ecg

Normal Sinus Rhythm

rate: 60-100bpm

rhythm: regular

Pwave: present with each QRS, upright, round, regular, <0.11s less than 3 boxes

PR interval: 0.12-0.20 sec (3-5 small boxes)

QRS: narrow, 0.04-0.11 seconds (<0.12 boxes)

Sinus Bradycardia

rate: 20-60 (<60bpm)

rhythm: regular

Pwave: present with each QRS; upright, round, regular, <0.11 seconds

PR interval: 0.12-0.20 seconds

QRS: narrow, 0.04-0.11 seconds

Sinus Tachycardia

rate: 100-150 (>100bpm)

rhythm: regular

p wave: present with each QRS; upright, round, regular

PR interval: 0.12-0.20 seconds

QRS: narrow; 0.04-0.11 seconds (<0.12 seconds)

Sinus Dysrhythmia/Arrythmia

rate: varies, generally 60-100 bpm

rhythm: irregularly, usually regularly irregular

p wave: present with each QRS; upright, round

PR interval: 0.12-0.20 seconds

QRS: narrow; 0.04-0.11 seconds

Sinus Arrest

rate: varies, depending on the length of arrest, may be bradycardic

rhythm: irregular, due to dropped complexes. arrest time must be greater than 2 seconds; if less than 2 seconds rhythm is called sinus pause.

p wave: present with each QRS, upright, round

PR interval: 0.12-0.20 seconds

QRS: narrow, 0.04-0.11 seconds (when measuring R-R continuing measurement through arrest phase, the 1st R wave after the arrest will not match up within 0.08 seconds (2 small boxes))

sinus block

rate: varies, may be bradycardic depending on length of block

rhythm: irregular due to dropped complexes, block time must be greater than 2 seconds, if less than 2 seconds it is sinus pause

p wave: present with each QRS, upright, round

pr interval: 0.12-0.20 seconds

QRS: narrow, 0.04-0.11 seconds (when measuring R-R the first R wave after the block period will synch with previous R-R within less than 0.08 seconds) (FALLS back, on beat (SKIPS A BEAT))

Sinus Rhythm with Premature Atrial Contraction (PAC)

rate: varies generally 60-100bpm

rhythm: irregular

p wave: present, upright, round, premature QRS complex P waves may present with a different shape (pointed, inverted)

PR interval: 0.12-0.20 seconds

QRS: narrow, 0.04-0.11 seconds (<0.12s) (BEAT goes before its supposed to)

ectopic atrial rhythm (ear)

rate: 60-100bpm

rhythm: regular

p wave: inverted, may be biphasic

PR interval: 0.12-0.20 seconds

QRS: narrow, 0.04-0.11 seconds

ectopic atrial tachycardia (eat)

rate: >100bpm

rhythm: regular

P wave: inverted

PR interval: 0.12-0.20 seconds

QRS: narrow, 0.04-0.11 seconds

supraventricular tachycardia (SVT)

rate: >150bpm (kids[1-10] is 180; infants is 220)

rhythm: regular (narrow complex regular SVT), may be irregular (narrow complex irregular SVT)

p wave: present with each QRS in regular SVT, generally upright, may be buried in preceding T wave in adults, generally not present in irregular SVT.

PR interval: 0.12-0.20 seconds

QRS: narrow 0.04-0.11 seconds

Wolff parkinson - white syndrome (WPW)

rate: 60-100bpm (may be tachycardic)

rhythm: regular

P wave: present with each QRS, upright, connecting Delta wave

PR interval: usually less than 0.12 w/ delta wave present

QRS: narrow, not greater than 0.11 seconds

lown ganong levine syndrome (LGL)

rate: 60-100bpm (may be tachycardic)

rhythm: regular

P wave: present, upright, round

PR interval: short, less than 0.12 seconds. (NO delta wave)

