Rhythm Identification
Copyright © 2006 by Mosby Inc. All rights reserved.
Ventricular rate/rhythm
68 bpm/regular
Atrial rate/rhythm
68 bpm/regular
PR interval
0.24 sec
QRS duration
0.06 to 0.08 sec
Identification
Sinus rhythm with first-degree
AV block, ST-segment elevation
Copyright © 2006 by Mosby Inc. All rights reserved.
Rhythm Identification
Copyright © 2006 by Mosby Inc. All rights reserved.
Ventricular rate/rhythm
83/min (sinus beats)/
Regular except for the event
Atrial rate/rhythm
83/min (sinus beats)/
Regular except for the event
PR interval
0.20 sec
QRS duration
0.08 to 0.10 sec
Identification
Sinus rhythm with two PJCs,
ST-segment elevation
Copyright © 2006 by Mosby Inc. All rights reserved.
Rhythm Identification

This rhythm strip is from an 83-year-old
woman with syncope.
Copyright © 2006 by Mosby Inc. All rights reserved.
Ventricular rate/rhythm
38 to 75 bpm/irregular
Atrial rate/rhythm
75 bpm/regular
PR interval
Lengthening
QRS duration
0.06 to 0.08 sec
Identification
Second-degree AV block, type I
Copyright © 2006 by Mosby Inc. All rights reserved.
Rhythm Identification

This rhythm strip is from an 82-year-old man
complaining of back pain.

Top = lead II, bottom = MCL1
Copyright © 2006 by Mosby Inc. All rights reserved.
Ventricular rate/rhythm
41 to 73 bpm/irregular
Atrial rate/rhythm
56 to 125 bpm/irregular
PR interval
0.20 sec
QRS duration
0.12 sec
Identification
Sinus rhythm with a nonconducted PAC
Copyright © 2006 by Mosby Inc. All rights reserved.
Rhythm Identification

This rhythm strip is from an 86-year-old
woman who experienced a cardiopulmonary
arrest. The initial rhythm was asystole. The
following rhythm resulted after IV
administration of epinephrine and atropine.
Copyright © 2006 by Mosby Inc. All rights reserved.
Ventricular rate/rhythm
40 bpm/regular
Atrial rate/rhythm
None
PR interval
None
QRS duration
0.18 sec
Identification
Idioventricular rhythm (IVR)
(ventricular escape rhythm)
Copyright © 2006 by Mosby Inc. All rights reserved.
Rhythm Identification

This rhythm strip is from a 69-year-old man
complaining of shortness of breath. Lung
sounds reveal bilateral rales. Blood pressure:
160/58.
Copyright © 2006 by Mosby Inc. All rights reserved.
Ventricular rate/rhythm
107 bpm (sinus beats)/
Regular except for the events
Atrial rate/rhythm
107 bpm (sinus beats)/
Regular except for the events
PR interval
0.20 sec (sinus beats)
QRS duration
0.08 sec (sinus beats)
Identification
Sinus tachycardia with uniform PVCs
Copyright © 2006 by Mosby Inc. All rights reserved.
Rhythm Identification
Copyright © 2006 by Mosby Inc. All rights reserved.
Ventricular rate/rhythm
68 bpm/regular
Atrial rate/rhythm
68 bpm/regular
PR interval
0.28 sec
QRS duration
0.06 sec
Identification
Sinus rhythm with first-degree AV
block, ST-segment depression
Copyright © 2006 by Mosby Inc. All rights reserved.
Rhythm Identification
Copyright © 2006 by Mosby Inc. All rights reserved.
Ventricular rate/rhythm
214 bpm/regular
Atrial rate/rhythm
Unable to determine
PR interval
Unable to determine
QRS duration
0.14 sec
Identification
Monomorphic ventricular tachycardia
Copyright © 2006 by Mosby Inc. All rights reserved.
Rhythm Identification
Copyright © 2006 by Mosby Inc. All rights reserved.
Ventricular rate/rhythm
214 bpm (VT) to 71 bpm (atrial fib)/
Irregular
Atrial rate/rhythm
Unable to determine
PR interval
Unable to determine
QRS duration
0.12 to 0.16 sec (VT) to 0.06 sec
(atrial fib)
Identification
Monomorphic VT to atrial fibrillation
Copyright © 2006 by Mosby Inc. All rights reserved.
Rhythm Identification
Copyright © 2006 by Mosby Inc. All rights reserved.
Ventricular rate/rhythm
88 bpm/regular
Atrial rate/rhythm
Unable to determine
PR interval
Unable to determine
QRS duration
0.06 sec
Identification
Atrial flutter with ST-segment
depression
Copyright © 2006 by Mosby Inc. All rights reserved.
Rhythm Identification
Copyright © 2006 by Mosby Inc. All rights reserved.
Ventricular rate/rhythm
32 bpm/regular
Atrial rate/rhythm
32 bpm (sinus beats)/
None (junctional beats) to regular
(sinus beats)
PR interval
0.14 sec (sinus beats)
QRS duration
0.04 to 0.06 sec
Identification
Junctional bradycardia with STsegment depression to sinus
bradycardia, inverted T waves
Copyright © 2006 by Mosby Inc. All rights reserved.
Rhythm Identification
Copyright © 2006 by Mosby Inc. All rights reserved.
Ventricular rate/rhythm
35 bpm/regular
Atrial rate/rhythm
71 bpm/regular
PR interval
Varies
QRS duration
0.12 sec
Identification
Complete (third-degree) AV block
with inverted T waves
Copyright © 2006 by Mosby Inc. All rights reserved.
Rhythm Identification

This rhythm strip is from a 52-year-old man
found unresponsive, apneic, and pulseless.
Copyright © 2006 by Mosby Inc. All rights reserved.
Ventricular rate/rhythm
88 bpm/regular
Atrial rate/rhythm
None
PR interval
None
QRS duration
0.12 to 0.14 sec
Identification
Accelerated idioventricular rhythm
(AIVR)
Copyright © 2006 by Mosby Inc. All rights reserved.
Rhythm Identification
Copyright © 2006 by Mosby Inc. All rights reserved.
Ventricular rate/rhythm
79 bpm (sinus beats)/
Regular except for the event(s)
Atrial rate/rhythm
79 bpm (sinus beats)/
Regular except for the event(s)
PR interval
0.24 sec (sinus beats)
QRS duration
0.08 sec (sinus beats)
Identification
Sinus rhythm with first-degree AV
block and PACs
Copyright © 2006 by Mosby Inc. All rights reserved.
Rhythm Identification
Copyright © 2006 by Mosby Inc. All rights reserved.
Ventricular rate/rhythm
48 to 83 bpm/irregular
Atrial rate/rhythm
167 bpm/regular
PR interval
0.24 sec
QRS duration
0.12 sec
Identification
Second-degree AV block type II
with ST-segment depression
Copyright © 2006 by Mosby Inc. All rights reserved.
Rhythm Identification
Copyright © 2006 by Mosby Inc. All rights reserved.
Atrial paced activity?
Yes
Ventricular paced activity? Yes
Paced interval rate
71
Identification
100% paced rhythm –
AV sequential pacemaker
Copyright © 2006 by Mosby Inc. All rights reserved.
Rhythm Identification

These rhythm strips are from a 78-year-old
man complaining of shortness of breath. He
has a history of COPD, coronary artery
disease, and hypertension.
Copyright © 2006 by Mosby Inc. All rights reserved.
Ventricular rate/rhythm
55 to 94 bpm/irregular
Atrial rate/rhythm
Unable to determine
PR interval
Unable to determine
QRS duration
0.10 sec
Identification
Atrial fibrillation (controlled)
Copyright © 2006 by Mosby Inc. All rights reserved.
Rhythm Identification

This rhythm strip is from a 97-year-old
woman after a fall.
Copyright © 2006 by Mosby Inc. All rights reserved.
Ventricular rate/rhythm
88 bpm/regular
Atrial rate/rhythm
88 bpm/regular
PR interval
0.24 sec
QRS duration
0.06 sec
Identification
Sinus rhythm with first-degree AV
block, ST-segment depression
Copyright © 2006 by Mosby Inc. All rights reserved.
Rhythm Identification

This rhythm strip is from a 70-year-old man
complaining of a sharp pain across his
shoulders. Blood pressure: 218/86.
Copyright © 2006 by Mosby Inc. All rights reserved.
Ventricular rate/rhythm
115/min (sinus beats)/
Regular except for the events
Atrial rate/rhythm
115/min (sinus beats)/
Regular except for the events
PR interval
0.18 sec (sinus beats)
QRS duration
0.06 sec (sinus beats)
Identification
Sinus tachycardia with uniform PVCs
Copyright © 2006 by Mosby Inc. All rights reserved.
Rhythm Identification

