EKG Interpretation

normal sinus rhythm

• HR: 60-100 bpm

• Reg. rhythm

• P wave before every QRS

• PRI: 0.12-0.20

• QRS: <0.12

rhythm interpretation

1. Rate

2. Rhythm (regular or irregular?)

3. P waves (present? Consistent?)

4. PRI

5. QRS

1st degree heart block

• Sinus rhythm

• Reg R to R

• P waves same before QRS

• PRI >0.20

• QRS normal

  • P:QRS 1:1

• “1 looks like SR/SB x PRI >.20”

2nd degree type I

• Irregular R to R

• PRI variable (increases until QRS dropped)

• QRS normal

  • Not all P:QRS

• Repeat pattern

• “2^1 P, measure PRI” (repeats in length pattern)

2nd degree type II

• Reg or irreg R to R

• P waves same, but lots of extra

• PRI same/constant (norm or abnorm)

• QRS norm or prolonged (in clusters)

• “2^2 P, measure PRI” (PRI = Same)

3rd degree/complete block

• Reg R to R

• No P waves

• PRI variable

• QRS normal (junctional) or wide – Narrow or wide

• “3 P, measure PRI (variable/no pattern)”

junctional

• missing/inverted P waves, narrow QRS

  • Reg rhythm

  • HR: 40-60

  • False p waves (upside down)

  • PRI unmeasureable

idioventricular

• no P, slow & wide QRS

  • HR: 20-40

  • No p waves

  • No PRI

  • QRS 40-100; Reg & wide; >0.12

svt

• No p waves

• HR: >150-160

a fib

• No p waves

• PRI unmeasurable

• QRS normal

A fib w/ RVR

>100 bpm

a flutter

• Sawtooth p waves

• PRI unmeasureable

• QRS normal

torsades

twisting around baseline

PVCs

• early & wide (ugly beat)

  • No P waves

  • T wave in opposite direction as QRS

PACs

•  early beat, narrow QRS

  • P waves present, but different

  • QRS normal

v tach

• >3 consecutive PVCs

• HR: 110-250 bpm

• Reg R to R

• No P waves

• QRS >0.12

v fib

ventricular quiver, no contraction