Those nasty rhythm problems
Basic ECG Identification
- 1. Rate:
- Look at the rate first..
- You can use the blocks on the strip to count.. (0.20 secs).
1 block between QRS complexes is 300 beats a min, 2 blocks is 150, 3 is 100,
then 75, 60, 50..
- Rate over 100 = tachycardia
- Rate under 60 = bradycardia
- 2. Rhythm:
- Next look at the rhythm,
- A regular rhythm =normal rhythm or a brady or tachy as above.
- A regular rhythm with irregular beats = premature beats (either PAC's or PVC's)
- An irregularly irregular rhythm = chaotic rhythm,
often Atrial fibrillation or Ventricular Fibrillation,
or frequent multifocal PVC's.
- 3. P wave:
- Is there a P wave before each QRS?
- Is there only one P wave per QRS?
- Is it always the same configuration?
- Is the distance between the P and the QRS constant?
- Is the distance between a P and a QRS is .10 to .20 seconds?
- P waves not present:
- No P, Narrow QRS, normal or slow, Regular = Junctional
- No P, Narrow QRS, fast or slow, Irregular = Atrial fib
- No P, Wide QRS, Slow, Regular= idioventricular
- No P, Wide QRS Fast, basically Regular =V Tach
- 1 P per QRS
- 1 P wave, Narrow QRS, Regular, normal rate = NSR
- 1 P wave present but with different configurations: = wandering pacer
- 1 P wave longer than .20sec:
- P with every QRS= 1st degree AV Block.
- PR constant with dropped QRS's= 2nd degree heart Block
- with progressive PR prolongation =2nd degree AV Block, Wenkebach (type I)
- No relationship between P's and QRS's = 3rd degree AV block
- More than 1 P wave:
- irregularly irregular = Atrial Fib
- Many P's same configuration, Regular = Atrial flutter (P Rate often 300 and QRS rate might be 150 (2:1), or 100 (3:1))
- P's grouped with regular R to R's = 2nd degree Block, type 11
- Increasing PR intervals, Basically regular with dropped QRS's =2nd degree block type 1, Wenkebach
- No relationship between P's and QRS's = 3rd degree Block, Complete Heart Block
- 4. QRS:
- Narrow or wide(.06 .10)?
- Regular?
- Rate
- P wave preceding each QRS?
- Narrow
- Narrow,Regular, fast, P with every QRS =
sinus Tachy, rate greater than 150= SVT
(Supraventricular Ventricular Tachycardia)
- Narrow, Regular, slow, P with every QRS = sinus Brady
- Mixed narrow and wide
- Mixed narrow and wide, regular wide beats =unifocal PVC's
- Mixed narrow and wide, irregular wide beats = multifocal PVC's
- Wide
- Wide, Regular, slow or normal rate, P per QRS = BBB
- Wide,regular, fast, P per QRS = ST or SVT with aberrancy
- Wide, regular, with no relationship between P and QRS =3rd degree AVBlock
- Wide, regular, slow =idioventricular
- Wide, regular, Fast = V Tach
- 5. QT/T wave abnormality:
- ST depression = myocardial ischemia
- ST elevation = myocardial injury
- Prolonged QT with flat T waves = hypokalemiaAVBlock
- Early Peaked T waves = hyperkalemia.
- 6. No P's or QRS's (as an afterthought):
- Completely irratic = V fib
- Straight line = asystole

12 Lead ECG Library
Electrocardiographic
Rhythms
Rhythm Strips
Electrocardiograms
ECG Interpretation Algorithms
12 Lead ECG of MI
Rhythm Disorders
ECG Rhythm Tutorial
ECG Course ( a CEU course)
Heart Tests
Home
Hosting by WebRing.
Navigation by WebRing.