This rhythm strip is from a 76-year-old man
complaining of indigestion.
Copyright © 2006 by Mosby Inc. All rights reserved.
Ventricular rate/rhythm
32 bpm/regular
Atrial rate/rhythm
None
PR interval
None
QRS duration
0.06 sec
Identification
Junctional bradycardia with
ST-segment depression and
inverted T waves
Copyright © 2006 by Mosby Inc. All rights reserved.
Rhythm Identification

This rhythm strip is from an 80-year-old
woman complaining of weakness.
Copyright © 2006 by Mosby Inc. All rights reserved.
Atrial paced activity?
No
Ventricular paced activity? Yes
Paced interval rate
83
Identification
100% ventricular paced rhythm
Copyright © 2006 by Mosby Inc. All rights reserved.
Rhythm Identification
Copyright © 2006 by Mosby Inc. All rights reserved.
Ventricular rate/rhythm
55/min (sinus beats)/
Regular except for the event (every
other beat is an ectopic beat)
Atrial rate/rhythm
55/min (sinus beats)/
Regular except for the event (every
other beat is an ectopic beat)
PR interval
0.12 sec (sinus beats)
QRS duration
0.08 to 0.10 sec (sinus beats)
Identification
Sinus bradycardia with ventricular
bigeminy
Copyright © 2006 by Mosby Inc. All rights reserved.
Rhythm Identification

This rhythm strip is from a 90-year-old
woman complaining of hip pain after a fall.
Copyright © 2006 by Mosby Inc. All rights reserved.
Ventricular rate/rhythm
75 bpm/regular
Atrial rate/rhythm
75 bpm/regular
PR interval
0.18 sec
QRS duration
0.08 to 0.10 sec
Identification
Sinus rhythm with
ST-segment depression
Copyright © 2006 by Mosby Inc. All rights reserved.
Rhythm Identification

This rhythm strip is from an 86-year-old
woman complaining of chest pain that she
rates a 4 on a scale of 0 to 10. Blood
pressure: 142/72.
Copyright © 2006 by Mosby Inc. All rights reserved.
Ventricular rate/rhythm
60 bpm/regular
Atrial rate/rhythm
60 bpm/regular
PR interval
0.20 sec
QRS duration
0.06 sec
Identification
Sinus rhythm
Copyright © 2006 by Mosby Inc. All rights reserved.
Rhythm Identification

This rhythm strip is from a 78-year-old man
complaining of palpitations. Note the point at
which the patient was defibrillated.
Copyright © 2006 by Mosby Inc. All rights reserved.
Ventricular rate/rhythm
63 to 79 bpm (sinus beats)/
Irregular (sinus beats)
Atrial rate/rhythm
63 to 79 bpm (sinus beats)/
Irregular (sinus beats)
PR interval
0.12 sec (sinus beats)
QRS duration
0.04 to 0.06 sec (sinus beats)
Identification
Monomorphic ventricular
tachycardia – shock – ventricular
beats – sinus arrhythmia
Copyright © 2006 by Mosby Inc. All rights reserved.
Rhythm Identification
Copyright © 2006 by Mosby Inc. All rights reserved.
Ventricular rate/rhythm
68 bpm (sinus beats)/
Regular except for the event
Atrial rate/rhythm
68 bpm (sinus beats)/
Regular except for the event
PR interval
0.18 sec (sinus beats)
QRS duration
0.06 sec (sinus beats)
Identification
Sinus rhythm with uniform PVCs
Copyright © 2006 by Mosby Inc. All rights reserved.
Rhythm Identification
Copyright © 2006 by Mosby Inc. All rights reserved.
Ventricular rate/rhythm
115 bpm (sinus beats)/
Regular except for the event
Atrial rate/rhythm
115 bpm (sinus beats)/
Regular except for the event
PR interval
0.16 sec
QRS duration
0.08 to 0.10 sec
Identification
Sinus tachycardia with PACs
Copyright © 2006 by Mosby Inc. All rights reserved.
Rhythm Identification

This rhythm strip is from a 3-month-old
infant who had an altered level of
responsiveness. She was limp with a
respiratory rate of 4 breaths/min. Blood
sugar was 174.
Copyright © 2006 by Mosby Inc. All rights reserved.
Ventricular rate/rhythm
125 bpm/regular
Atrial rate/rhythm
125 bpm/regular
PR interval
0.12 to 0.16 sec
QRS duration
0.06 sec (sinus beats)
Identification
Sinus tachycardia with an
interpolated PVC
Copyright © 2006 by Mosby Inc. All rights reserved.
Rhythm Identification

This rhythm strip is from an 83-year-old man
complaining of chest pain. He had a new
pacemaker implanted 5 days ago. His blood
pressure is 148/60.
Copyright © 2006 by Mosby Inc. All rights reserved.
Ventricular rate/rhythm
79 bpm/regular
Atrial rate/rhythm
Unable to determine
PR interval
Unable to determine
QRS duration
0.08 sec
Identification
Atrial fibrillation (controlled)
Copyright © 2006 by Mosby Inc. All rights reserved.
Rhythm Identification

This rhythm strip is from a 52-year-old man
with substernal chest pain. He has a history
of COPD and mitral valve regurgitation. Blood
pressure: 140/78.
Copyright © 2006 by Mosby Inc. All rights reserved.
Ventricular rate/rhythm
75 bpm/regular
Atrial rate/rhythm
75 bpm/regular
PR interval
0.14 sec
QRS duration
0.06 to 0.08 sec
Identification
Sinus rhythm with ST-segment
depression
Copyright © 2006 by Mosby Inc. All rights reserved.
Rhythm Identification
Copyright © 2006 by Mosby Inc. All rights reserved.
Ventricular rate/rhythm
34 bpm/regular
Atrial rate/rhythm
68 bpm/regular
PR interval
0.14 to 0.16 sec
QRS duration
0.10 sec
Identification
2:1 AV block, probably type I
Copyright © 2006 by Mosby Inc. All rights reserved.
Rhythm Identification
Copyright © 2006 by Mosby Inc. All rights reserved.
Ventricular rate/rhythm
60 to 98 bpm/irregular
Atrial rate/rhythm
111 bpm/regular
PR interval
Lengthens
QRS duration
0.08 sec
Identification
Second-degree AV block, type I
Copyright © 2006 by Mosby Inc. All rights reserved.
Rhythm Identification
Copyright © 2006 by Mosby Inc. All rights reserved.
Ventricular rate/rhythm
75 bpm/regular
Atrial rate/rhythm
None
PR interval
None
QRS duration
0.08 sec
Identification
Accelerated junctional rhythm
Copyright © 2006 by Mosby Inc. All rights reserved.
Rhythm Identification
Copyright © 2006 by Mosby Inc. All rights reserved.
Ventricular rate/rhythm
54 bpm/regular
Atrial rate/rhythm
Unable to determine
PR interval
Unable to determine
QRS duration
0.08 sec
Identification
Atrial fibrillation (controlled)
Copyright © 2006 by Mosby Inc. All rights reserved.
Rhythm Identification
Copyright © 2006 by Mosby Inc. All rights reserved.
Ventricular rate/rhythm
None
Atrial rate/rhythm
None
PR interval
None
QRS duration
None
Identification
Asystole
Copyright © 2006 by Mosby Inc. All rights reserved.
Rhythm Identification
Copyright © 2006 by Mosby Inc. All rights reserved.
Atrial paced activity?
No
Ventricular paced activity? Yes
Paced interval rate
65
Identification
100% ventricular paced rhythm
Copyright © 2006 by Mosby Inc. All rights reserved.
Rhythm Identification

These rhythm strips are from a 46-year-old
woman complaining of abdominal pain.
Copyright © 2006 by Mosby Inc. All rights reserved.
Ventricular rate/rhythm
107 bpm (sinus beats)/
Regular except for the events
Atrial rate/rhythm
107 bpm (sinus beats)/
Regular except for the events
PR interval
0.14 sec (sinus beats)
QRS duration
0.06 sec (sinus beats)
Identification
Sinus tachycardia with uniform PVCs
Copyright © 2006 by Mosby Inc. All rights reserved.
Rhythm Identification

