EKGRefresh and Practice Normal SinusRhythm . Rate: 60 - 100beats per minute r Rhythrn: Atrial - Regular Ventricular- Regular o Pwaves: Uniform in appearance Upright w/ normal shape OnePreceding each QRS Nor morethan .10 second o PR interval: 0.12- 0.20second r QRS: 0.10second or less

P-Waves: Shouldbe no more than 2.5 mm in height, and no more than .10 secondin width

PRInterval: Includesthe p-wave as it leavesthe baselineand endsat the betinning ofthe QRS complex

QRSComplex: Measuredfrom the beginningof the QRS complex(as the first wave leavesthe baseline)to the end of the the eRS complex(when thelast wave beginsto level out into the ST segment).The end of QRS complexis calledthe J-Point'

Normally positive in lead II

ST Segment: Beginswith the end of the QRS complexand endswith the onsetof the T-wave. Normally flat. Coisidered elevatedif it is abovethe baselineand depressedif it is below the baseline. An elevatedST segrnentis a sign of myocardialinfarct.

T-Wave: Beginsas the deflection graduallyslopes upward from the ST segmentand endswhen the waveform retumsto baseline. Shouldbe positive in a Lead II.

Analyzing a Rhythm StriP o What is the rate? o Is it regular or irregular? o If irregular, is there a pattem of irregularity? o Are there P-waves?...are they all the same? o If so, is the P-R interval of normal length and are they all the same? o Is there only one P-Wavefor every QRS complex? Rhythm Regularity Rate P Waves QRS Complex Positive; Rounded;Normal PR Normal Sinus Regular 60to 100 Interval; One P wave for each Narrow Rhythm (NSR) QRS complex

Positive;Rounded; Normal PR Sinus Regular Lessthan 60 Interval; One P wave for each Narrow Bradvcardia QRS complex

Positive;Rounded; Normal PR Sinua Regular 100to 170 Interval;One P wavefor each Narrow Tachycardia QRScomplex Rhvthm Regularity Rate P Waves QRS Complex Supraventricular Not visible,though may be Tachycardia Regular Over170 presentburried in QRScomplex Narrow (svr) or T waves

PrematureAtrial Regular with That of Positive; Rounded;Normal PR Contraction Isolated Underlying Interval; One P wave for each Narrow (PAC) Anomalv Rhythm QRS Complex

Positive;Rounded; Normal PR Sinus Irregular 60to 100 Interval;One P wavefor each Narrow Anhythmia QRSComplex Rhythm Regularity Rate P Waves QRS Complex Positive; Rounded;Normal PR SinusBlock or Regular with 60to 100 Interval; May seeone non- Narrow SinusArrest SuddenPause conducting P before pause

Atrial: 250-400: Positive; Peakedor "Sawtooth" Regular or Atrial Flutter Ventricular Appearanceto Baseline;Unable Narrow Irregular usuallv60-100 to measurePR Interval

Atrial: No coordinated Atrial None; Wavy deflectionsaffecting Irregular systole; Narrow Fibrillation baselineas atria quiver Ventricular usuallv60-100 Rhythm Regularity Rate P Waves QRS Complex Junctional lnverted;May occurbefore/after Regular 40 to 60 Narrow Rhvthm ORScomplex or be hidden

Accelerated Inverted;May occurbefore/after Regular 60to 100 Narrow Junctional QRScomplex or be hidden

Junctional Inverted; May occur before/after Regular Morethan 100 Narrow Tachvcardia QRS complex or be hidden Rhythm Regularity Rate P Waves QRS Complex Premafure Usually That of That of Underlying Rhythm; PJC Junctional Regular with Underlying will have Inverted or hidden P Narrow Contraction Isolated Rhythm wave (PJC) Anomaly

Thatof Positive; Rounded;PR Interval Underlying 1' AV Block Regular more that0.20sec; One P wave Narrow Rhythm;Usually for each Complex 60to 100 QRS

Positive;Rounded; PR Interval 2' AV Block, Usually60 to Regularly WNL at first but lengthens Mobitz I 100,May be Narrow Irregular progressivelyuntil P doesnot (Wenckebach) Bradycardic conductto QRS Rhythm Regularity Rate P Waves QRS Complex Atrial: Varies, Positive;Rounded; PR Interval Usually 2" AV Block, Ventricular: for conductingbeats is always Regular,May UsuallyNarrow Mobitz II UsuallyLess WNL; More than I P wavefor be Iregular Than60 eachQRS Complex

Atrial and Atrial: 60 to Positive; Rounded;Unable to 3' AV Block Ventricular 100, MeasurePR Interval; P:QRS (CompleteHeart TypicallyWidened Regularbut not Ventricular: Ratio variable; P waves may be Block) Corresponding Usuallv20-40 hidden in QRS or T waves

Thatof That of Positive; Rounded;Normal PR BorderlineWide: 0.10 Bundle Branch Underlying Underlying Interval; One P wave for each 0.14sec; Usually Block Rhvthm Rhrrthm QRS Complex Notched(QRR'S) Rhythm Regularity Rate P Waves QRS Complex Idioventricular Regular 20 to 40 Absent Wide Rhythm GVR)

AcceleratedIVR Regular 40 to 100 Absent Wide L

Thatof Underlying Thatof Premature Rhythm;PVC Wide Underlying Thatof Ventricular That of Underlying Rhythm; No P and May Have Rhythmwith Underlying Conntraction Wave PreceedinePVC OppositeDeflection Isolated Rhythm (PVC) from Underlying Anomaly Rhrrthm Rhythm Regularity Rate P Waves QRS Complex Wide;QRS Adjacent Ventricular UsuallyAbsent; If PresentWill to QRSor Only T Regular 100to 250 Tachvcardia Not Correlatewith QRSComplex WavesVisible MaskineBaseline

No CoordinatedSystole; Wavy Ventricular Irregular Zero Deflections Affecting Baselineas Absent Fibrillation Ventrical Quiver

Lack of ElectricalActivity; BaselineUsually Flat or Nearly Asystole None Zero Absent Flat(Mild DeflectionsWill Be LessThan 2mm in Height)