Prepared by : ANWAR ISSARN-BSN-CCRT-ICU

• P wave : is P wave normal ?

• PR interval : is PR interval normal ?

• QRS complex : is QRS normal ?

• P-QRS relation : what is the relation between P wave and QRS ?

• Rate : what is the rate ?

How to analyze a rhythm strip ?

• Are the P waves regular ?

• Is the P wave normal and upright in lead II ?

• Do all P waves look alike ?

P WAVE

• Are all the PRI ‘s constant?

• Is the PRI measurement within normal range?

• If the PRI varies, is there a pattern to the changing measurements?

PR INTERVAL

• Are all the QRS complexes of equal duration?

• What is the measurement of the QRS complex?

• Is the QRS measurement within normal limits?

• Do all the QRS complexes look alike?

• Are the unusual QRS complexes associated with ectopic beats?

QRS COMPLEX

• Is there a P for every QRS and vice versa?

• Are they related to each other?

• More P’s? More QRS’s ?

P-QRS RELATION

• What is the exact rate?

• Is the atrial rate the same as the ventricular rate? - If the rhythm is regular--- 300/# of big squares between RR.

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-If the rhythm is irregular --- count the R waves on a 6 second strip and multiply by 10.

HEART RATE

Normal sinus rhythm

* Condition where SA node stops firing, causing pause in electrical activity. * During the pause, atrial and ventricularcontraction do not occur.

MATMultifocal Atrial Tachycardia

Multifocal atrial tachycardia: narrow-complex tachycardia at 140 to 160 bpm with multiple P-wave morphologies (arrows)

Atrial fibrillation / flutter

Atrial fibrillation

Atrial flutter

Junctional TachycardiaRate > 100/min

SVT (SupraVentricular Tachycardia)

PSVT(Paroxysmal Supraventricular Tachycardia)

Sinus rhythm with paroxysmal onset (arrow) of supraventricular tachycardia (PSVT)

Wolff-Parkinson-White

Wolff-Parkinson-White syndrome: normal sinus rhythm with delta wave notching of positive upstroke of QRS complex

Premature Ventricular Contractions (PVC’s)

Ventricular Tachycardia

Monomorphic ventricular tachycardia

Polymorphic Ventricular Tachycardia:

Torsades de pointes

Polymorphic ventricular tachycardia: QRS complexes display multiple morphologies (“polymorphic”)

Ventricular fibrillation

Coarse VF

Fine VF

Pacing above threshold (60 mA): with capture (QRS complex broad and ventricular; T wave opposite QRS)

Pacing attempted: note pacing stimulus indicator (arrow) which is below threshold; no capture

Pacing Rhythms

2

1

Idio-Ventricular Rhythm

Asystole / Stand still

RATE SINUS AV NODE

VENTRICULAR

> 100 Sinus tachycardia

Junctionaltachycardia

Ventricular tachycardia

60-100 NormalSinus

AcceleratedJunctional

40-60 SinusBradycardia

Junctional rhythm

Accelerated ventricularRhythm

20-40 Idioventricular rhythm