This rhythm strip is from a 61-year-old man
with a history of heart failure.
Copyright © 2006 by Mosby Inc. All rights reserved.
Ventricular rate/rhythm
65 to 75 bpm (sinus beats)/Irregular
Atrial rate/rhythm
65 to 75 bpm (sinus beats)/Irregular
PR interval
0.32 sec (sinus beats)
QRS duration
0.18 sec (sinus beats)
Identification
Sinus rhythm with first-degree AV
block, wide QRS (bundle branch
block), multiform PVCs, and STsegment elevation
Copyright © 2006 by Mosby Inc. All rights reserved.
Rhythm Identification

This rhythm strip is from a 1-month-old infant
after a 3-minute seizure.
Copyright © 2006 by Mosby Inc. All rights reserved.
Ventricular rate/rhythm
130 bpm/regular
Atrial rate/rhythm
130 bpm/regular
PR interval
0.14 to 0.16 sec
QRS duration
0.06 to 0.08 sec
Identification
Sinus tachycardia
Copyright © 2006 by Mosby Inc. All rights reserved.
Rhythm Identification
Copyright © 2006 by Mosby Inc. All rights reserved.
Ventricular rate/rhythm
45 bpm/regular
Atrial rate/rhythm
115 bpm/regular
PR interval
Varies
QRS duration
0.16 sec
Identification
Complete (third-degree) AV block
Copyright © 2006 by Mosby Inc. All rights reserved.
Rhythm Identification

This rhythm strip is from a 72-year-old man
complaining of chest pain.
Copyright © 2006 by Mosby Inc. All rights reserved.
Atrial paced activity?
No
Ventricular paced activity? Yes
Paced interval rate
60
Identification
100% ventricular paced rhythm
Copyright © 2006 by Mosby Inc. All rights reserved.
Rhythm Identification

This rhythm strip is from a 77-year-old
woman with a congested cough.
Copyright © 2006 by Mosby Inc. All rights reserved.
Ventricular rate/rhythm
107 to 200 bpm/irregular
Atrial rate/rhythm
Unable to determine
PR interval
Unable to determine
QRS duration
0.06 to 0.08 sec
Identification
Atrial fibrillation (uncontrolled)
Copyright © 2006 by Mosby Inc. All rights reserved.
Rhythm Identification
Copyright © 2006 by Mosby Inc. All rights reserved.
Ventricular
rate/rhythm
30 bpm (junctional beats) to 56 bpm (sinus beats)/
Irregular (junctional beats) to regular (sinus beats)
Atrial rate/rhythm
None (junctional beats) to 56 bpm (sinus beats)/
None (junctional beats) to regular (sinus beats)
PR interval
None (junctional beats) to 0.18 (sinus beats)
QRS duration
0.04 sec (junctional beats) to 0.08 (sinus beats)
Identification
Junctional bradycardia to sinus bradycardia
Copyright © 2006 by Mosby Inc. All rights reserved.
Rhythm Identification
Copyright © 2006 by Mosby Inc. All rights reserved.
Ventricular rate/rhythm
83 bpm (sinus beats)/regular
Atrial rate/rhythm
83 bpm (sinus beats)/regular
PR interval
0.20 sec (sinus beats)
QRS duration
0.06 to 0.08 sec (sinus beats)
Identification
Atrial flutter to sinus rhythm
Copyright © 2006 by Mosby Inc. All rights reserved.
Rhythm Identification
Copyright © 2006 by Mosby Inc. All rights reserved.
Ventricular rate/rhythm
96 bpm (sinus beats)/
Regular except for the event
Atrial rate/rhythm
96 bpm (sinus beats)/
Regular except for the event
PR interval
0.12 sec (sinus beats)
QRS duration
0.08 to 0.10 sec (sinus beats)
Identification
Sinus rhythm with uniform PVCs
Copyright © 2006 by Mosby Inc. All rights reserved.
Rhythm Identification

This rhythm strip is from a 54-year-old man
who had a syncopal episode.
Copyright © 2006 by Mosby Inc. All rights reserved.
Ventricular rate/rhythm
58 bpm/regular
Atrial rate/rhythm
58 bpm/regular
PR interval
0.20 sec
QRS duration
0.08 sec
Identification
Sinus bradycardia
Copyright © 2006 by Mosby Inc. All rights reserved.
Rhythm Identification

This rhythm strip is from a 66-year-old man
complaining of chest pain. Blood pressure:
170/96.
Copyright © 2006 by Mosby Inc. All rights reserved.
Ventricular rate/rhythm
107 bpm/regular
Atrial rate/rhythm
107 bpm/regular
PR interval
0.24 sec
QRS duration
0.08 sec
Identification
Sinus tachycardia with
first-degree AV block
Copyright © 2006 by Mosby Inc. All rights reserved.
Rhythm Identification

This rhythm strip is from a 43-year-old
woman complaining of palpitations.
Copyright © 2006 by Mosby Inc. All rights reserved.
Ventricular rate/rhythm
214 bpm/regular
Atrial rate/rhythm
Unable to determine
PR interval
Unable to determine
QRS duration
0.08 sec
Identification
Narrow-QRS tachycardia
Copyright © 2006 by Mosby Inc. All rights reserved.
Rhythm Identification

A 43-year-old woman is complaining of palpitations.
The patient has a history of SVT and states she
cannot tolerate adenosine. The following rhythm is
observed on the cardiac monitor after diltiazem
administration.
Copyright © 2006 by Mosby Inc. All rights reserved.
Ventricular rate/rhythm
187 bpm (atrial beats)/
Regular (atrial beats)
Atrial rate/rhythm
Unable to determine
PR interval
Unable to determine
QRS duration
0.08 sec (atrial beats)
Identification
Junctional to sinus
to narrow-QRS tachycardia
Copyright © 2006 by Mosby Inc. All rights reserved.
Rhythm Identification
Copyright © 2006 by Mosby Inc. All rights reserved.
Ventricular rate/rhythm
Unable to determine
Atrial rate/rhythm
Unable to determine
PR interval
Unable to determine
QRS duration
Unable to determine
Identification
Ventricular fibrillation (coarse)
Copyright © 2006 by Mosby Inc. All rights reserved.
Rhythm Identification
Copyright © 2006 by Mosby Inc. All rights reserved.
Ventricular rate/rhythm
37 bpm/regular
Atrial rate/rhythm
75 bpm/regular
PR interval
0.28 sec
QRS duration
0.06 sec
Identification
2:1 AV block, probably type I
Copyright © 2006 by Mosby Inc. All rights reserved.
Rhythm Identification
Copyright © 2006 by Mosby Inc. All rights reserved.
Ventricular rate/rhythm
27 bpm/regular
Atrial rate/rhythm
27 bpm/regular
PR interval
0.22 sec
QRS duration
0.12 sec
Identification
Sinus bradycardia with first-degree
AV block, wide-QRS (probable
bundle branch block),
ST-segment depression
Copyright © 2006 by Mosby Inc. All rights reserved.
Rhythm Identification

This rhythm strip is from a 76-year-old
woman complaining of back pain. Her
medical history includes a myocardial
infarction 2 years ago.
Copyright © 2006 by Mosby Inc. All rights reserved.
Atrial paced activity?
No
Ventricular paced activity? Yes
Paced interval rate
65
Identification
100% ventricular paced rhythm
Copyright © 2006 by Mosby Inc. All rights reserved.
Rhythm Identification

This rhythm strip is from an 80-year-old man
found sitting in a chair. He is unresponsive,
apneic, and pulseless.
Copyright © 2006 by Mosby Inc. All rights reserved.
Ventricular rate/rhythm
None
Atrial rate/rhythm
None
PR interval
None
QRS duration
None
Identification
Asystole – the electrical activity
shown is caused by pacemaker
spikes from the patient’s
permanent pacemaker (no
capture)
Copyright © 2006 by Mosby Inc. All rights reserved.
Rhythm Identification

This rhythm strip is from an 88-year-old
woman complaining of hip pain after a fall
injury.
Copyright © 2006 by Mosby Inc. All rights reserved.
Ventricular rate/rhythm
68 to 125 bpm/irregular
Atrial rate/rhythm
Unable to determine
PR interval
Unable to determine
QRS duration
0.08 sec
Identification
Atrial fibrillation
Copyright © 2006 by Mosby Inc. All rights reserved.
Rhythm Identification
Copyright © 2006 by Mosby Inc. All rights reserved.
Ventricular rate/rhythm
42 to 68 bpm/irregular
Atrial rate/rhythm
68 bpm/regular
PR interval
Lengthens
QRS duration
0.10 sec
Identification
Second-degree AV block type I
with a ventricular complex
Copyright © 2006 by Mosby Inc. All rights reserved.
Rhythm Identification
Copyright © 2006 by Mosby Inc. All rights reserved.
Ventricular rate/rhythm
48 bpm (junctional beats)/ regular
Atrial rate/rhythm
Unable to determine (junctional beats)
PR interval
Unable to determine (junctional beats)
QRS duration
0.06 to 0.08 sec
Identification
Sinus bradycardia with a first-degree
AV block to junctional escape rhythm
Copyright © 2006 by Mosby Inc. All rights reserved.
Rhythm Identification