QRS: narrow, 0.04-0.11 seconds

Atrial Fibrillation (A-FIB)

rate: varies, may be bradycardic, 60-100, tachycardic, SVT (narrow complex irregular)

rhythm: irregularly irregular

p wave: no obvious P wave

PR interval: unable to determine due to no P wave

QRS: narrow, 0.04-0.11 seconds

Atrial Flutter (AF)

rate: varies, ventricular complexes may be normal tachycardic, SVT, atrial rate can exceed 300

rhythm: varies, generally regular but can be irregular

P wave: multiple are present for each QRS (F wave) (SAWTOOTH)

PR interval: varies but can be regular

QRS: narrow; 0.04-0.11 seconds

Wandering Atrial Pacemaker(WAP)

rate: 60-100 (<100), may be bradycardic

rhythm: irregular

p wave: present, with each QRS, may be round, pointed, biphasic (3+ different P waves)

PR interval: varies, with different shaped P waves, generally 0.08-0.20 seconds (short < 0.12 / 3 boxes)

QRS: narrow, 0.04-0.11 seconds.

Multifocal Atrial Tachycardia (MAT)

rate: tachycardic (100-150), SVT (>150)

rhythm: irregular

P wave: 3 + different P waves

PR interval: 0.08-0.20 (short < 0.12 seconds)

QRS: narrow, 0.04-0.11 seconds

AV Nodal Reentry Tachycardia (AVNRT)

rate: >150

rhythm: generally regular, unless PSVT seen

p wave: absent, may be seen in retrograde QRS

PR interval: unable to determine

QRS: narrow, 0.04-0.11 seconds. **NOTE: if PSVT is witnessed, preceding QRS complex will be PAC with long PR interval.

Premature Ventricular Complex- Trigeminy

rate: varies

rhythm: irregular

P wave: none

PR interval: none

QRS: Wide (EVERY THIRD ONE IS A PVC)

Idioventricular Rhythm (IVR) (ventricular escape rhythm)

rate: 20-40

rhythm: regular

p wave: absent

PR interval: unable to obtain

QRS: wide, 0.12 or >

Accelerated Idioventricular Rhythm (AIVR)

rate: 40-100

rhythm: regular

p wave: absent

PR interval: unable to obtain

QRS: wide 0.12 seconds or >

Ventricular Tachycardia (V TACH, VT)

rate: 100 or >, usually 130-220

rhythm: regular

p wave: absent

PR interval: unable to obtain

QRS: Wide, 0.12 or >

Premature Junctional Complex (PJC)

rate: varies, depends on underlying rhythm

rhythm: irregular

p wave: will be inverted before QRS, or absent, or inverted after QRS

PR interval: will be short (<0.12 seconds) if p wave is before QRS

QRS: narrow, 0.04-0.11 seconds

Polymorphic VT (Torsades De Pointes)

rate: 150-220

rhythm: irregular

P wave: absent

PR interval: unable to obtain

QRS: wide, 0.12 or >

premature ventricular complex-unifocal

Rate: varies, depending on underlying rhythm

rhythm: irregular

P wave: absent

Pr interval: absent

QRS: wide, >0.12 seconds (PVCs looks the same)

premature ventricular complex-multifocal

rate: varies

rhythm: irregular

p wave: absent

PR interval: absent

QRS: wide (PVCs look different)

premature ventricular complex-couplet

rate: varies

rhythm: irregular

p wave: absent

PR interval: absent

QRS: wide ( 2 PVCs in a row [BACK to BACK])

premature ventricular complex-triplett

rate: varies

rhythm: irregular

p wave: absent

PR interval: absent

QRS: wide (run of VT, three PVCs in a row [also back to back])

Premature Ventricular Complex- bigeminy

rate: varies

rhythm: irregular

p wave: none

PR interval: none

QRS: wide (every other one is a PVC)

