)/regular except for 63 bpm (sinus beats)/regular except for the event (every third beat is a PJC)the event (every third beat is a PJC)

PR intervalPR interval 0.12 to 0.16 sec (sinus beats)0.12 to 0.16 sec (sinus beats)


IdentificationIdentification Sinus rhythm with PJCsSinus rhythm with PJCs



180/min/regular180/min/regular




IdentificationIdentification AVNRT at 180 bpm, ST-segment AVNRT at 180 bpm, ST-segment elevationelevation


Rhythm IdentificationRhythm Identification This rhythm strip is from a 61-year-old woman complaining This rhythm strip is from a 61-year-old woman complaining

of shortness of breath. Blood pressure 176/110.of shortness of breath. Blood pressure 176/110.



125 bpm/essentially regular except for 125 bpm/essentially regular except for eventsevents

Atrial rate/rhythmAtrial rate/rhythm 125 bpm/essentially regular except for 125 bpm/essentially regular except for eventsevents

PR intervalPR interval 0.12 sec (sinus beats) 0.12 sec (sinus beats)


IdentificationIdentification Sinus tachycardia with multiform PVCsSinus tachycardia with multiform PVCs






IdentificationIdentification Sinus tachycardia with first-degree Sinus tachycardia with first-degree AV blockAV block






IdentificationIdentification Accelerated idioventricular rhythm Accelerated idioventricular rhythm (AIVR) with ST-segment elevation(AIVR) with ST-segment elevation

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