This rhythm strip is from a 67-year-old
woman found unresponsive on the side of the
road. Outdoor temperature is 112°F. Blood
pressure: 238/110, respiratory rate: 60/min.
Copyright © 2006 by Mosby Inc. All rights reserved.
Ventricular rate/rhythm
136 bpm/regular
Atrial rate/rhythm
136 bpm/regular
PR interval
0.16 sec
QRS duration
0.08 sec
Identification
Sinus tachycardia with
ST-segment depression
Copyright © 2006 by Mosby Inc. All rights reserved.
Rhythm Identification

This rhythm strip is from an 84-year-old man
complaining of dizziness. He had a triple
bypass 4 days ago.
Copyright © 2006 by Mosby Inc. All rights reserved.
Ventricular rate/rhythm
60 bpm (sinus beats)/
Regular except for the event (every
other beat is an ectopic beat)
Atrial rate/rhythm
60 bpm (sinus beats)/
Regular except for the event
PR interval
0.16 sec (sinus beats)
QRS duration
0.08 sec (sinus beats)
Identification
Sinus rhythm with ventricular
bigeminy, ST-segment depression
Copyright © 2006 by Mosby Inc. All rights reserved.
Rhythm Identification

This rhythm strip is from an 81-year-old
woman with an altered level of
responsiveness. blood pressure: 160/70,
blood sugar: 114.
Copyright © 2006 by Mosby Inc. All rights reserved.
Ventricular rate/rhythm
56 bpm/regular
Atrial rate/rhythm
56 bpm/regular
PR interval
0.24 sec
QRS duration
0.06 sec
Identification
Sinus bradycardia with
first-degree AV block
Copyright © 2006 by Mosby Inc. All rights reserved.
Rhythm Identification

This rhythm strip is from a 80-year-old woman who
was playing Bingo when she felt dizzy and slumped
over in her chair. Bystanders state she was
unresponsive for approximately 5 minutes. A pulse is
present.
Copyright © 2006 by Mosby Inc. All rights reserved.
Ventricular rate/rhythm
75 to 94 bpm/irregular
Atrial rate/rhythm
Unable to determine
PR interval
Unable to determine
QRS duration
0.08 sec
Identification
Atrial fibrillation (controlled)
Copyright © 2006 by Mosby Inc. All rights reserved.
Rhythm Identification

This rhythm strip is from a 91-year-old
woman complaining of chest pain and
difficulty breathing.
Copyright © 2006 by Mosby Inc. All rights reserved.
Ventricular rate/rhythm
94 to 108 bpm/irregular
Atrial rate/rhythm
Unable to determine
PR interval
Unable to determine
QRS duration
0.10 sec
Identification
Atrial fibrillation with
ST-segment elevation
Copyright © 2006 by Mosby Inc. All rights reserved.
Rhythm Identification

This rhythm strip is from an 85-year-old
woman complaining of numbness in her legs.
Copyright © 2006 by Mosby Inc. All rights reserved.
Ventricular rate/rhythm
48 bpm/regular
Atrial rate/rhythm
48 bpm/regular
PR interval
0.16 sec
QRS duration
0.08 sec
Identification
Sinus bradycardia
Copyright © 2006 by Mosby Inc. All rights reserved.
Rhythm Identification

This rhythm strip is from a 59-year-old
woman who complained of sudden weakness
in her legs and fell to the floor in her kitchen.
Copyright © 2006 by Mosby Inc. All rights reserved.
Ventricular rate/rhythm
50 to 79 bpm/irregular
Atrial rate/rhythm
Unable to determine
PR interval
Unable to determine
QRS duration
0.12 sec
Identification
Atrial fibrillation (controlled)
with ST-segment elevation
Copyright © 2006 by Mosby Inc. All rights reserved.
Rhythm Identification

This rhythm strip is from an 82-year-old
woman with vomiting x 2 days.
Copyright © 2006 by Mosby Inc. All rights reserved.
Ventricular rate/rhythm
115 bpm/regular
Atrial rate/rhythm
115 bpm/regular
PR interval
0.18 sec
QRS duration
0.06 sec
Identification
Sinus tachycardia
Copyright © 2006 by Mosby Inc. All rights reserved.
Rhythm Identification

This rhythm strip is from a 62-year-old
woman complaining of chest pain. Her blood
pressure is 146/104, respirations are 20.
Breath sounds are clear.
Copyright © 2006 by Mosby Inc. All rights reserved.
Ventricular rate/rhythm
167 bpm/regular
Atrial rate/rhythm
Unable to determine
PR interval
Unable to determine
QRS duration
0.06 sec
Identification
Narrow-QRS tachycardia (SVT)
with ST-segment depression
Copyright © 2006 by Mosby Inc. All rights reserved.
Rhythm Identification

This rhythm strip is from a 6-year-old boy
immediately after a seizure.
Copyright © 2006 by Mosby Inc. All rights reserved.
Ventricular rate/rhythm
68 to 88 bpm/irregular
Atrial rate/rhythm
68 to 88 bpm/irregular
PR interval
0.12 sec
QRS duration
0.08 sec
Identification
Sinus arrhythmia
Copyright © 2006 by Mosby Inc. All rights reserved.
Rhythm Identification

This rhythm strip is from a 76-year-old man
who was playing golf and experienced a
syncopal episode.
Copyright © 2006 by Mosby Inc. All rights reserved.
Ventricular rate/rhythm
65 bpm/regular
Atrial rate/rhythm
65 bpm/regular
PR interval
0.16 sec
QRS duration
0.08 sec
Identification
Sinus rhythm with ST-segment
elevation
Copyright © 2006 by Mosby Inc. All rights reserved.
Rhythm Identification

These rhythm strips are from a 44-year-old
woman complaining of chest pain.
Copyright © 2006 by Mosby Inc. All rights reserved.
Ventricular rate/rhythm
176 bpm/regular
Atrial rate/rhythm
None
PR interval
None
QRS duration
0.12 to 0.14 sec
Identification
Monomorphic ventricular
tachycardia
Copyright © 2006 by Mosby Inc. All rights reserved.
Rhythm Identification
Copyright © 2006 by Mosby Inc. All rights reserved.
Ventricular rate/rhythm
29 bpm/regular
Atrial rate/rhythm
71 bpm/regular
PR interval
Varies
QRS duration
0.16 sec
Identification
Complete (third-degree) AV block
with ST-segment elevation
Copyright © 2006 by Mosby Inc. All rights reserved.
Rhythm Identification

This rhythm strip is from an 81-year-old
woman complaining of chest pain.
Copyright © 2006 by Mosby Inc. All rights reserved.
Ventricular rate/rhythm
76 bpm/regular
Atrial rate/rhythm
None
PR interval
None
QRS duration
0.12 to 0.14 sec
Identification
Accelerated idioventricular rhythm
(AIVR)
Copyright © 2006 by Mosby Inc. All rights reserved.
Rhythm Identification

This rhythm strip is from a 74-year-old
woman complaining of weakness.
Copyright © 2006 by Mosby Inc. All rights reserved.
Atrial paced activity?
No
Ventricular paced activity? Yes
Paced interval rate
68
Identification
Ventricular demand pacemaker
Copyright © 2006 by Mosby Inc. All rights reserved.
Rhythm Identification
Copyright © 2006 by Mosby Inc. All rights reserved.
Ventricular rate/rhythm
75 to 150 bpm/irregular
Atrial rate/rhythm
Unable to determine
PR interval
Unable to determine
QRS duration
0.08 sec
Identification
Atrial flutter
Copyright © 2006 by Mosby Inc. All rights reserved.
Rhythm Identification
Copyright © 2006 by Mosby Inc. All rights reserved.
Ventricular rate/rhythm
42 bpm (sinus beats)/
Regular except for the event (every
other beat is an ectopic beat)
Atrial rate/rhythm
42 bpm (sinus beats)/
Regular except for the event
PR interval
0.12 sec (sinus beats)
QRS duration
0.08 to 0.10 sec (sinus beats)
Identification
Sinus bradycardia with
ventricular bigeminy
Copyright © 2006 by Mosby Inc. All rights reserved.
Rhythm Identification
Copyright © 2006 by Mosby Inc. All rights reserved.
Ventricular rate/rhythm
42 bpm/regular
Atrial rate/rhythm
None
PR interval
None
QRS duration
0.24 sec
Identification
Accelerated idioventricular rhythm
(AIVR)
Copyright © 2006 by Mosby Inc. All rights reserved.
Rhythm Identification