Junctional Escape Rhythm

rate: 40-60bpm

rhythm: regular

p wave: inverted before QRS, or absent, or after QRS

PR interval: will be short <0.12s if P wave is before QRS

QRS: narrow, 0.04-0.11 seconds

Accelerated Junctional Rhythm

rate: 60-100 bpm

rhythm: regular

p wave: inverted before QRS, or absent after QRS

PR interval: will be short <0.12 seconds, if p wave is before QRS

QRS: narrow, 0.04-0.11 seconds

Junctional Tachycardia

rate: 100-150 bpm (>100)

rhythm: regular

p wave: inverted before QRS, or absent after QRS

PR interval: will be short <0.12 s, if p wave is before QRS

QRS: narrow, 0.04-0.11 seconds

ventricular fibrillation (V fib)

rate: 0 (fast)

rhythm: irregular (chaotic baseline)

p wave: absent

PR interval: absent

QRS: none

asystole

rate: 0

rhythm: none

p wave: none

PR interval: none

QRS: none (flat isometric line)

sinus w/ 1st degree block

rate: 60-100 (may be higher or slower)

rhythm: regular

p wave: upright, round

PR interval: > than 0.12-0.20 seconds

QRS: narrow, 0.04-0.11 seconds (LONG PR INTERVAL)

2nd degree Type 1 (wenckebach)

rate: usually lower normal ranges of 60-80, may be bradycardic, rarely tachycardic.

rhythm: regularly irregular

p wave: upright, round, p wave is present before each QRS, one or more p wave may be present w/o a corresponding QRS.

PR interval: progressively lengthening PRI until 1 or more QRS complexes are blocked (dropped). [going, going, gone {longer, longer, drops QRS}]

QRS: narrow, 0.04-0.11 seconds

2nd degree type 2

rate: varies (usually slow normal to bradycardia)

rhythm: mostly irregular; occasionally regular

P wave: upright, round; present before each QRS, one or more P waves may not be associated w/o QRS

PR interval: 0.12-0.20 where a PRI can be measured may be slightly longer but will be constant throughout rhythm

QRS: narrow, 0.04-0.11 seconds

atrial pacemaker

rate: 60-100, may be slightly tachycardic

rhythm: regular

p wave: usually upright, round, and may be inverted; possible pacer spike noted preceding p wave; 12 lead will have arrows at bottom that align with pacer spike.

PR interval: usually normal at 0.12-0.20 seconds.

QRS: narrow, 0.04-0.11 seconds

3rd degree block

rate: p wave rate usually 60-100, QRS rate varies from 20-80, extreme rarity for tachycardia.

rhythm: p to p regular, r-r regular, no consistent rhythm between p wave and r wave.

p wave: upright, round

PR interval: extreme inconsistency

QRS: may be measured as narrow 0.04-0.11 seconds (3rd degree block) or may be seen as a wide 0.12 or > (complete 3rd degree block)

ventricular pacemaker

rate: 70-110

rhythm: regular

p wave: absent

PR interval: unable to obtain

QRS: wide, 0.12 or >; possible pacer spike noted preceding QRS complex; 12 lead will have arrows at bottom aligning with QRS complexes depending on pacer type (demand vs non demand)

dual sequential pacemaker

rate: 60-100, may be slightly tachycardic

rhythm: regular

p wave: may be present but a pacer spike will precede p wave, if present

PR interval: normal, 0.12-0.20

QRS: wide; 0.12 or > with pacer spike preceding QRS; 12 lead will have arrows aligning with each atrial and ventricular pacer spike

failure to capture

rate: usually below 60

rhythm: irregular R-R

p wave: generally absent

PR interval: generally unable to obtain

QRS: wide, 0.12 or > with pacer spike preceding each QRS and pacer spikes seen without corresponding QRS complexes

failure to synchronize

rate: usually bradycardic, less than 60

rhythm: irregular

p wave: may be present if pacemaker is atrial based; not present if pacemaker is ventricular based

PR interval: should be normal, 0.12-0.20 seconds if pacemaker is atrial based; UTO, if pacemaker is ventricular based.

QRS: may be narrow or wide depending on location of pacemaker, wide, ventricular escape beats without pacer spike preceding QRS. pacer spike noted on 12 lead.