These rhythm strips are from a 63-year-old woman
who experienced a syncopal episode. Blood
pressure is 200/90, blood sugar is 98.
Copyright © 2006 by Mosby Inc. All rights reserved.
Ventricular rate/rhythm
44 bpm/regular
Atrial rate/rhythm
88 bpm/regular
PR interval
0.20 sec
QRS duration
0.10 sec
Identification
2:1 AV block, probably type I
Copyright © 2006 by Mosby Inc. All rights reserved.
Rhythm Identification

This rhythm strip is from an 84-year-old
woman with a nosebleed. Blood pressure:
250/74.
Copyright © 2006 by Mosby Inc. All rights reserved.
Ventricular rate/rhythm
68 bpm/regular
Atrial rate/rhythm
68 bpm/regular
PR interval
0.16 sec
QRS duration
0.08 sec
Identification
Sinus rhythm
Copyright © 2006 by Mosby Inc. All rights reserved.
Rhythm Identification

This rhythm strip is from a 79-year-old man
complaining of palpitations. His initial blood
pressure was 112/84. His second blood
pressure, 8 minutes after the first, was 78/P.
Copyright © 2006 by Mosby Inc. All rights reserved.
Ventricular rate/rhythm
147 bpm/regular
Atrial rate/rhythm
Unable to determine
PR interval
Unable to determine
QRS duration
0.06 to 0.08 sec
Identification
Narrow-QRS tachycardia (SVT)
with ST-segment depression
Copyright © 2006 by Mosby Inc. All rights reserved.
Rhythm Identification
Copyright © 2006 by Mosby Inc. All rights reserved.
Atrial paced activity?
No
Ventricular paced activity? Yes
Paced interval rate
60
Identification
100% ventricular paced rhythm
Copyright © 2006 by Mosby Inc. All rights reserved.
Rhythm Identification

This rhythm strip is from an 80-year-old man
complaining of weakness and dizziness.
Blood pressure is 160/98, blood sugar is 88.
Copyright © 2006 by Mosby Inc. All rights reserved.
Ventricular rate/rhythm
63 to 100 bpm/irregular
Atrial rate/rhythm
Unable to determine
PR interval
Unable to determine
QRS duration
0.08 to 0.10 sec
Identification
Atrial fibrillation (controlled)
Copyright © 2006 by Mosby Inc. All rights reserved.
Rhythm Identification
Copyright © 2006 by Mosby Inc. All rights reserved.
Ventricular rate/rhythm
42 to 71 bpm/irregular
Atrial rate/rhythm
125 bpm/regular
PR interval
0.24 sec
QRS duration
0.10 to 0.12 sec
Identification
Second-degree AV block type II
Copyright © 2006 by Mosby Inc. All rights reserved.
Rhythm Identification

This rhythm strip is from a 58-year-old man
with chest pain that he rates as a 2 on a scale
of 0 to 10. He states he recently began taking
pills for weight control.
Copyright © 2006 by Mosby Inc. All rights reserved.
Ventricular rate/rhythm
91 bpm (sinus beats)/
Regular except for the event(s)
Atrial rate/rhythm
91 bpm (sinus beats)/
Regular except for the event(s)
PR interval
0.20 sec (sinus beats)
QRS duration
0.06 sec (sinus beats)
Identification
Sinus rhythm with uniform PVCs,
ST-segment depression
Copyright © 2006 by Mosby Inc. All rights reserved.
Rhythm Identification

This rhythm strip is from a 60-year-old
woman complaining of palpitations and
shortness of breath.
Copyright © 2006 by Mosby Inc. All rights reserved.
Ventricular rate/rhythm
130 to 214 bpm/ irregular
Atrial rate/rhythm
Unable to determine
PR interval
Unable to determine
QRS duration
0.08 sec
Identification
Atrial fibrillation with a rapid
ventricular response (RVR)
Copyright © 2006 by Mosby Inc. All rights reserved.
Rhythm Identification

This rhythm strip is from a 60-year-old
woman complaining of palpitations and
shortness of breath after administration of
adenosine 6 mg IV.
Copyright © 2006 by Mosby Inc. All rights reserved.
Ventricular rate/rhythm
28 to 63 bpm/irregular
Atrial rate/rhythm
Unable to determine
PR interval
Unable to determine
QRS duration
0.08 sec
Identification
Atrial fibrillation
Copyright © 2006 by Mosby Inc. All rights reserved.
Rhythm Identification

This rhythm strip is from a 60-year-old
woman complaining of palpitations and
shortness of breath 1 minute after
administration of adenosine 12 mg IV.
Copyright © 2006 by Mosby Inc. All rights reserved.
Ventricular rate/rhythm
18 to 21 bpm/irregular
Atrial rate/rhythm
Unable to determine
PR interval
Unable to determine
QRS duration
0.08 sec
Identification
Atrial fibrillation
Copyright © 2006 by Mosby Inc. All rights reserved.
Rhythm Identification

This rhythm strip is from a 60-year-old woman
complaining of palpitations and shortness of
breath two minutes after administration of
adenosine 6 mg IV.
Copyright © 2006 by Mosby Inc. All rights reserved.
Ventricular rate/rhythm
115 to 250 bpm/irregular
Atrial rate/rhythm
Unable to determine
PR interval
Unable to determine
QRS duration
0.08 sec
Identification
Atrial fibrillation with a rapid
ventricular response (RVR)
Copyright © 2006 by Mosby Inc. All rights reserved.
Rhythm Identification
Copyright © 2006 by Mosby Inc. All rights reserved.
Ventricular rate/rhythm
30 bpm (junctional beats)/irregular
Atrial rate/rhythm
None (junctional beats)/irregular
PR interval
0.16 sec (sinus beats)
QRS duration
0.06 sec
Identification
Sinus beat, two junctional beats,
sinus beat; ST-segment depression
Copyright © 2006 by Mosby Inc. All rights reserved.
Rhythm Identification

This rhythm strip is from a 90-year-old
woman with shortness of breath.
Copyright © 2006 by Mosby Inc. All rights reserved.
Atrial paced activity?
No
Ventricular paced activity? Yes
Paced interval rate
60
Identification
100% ventricular paced rhythm
Copyright © 2006 by Mosby Inc. All rights reserved.
Rhythm Identification
Copyright © 2006 by Mosby Inc. All rights reserved.
Ventricular rate/rhythm
75 bpm (sinus beats)/
Regular except for the event(s)
Atrial rate/rhythm
75 bpm (sinus beats)/
Regular except for the event(s)
PR interval
0.16 to 0.18 sec (sinus beats)
QRS duration
0.04 to 0.06 sec (sinus beats)
Identification
Sinus rhythm with uniform PVCs
Copyright © 2006 by Mosby Inc. All rights reserved.
Rhythm Identification
Copyright © 2006 by Mosby Inc. All rights reserved.
Ventricular rate/rhythm
100 bpm (sinus beats) to 150 bpm
(VT)/Regular
Atrial rate/rhythm
100 bpm (sinus beats)/
Regular to unable to determine
PR interval
0.24 sec (sinus beats)
QRS duration
0.08 sec (sinus beats)
Identification
Sinus rhythm with first-degree AV
block to monomorphic ventricular
tachycardia (VT)
Copyright © 2006 by Mosby Inc. All rights reserved.
Rhythm Identification
Copyright © 2006 by Mosby Inc. All rights reserved.
Ventricular rate/rhythm
47 bpm/regular
Atrial rate/rhythm
115 bpm/regular
PR interval
Varies
QRS duration
0.08 sec
Identification
Complete (third-degree) AV block
with ST-segment elevation
Copyright © 2006 by Mosby Inc. All rights reserved.
Rhythm Identification
Copyright © 2006 by Mosby Inc. All rights reserved.
Ventricular rate/rhythm
88 to 167 bpm/irregular
Atrial rate/rhythm
Unable to determine
PR interval
Unable to determine
QRS duration
0.06 to 0.08 sec
Identification
Atrial fibrillation
Copyright © 2006 by Mosby Inc. All rights reserved.
Rhythm Identification
Copyright © 2006 by Mosby Inc. All rights reserved.
Ventricular rate/rhythm
None
Atrial rate/rhythm
94 bpm/regular
PR interval
None
QRS duration
None
Identification
P-wave asystole
Copyright © 2006 by Mosby Inc. All rights reserved.
Rhythm Identification

This rhythm strip is from a 74-year-old
woman with chest pain. Blood pressure:
192/90. She rates her pain as a 9 on a scale
of 0 to 10.
Copyright © 2006 by Mosby Inc. All rights reserved.
Ventricular rate/rhythm
136 bpm/regular
Atrial rate/rhythm
136 bpm/regular
PR interval
0.14 sec
QRS duration
0.08 sec
Identification
Sinus tachycardia
Copyright © 2006 by Mosby Inc. All rights reserved.
Rhythm Identification
Copyright © 2006 by Mosby Inc. All rights reserved.
Ventricular rate/rhythm
91 bpm/
Regular except for the event
Atrial rate/rhythm
91 bpm/
Regular except for the event
PR interval
0.16 sec
QRS duration
0.06 sec
Identification
Sinus rhythm with a nonconducted PAC
Copyright © 2006 by Mosby Inc. All rights reserved.
Rhythm Identification
Copyright © 2006 by Mosby Inc. All rights reserved.
Ventricular rate/rhythm
35 bpm/regular
Atrial rate/rhythm
35 bpm/regular
PR interval
0.16 sec
QRS duration
0.06 sec
Note
U waves are present
(they follow the T waves)
Identification
Sinus bradycardia with
ST-segment depression
Copyright © 2006 by Mosby Inc. All rights reserved.
Rhythm Identification

This rhythm strip is from a 97-year-old man
with chest pain.
Copyright © 2006 by Mosby Inc. All rights reserved.
Atrial paced activity?
Yes
Ventricular paced activity? Yes
Paced interval rate
60
Identification
AV sequential pacemaker with
failure to capture
Copyright © 2006 by Mosby Inc. All rights reserved.
Rhythm Identification

This rhythm strip is from an 85-year-old
woman with an altered level of
responsiveness. Blood pressure: 136/78,
blood sugar is 96.
Copyright © 2006 by Mosby Inc. All rights reserved.
Ventricular rate/rhythm
115 bpm (sinus beats)/
Regular except for the event
Atrial rate/rhythm
115 bpm (sinus beats)/
Regular except for the event
PR interval
0.20 sec (sinus beats)
QRS duration
0.08 to 0.10 sec (sinus beats)
Identification
Sinus tachycardia with a PVC and
a ventricular couplet
Copyright © 2006 by Mosby Inc. All rights reserved.
Rhythm Identification

This rhythm strip is from an 88-year-old man
complaining of chest pain that he rates as a 6
on a scale of 0 to 10. Blood pressure: 170/80.
Copyright © 2006 by Mosby Inc. All rights reserved.
Ventricular rate/rhythm
115 bpm (sinus beats)/
Regular except for the event
Atrial rate/rhythm
115 bpm (sinus beats)/
Regular except for the event
PR interval
0.16 sec
QRS duration
0.08 sec
Identification
Sinus tachycardia with PACs
Copyright © 2006 by Mosby Inc. All rights reserved.
Rhythm Identification
Copyright © 2006 by Mosby Inc. All rights reserved.
Ventricular rate/rhythm
29 bpm/essentially regular
Atrial rate/rhythm
None
PR interval
None
QRS duration
0.04 to 0.06 sec
Identification
Junctional bradycardia
with ST-segment depression
Copyright © 2006 by Mosby Inc. All rights reserved.
Rhythm Identification
Copyright © 2006 by Mosby Inc. All rights reserved.
Ventricular rate/rhythm
88 bpm/regular
Atrial rate/rhythm
88 bpm/regular
PR interval
0.28 sec
QRS duration
0.08 sec
Identification
Sinus rhythm with first-degree AV
block; ST-segment elevation
Copyright © 2006 by Mosby Inc. All rights reserved.
Rhythm Identification

This rhythm strip is from a 44-year-old construction
worker with a sudden onset of chest pressure.
Copyright © 2006 by Mosby Inc. All rights reserved.
Ventricular rate/rhythm
52 to 94 bpm/irregular
Atrial rate/rhythm
52 to 94 bpm/irregular
PR interval
0.12 sec
QRS duration
0.08 sec
Identification
Sinus arrhythmia at 52 to 94 bpm
Copyright © 2006 by Mosby Inc. All rights reserved.
Rhythm Identification
Copyright © 2006 by Mosby Inc. All rights reserved.
Atrial pacing?
No
Ventricular pacing?
Yes
Paced interval
80
Identification
Ventricular-paced rhythm with
pacemaker malfunction
(failure to capture)
Copyright © 2006 by Mosby Inc. All rights reserved.
Rhythm Identification


This rhythm strip is from an 82-year-old man
complaining of back pain.
Top = lead II, bottom = MCL1.
Copyright © 2006 by Mosby Inc. All rights reserved.
Ventricular rate/rhythm
41 to 73 bpm/irregular
Atrial rate/rhythm
56 to 125 bpm/irregular
PR interval
0.20 sec
QRS duration
0.12
Identification
Sinus rhythm at 41 to 73 bpm
with a nonconducted PAC
Copyright © 2006 by Mosby Inc. All rights reserved.
Rhythm Identification
Copyright © 2006 by Mosby Inc. All rights reserved.
Ventricular rate/rhythm
78/min/regular except for the event
Atrial rate/rhythm
78/min/regular except for the event
PR interval
0.16 sec
QRS duration
0.06 sec
Identification
Sinus rhythm at 78 bpm with a PAC
Copyright © 2006 by Mosby Inc. All rights reserved.
Rhythm Identification
Copyright © 2006 by Mosby Inc. All rights reserved.
Ventricular rate/rhythm
44 bpm/regular
Atrial rate/rhythm
44 bpm/regular
PR interval
0.14 sec
QRS duration
0.08 sec
Identification
Junctional rhythm; ST-segment
elevation
Copyright © 2006 by Mosby Inc. All rights reserved.
Rhythm Identification
Copyright © 2006 by Mosby Inc. All rights reserved.
Ventricular rate/rhythm
115 bpm (sinus beats)/regular
except for the event
Atrial rate/rhythm
115 bpm (sinus beats)/regular
except for the event
PR interval
0.16 sec (sinus beats)
QRS duration
0.06 sec (sinus beats)
Identification
Sinus tachycardia with a PJC
Copyright © 2006 by Mosby Inc. All rights reserved.
Rhythm Identification

This rhythm strip is from an 82-year-old man
complaining of chest pain.
Copyright © 2006 by Mosby Inc. All rights reserved.
Ventricular rate/rhythm
245 bpm/regular
Atrial rate/rhythm
245 bpm/regular
PR interval
None
QRS duration
0.28 sec
Identification
Monomorphic ventricular
tachycardia
Copyright © 2006 by Mosby Inc. All rights reserved.
Rhythm Identification
Copyright © 2006 by Mosby Inc. All rights reserved.
Ventricular rate/rhythm
21 bpm/irregular
Atrial rate/rhythm
21 bpm/irregular
PR interval
0.36 sec
QRS duration
0.08 to 0.10 sec
Identification
Sinus bradycardia with
junctional escape beats
Copyright © 2006 by Mosby Inc. All rights reserved.
Rhythm Identification
Copyright © 2006 by Mosby Inc. All rights reserved.
Ventricular rate/rhythm 48 to 83 bpm/irregular
Atrial rate/rhythm
167 bpm/regular
PR interval
0.24 sec
QRS duration
0.12 sec
Identification
Second-degree AV block type II;
ST-segment depression
Copyright © 2006 by Mosby Inc. All rights reserved.
Rhythm Identification
Copyright © 2006 by Mosby Inc. All rights reserved.
Ventricular rate/rhythm
115 to 215 bpm/irregular
Atrial rate/rhythm
Unable to determine/irregular
PR interval
Varies
QRS duration
0.04 to 0.06 sec
Identification
Multifocal atrial tachycardia
with ST-segment depression
Copyright © 2006 by Mosby Inc. All rights reserved.
Rhythm Identification
Copyright © 2006 by Mosby Inc. All rights reserved.
Ventricular rate/rhythm 71/min, regular
Atrial rate/rhythm
71/min, regular
PR interval
0.16 to 0.20 sec
QRS duration
0.12 to 0.14 sec
Identification
Sinus rhythm at 71 bpm with a wide QRS,
ST-segment depression
Copyright © 2006 by Mosby Inc. All rights reserved.
Rhythm Identification
Copyright © 2006 by Mosby Inc. All rights reserved.
Ventricular rate/rhythm 94 (sinus beats)/irregular
Atrial rate/rhythm
94 (sinus beats)/irregular
PR interval
0.16 sec (sinus beats)
QRS duration
0.08 sec (sinus beats)
Identification
Sinus rhythm with an episode of
couplets and a run of VT
Copyright © 2006 by Mosby Inc. All rights reserved.
Rhythm Identification
This rhythm strip is from a 73-year-old man complaining of chest pain.
History of hypertension and lung disease. Medications include aspirin,
albuterol, and Lotensin.

Copyright © 2006 by Mosby Inc. All rights reserved.
U wave
Ventricular rate/rhythm
44 bpm/regular
Atrial rate/rhythm
44 bpm/regular
PR interval
0.16 sec
QRS duration
0.06 sec
Identification
Sinus bradycardia at 44 bpm, ST-segment
depression. Note the upright U waves
following each T wave.
Copyright © 2006 by Mosby Inc. All rights reserved.
Rhythm Identification
Copyright © 2006 by Mosby Inc. All rights reserved.
Ventricular rate/rhythm 60 to 98 bpm/irregular
Atrial rate/rhythm
111 bpm/regular
PR interval
Lengthens
QRS duration
0.08 sec
Identification
Second-degree AV block type I;
ST-segment depression
Copyright © 2006 by Mosby Inc. All rights reserved.
Rhythm Identification

This rhythm strip is from a 69-year-old man who is
disoriented. He knows his name but has no idea
where he is or how he got there. BP: 172/98, R: 20.
Blood sugar: 127 mg/dL.
Copyright © 2006 by Mosby Inc. All rights reserved.
Ventricular rate/rhythm
79 bpm/regular
Atrial rate/rhythm
79 bpm/regular
PR interval
0.18 sec
QRS duration
0.06 to 0.08 sec
Identification
Sinus rhythm at 79 bpm
Copyright © 2006 by Mosby Inc. All rights reserved.
Rhythm Identification

This rhythm strip is from a 35-year-old woman
complaining of chest pain and palpitations.
Copyright © 2006 by Mosby Inc. All rights reserved.
Ventricular rate/rhythm
188/min/regular
Atrial rate/rhythm
Unable to determine
PR interval
Unable to determine
QRS duration
0.06 sec
Identification
Narrow-QRS tachycardia (AVNRT)
with ST-segment depression
Copyright © 2006 by Mosby Inc. All rights reserved.
Rhythm Identification
Copyright © 2006 by Mosby Inc. All rights reserved.
Ventricular rate/rhythm 64 bpm (sinus beats)/regular except for
the event
Atrial rate/rhythm
64 bpm (sinus beats)/regular except for
the event
PR interval
0.16 to 0.18 sec
QRS duration
0.08 sec
Identification
Sinus rhythm with an episode of sinus
arrest and a junctional escape beat
Copyright © 2006 by Mosby Inc. All rights reserved.
Rhythm Identification
This rhythm strip is from an 82-year-old man complaining of
back pain.

Lead II
Lead MCL1
Copyright © 2006 by Mosby Inc. All rights reserved.
Lead II
Lead MCL1
Ventricular rate/rhythm 75/min/regular except for event
Atrial rate/rhythm
75/min/regular except for event
PR interval
0.20 sec
QRS duration
0.12 sec
Identification
Sinus rhythm at 75 bpm with a wide QRS
and a nonconducted PAC
Copyright © 2006 by Mosby Inc. All rights reserved.
Rhythm Identification

This rhythm strip is from a 51-year-old man
complaining of dull chest pain that began about 2
hours ago. He rates his discomfort as a 6 on a scale
of 1 to 10. BP: 70/48, R: 24. His skin is cool, pale,
and diaphoretic.
Copyright © 2006 by Mosby Inc. All rights reserved.
Ventricular rate/rhythm
48 bpm/regular
Atrial rate/rhythm
71 bpm/slightly irregular
PR interval
Varies
QRS duration
0.08 to 0.10 sec
Identification
Complete AV block with
ST-segment elevation
Copyright © 2006 by Mosby Inc. All rights reserved.
Rhythm Identification
Copyright © 2006 by Mosby Inc. All rights reserved.
Ventricular rate/rhythm 250 to 333 bpm/irregular
Atrial rate/rhythm
Unable to determine
PR interval
Unable to determine
QRS duration
0.16 sec
Identification
Polymorphic VT
Copyright © 2006 by Mosby Inc. All rights reserved.
Rhythm Identification
Copyright © 2006 by Mosby Inc. All rights reserved.
Atrial pacing?
No
Ventricular pacing? Yes
Paced interval
74
Identification
100% ventricular paced rhythm
Copyright © 2006 by Mosby Inc. All rights reserved.
Rhythm Identification
These rhythm strips are from a 78-year-old man complaining of
shortness of breath. He has a history of COPD, coronary artery
disease, and hypertension.

Copyright © 2006 by Mosby Inc. All rights reserved.
Ventricular rate/rhythm 55-94/min/irregular
Atrial rate/rhythm
Unable to determine
PR interval
Unable to determine
QRS duration
0.10 sec
Identification
Controlled atrial fibrillation at 55-94 bpm
Copyright © 2006 by Mosby Inc. All rights reserved.
Rhythm Identification
Copyright © 2006 by Mosby Inc. All rights reserved.
Ventricular rate/rhythm 50 bpm/regular
Atrial rate/rhythm
167 bpm/regular
PR interval
Varies
QRS duration
0.06 sec
Identification
Third-degree AV block;
ST-segment elevation
Copyright © 2006 by Mosby Inc. All rights reserved.
Rhythm Identification

This rhythm strip is from a 1-year-old girl. Mom says
the infant suddenly went limp and her limbs began
shaking. The episode lasted about 45 sec. Her
temperature is normal.
Copyright © 2006 by Mosby Inc. All rights reserved.
Ventricular rate/rhythm
215 bpm/regular
Atrial rate/rhythm
215 bpm/regular
PR interval
0.10 sec
QRS duration
0.08 sec
Identification
Sinus tachycardia at 215 bpm
Copyright © 2006 by Mosby Inc. All rights reserved.
Rhythm Identification

This rhythm strip is from an 81-year-old woman
complaining of weakness. BP: 122/59, R: 12. Blood
sugar is 109 mg/dL.
Copyright © 2006 by Mosby Inc. All rights reserved.
Ventricular rate/rhythm
52 bpm/regular
Atrial rate/rhythm
52 bpm/regular
PR interval
0.16 to 0.20 sec
QRS duration
0.06 sec
Identification
Sinus bradycardia
Copyright © 2006 by Mosby Inc. All rights reserved.
Rhythm Identification
Copyright © 2006 by Mosby Inc. All rights reserved.
Ventricular rate/rhythm
71 bpm/regular
Atrial rate/rhythm
71 bpm/regular
PR interval
0.14 sec
QRS duration
0.08 sec
Identification
Accelerated junctional rhythm;
ST-segment elevation
Copyright © 2006 by Mosby Inc. All rights reserved.
Rhythm Identification
This rhythm strip is from a 26-year-old man after a
seizure.

Copyright © 2006 by Mosby Inc. All rights reserved.
Ventricular rate/rhythm
64 to 94 bpm/irregular
Atrial rate/rhythm
64 to 94 bpm/irregular
PR interval
0.16 sec
QRS duration
0.06 to 0.08 sec
Identification
Sinus arrhythmia at 64 to 94 bpm
Copyright © 2006 by Mosby Inc. All rights reserved.
Rhythm Identification

This rhythm strip is from an 18-year-old man with a
gunshot wound to his chest.
Copyright © 2006 by Mosby Inc. All rights reserved.
Ventricular rate/rhythm Unable to determine
Atrial rate/rhythm
None
PR interval
None
QRS duration
None
Identification
Coarse ventricular fibrillation
Copyright © 2006 by Mosby Inc. All rights reserved.
Rhythm Identification
Copyright © 2006 by Mosby Inc. All rights reserved.
Atrial pacing?
Yes
Ventricular pacing?
Yes
Paced interval
71
Identification
100% paced rhythm
– AV sequential pacemaker
Copyright © 2006 by Mosby Inc. All rights reserved.
Rhythm Identification
Copyright © 2006 by Mosby Inc. All rights reserved.
Ventricular rate/rhythm
88/min/regular
Atrial rate/rhythm
Unable to determine
PR interval
Unable to determine
QRS duration
0.06 sec
Identification
Atrial flutter at 88 bpm
with ST-segment depression
Copyright © 2006 by Mosby Inc. All rights reserved.
Rhythm Identification

This rhythm strip is from a 77-year-old woman who states that
she feels fine. She stopped at a blood pressure machine in WalMart and the machine would not read her pulse rate. She later
went to her physician’s office and then to the emergency
department.
Copyright © 2006 by Mosby Inc. All rights reserved.
Ventricular rate/rhythm
30 bpm/regular
Atrial rate/rhythm
68 bpm/regular
PR interval
0.28 sec
QRS duration
0.16 sec
Identification
2:1 AV block, probably type II;
ST-segment elevation
Copyright © 2006 by Mosby Inc. All rights reserved.
Rhythm Identification
This rhythm strip is from a 57-year-old man with no cardiac
history.

Copyright © 2006 by Mosby Inc. All rights reserved.
Ventricular rate/rhythm 111 bpm/regular except for event
Atrial rate/rhythm
111 bpm/regular except for event
PR interval
0.18 sec
QRS duration
0.08 sec
Identification
Sinus tachycardia at 111 bpm with a
nonconducted PAC
Copyright © 2006 by Mosby Inc. All rights reserved.
Rhythm Identification
Copyright © 2006 by Mosby Inc. All rights reserved.
Ventricular rate/rhythm
Two ventricular complexes to none
Atrial rate/rhythm
None
PR interval
None
QRS duration
0.14 sec to none
Identification
Agonal rhythm/asystole
Copyright © 2006 by Mosby Inc. All rights reserved.
Rhythm Identification
Copyright © 2006 by Mosby Inc. All rights reserved.
Ventricular rate/rhythm 30 bpm (sinus beats)/regular except for events
Atrial rate/rhythm
30 bpm (sinus beats)/regular except for events
PR interval
0.12 to 0.16 sec (sinus beats)
QRS duration
0.06 sec (sinus beats)
Identification
Sinus bradycardia with ventricular bigeminy,
inverted T waves, horizontal ST-segments
Copyright © 2006 by Mosby Inc. All rights reserved.
Rhythm Identification

These rhythm strips are from a 52-year-old man with
syncope.
Copyright © 2006 by Mosby Inc. All rights reserved.
Atrial pacing?
Yes
Ventricular pacing? No
Paced interval
79
Identification
Atrial pacemaker
Copyright © 2006 by Mosby Inc. All rights reserved.
Rhythm Identification
This rhythm strip is from a 79-year-old woman with a nosebleed.
Blood pressure is 222/118.

Copyright © 2006 by Mosby Inc. All rights reserved.
Ventricular rate/rhythm
130 bpm/regular
Atrial rate/rhythm
130 bpm/regular
PR interval
0.16 sec
QRS duration
0.12 sec
Identification
Sinus tachycardia at 130 bpm with a
wide-QRS and ST-segment depression
Copyright © 2006 by Mosby Inc. All rights reserved.
Rhythm Identification
Copyright © 2006 by Mosby Inc. All rights reserved.
Ventricular rate/rhythm 52 bpm/regular
Atrial rate/rhythm
None
PR interval
None
QRS duration
0.06 sec
Identification
Sinus beat to junctional escape
rhythm with inverted T waves
Copyright © 2006 by Mosby Inc. All rights reserved.
Rhythm Identification
Copyright © 2006 by Mosby Inc. All rights reserved.
Ventricular rate/rhythm 54 bpm/regular (sinus beats)
Atrial rate/rhythm
54 bpm/regular (sinus beats)
PR interval
0.12 sec (sinus beats)
QRS duration
0.06-0.08 sec (sinus beats)
Identification
Sinus bradycardia with
ventricular bigeminy
Copyright © 2006 by Mosby Inc. All rights reserved.
Rhythm Identification
Copyright © 2006 by Mosby Inc. All rights reserved.
Ventricular rate/rhythm 40 bpm/regular
Atrial rate/rhythm
83 bpm/regular
PR interval
0.24 sec
QRS duration
0.10 sec
Identification
2:1 AV block, probably type I;
ST-segment depression
Copyright © 2006 by Mosby Inc. All rights reserved.
Rhythm Identification
Copyright © 2006 by Mosby Inc. All rights reserved.
Ventricular rate/rhythm 36 bpm/regular
Atrial rate/rhythm
72 bpm/regular
PR interval
0.32 sec
QRS duration
0.10 sec
Identification
2:1 AV block, probably type 1
Copyright © 2006 by Mosby Inc. All rights reserved.
Rhythm Identification
Copyright © 2006 by Mosby Inc. All rights reserved.
Ventricular rate/rhythm
167 bpm/regular
Atrial rate/rhythm
167 bpm/regular
PR interval
0.12 sec
QRS duration
0.06 sec
Identification
Sinus tachycardia at 167 bpm
Copyright © 2006 by Mosby Inc. All rights reserved.
Rhythm Identification

This rhythm strip is from an 83-year-old woman with syncope.
Copyright © 2006 by Mosby Inc. All rights reserved.
Ventricular rate/rhythm
36 bpm/regular
Atrial rate/rhythm
72 bpm/regular
PR interval
0.20 to 0.22 sec
QRS duration
0.06 to 0.08 sec
Identification
2:1 AV block, probably type I
Copyright © 2006 by Mosby Inc. All rights reserved.
Rhythm Identification
Copyright © 2006 by Mosby Inc. All rights reserved.
Ventricular rate/rhythm
150 bpm/essentially regular
Atrial rate/rhythm
Unable to determine
PR interval
Unable to determine
QRS duration
0.12 to 0.16 sec
Identification
Monomorphic VT
Copyright © 2006 by Mosby Inc. All rights reserved.
Rhythm Identification
Copyright © 2006 by Mosby Inc. All rights reserved.
Atrial pacing?
No
Ventricular pacing?
Yes
Paced interval
79
Identification
100% ventricular-paced rhythm
Copyright © 2006 by Mosby Inc. All rights reserved.
Rhythm Identification
Copyright © 2006 by Mosby Inc. All rights reserved.
Ventricular rate/rhythm 63 bpm (sinus beats)/regular except for
the event (every third beat is a PJC)
Atrial rate/rhythm
63 bpm (sinus beats)/regular except for
the event (every third beat is a PJC)
PR interval
0.12 to 0.16 sec (sinus beats)
QRS duration
0.06 sec (sinus beats)
Identification
Sinus rhythm with PJCs
Copyright © 2006 by Mosby Inc. All rights reserved.
Rhythm Identification
Copyright © 2006 by Mosby Inc. All rights reserved.
Ventricular rate/rhythm 180/min/regular
Atrial rate/rhythm
Unable to determine
PR interval
Unable to determine
QRS duration
0.04 sec
Identification
AVNRT at 180 bpm, ST-segment elevation
Copyright © 2006 by Mosby Inc. All rights reserved.
Rhythm Identification

This rhythm strip is from a 61-year-old woman complaining
of shortness of breath. Blood pressure 176/110.
Copyright © 2006 by Mosby Inc. All rights reserved.
Ventricular rate/rhythm 125 bpm/essentially regular except for
events
Atrial rate/rhythm
125 bpm/essentially regular except for
events
PR interval
0.12 sec (sinus beats)
QRS duration
0.06 sec (sinus beats)
Identification
Sinus tachycardia with multiform PVCs
Copyright © 2006 by Mosby Inc. All rights reserved.
Rhythm Identification
Copyright © 2006 by Mosby Inc. All rights reserved.
Ventricular rate/rhythm
107 bpm/regular
Atrial rate/rhythm
107 bpm/regular
PR interval
0.24 sec
QRS duration
0.08 sec
Identification
Sinus tachycardia with first-degree
AV block
Copyright © 2006 by Mosby Inc. All rights reserved.
Rhythm Identification
Copyright © 2006 by Mosby Inc. All rights reserved.
Ventricular rate/rhythm
71 bpm/regular
Atrial rate/rhythm
Unable to determine
PR interval
Unable to determine
QRS duration
0.12 sec
Identification
Accelerated idioventricular rhythm
(AIVR) with ST-segment elevation
Copyright © 2006 by Mosby Inc. All rights reserved.