3

Heart Rate

Fast & Easy ECGs – A Self-Paced

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 Dysrhythmias
•  Irregularities in heart rate or rhythm
–  Some are of little significance whereas others
are life threatening

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 ECG Analysis
•  Five Step Process is a logical and systematic
process for analyzing ECG tracings

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 Normal Sinus Rhythm
Characteristics
•  Rate: 60 - 100 BPM
•  Rhythm: Regular
•  P waves: Upright and round, one preceding each QRS complex
•  QRS complexes: Narrow, 0.06 - 0.12 seconds in duration
•  PR Interval: 0.12 - 0.20 seconds in duration
•  T waves: Upright and slightly asymmetrical

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 Determining Heart Rate
•  First step in analyzing an ECG rhythm
•  Begin by quickly checking ECG monitor or
tracing to see if rate is slow, normal or fast

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 Calculating Heart Rate
•  Several methods can be used including:
–  6-Second Interval x 10 Method
–  300, 150, 100, 75, 60, 50 Method
–  1500 Method
–  Rate Calculator

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 6-Second Interval x 10 Method
•  Quick and easy and does not require tools or devices
•  Not as accurate as other methods
•  Multiply by 10 the number of QRS complexes found in a
six second portion of ECG tracing

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 Practice Makes Perfect
•  Determine the heart rate using the 6-second interval x 10
method

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 Practice Makes Perfect
•  Determine the heart rate using the 6-second interval x 10
method

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 Practice Makes Perfect
•  Determine the heart rate using the 6-second interval x 10
method

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300, 150, 100, 75, 60, 50 Method
•  Quick, fairly accurate, requires no special tools, or calculations
•  Cannot be used with irregular rhythms
•  Find an R wave located on a bold line. Then find the next
consecutive R wave. Bold line it falls on (or is closest to) represents
the heart rate.
300, 150, 100, 75, 60, 50 Method
•  If the second R wave does not fall on a bold line
the heart rate is approximated
–  Example: if it falls between the 4th and 5th bold line
the heart rate is between 60 and 75 BPM
300, 150, 100, 75, 60, 50 Method
•  If the second R wave falls in between two bold
lines the heart rate can be more precisely
determined using the identified values for each
thin line

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 Practice Makes Perfect
•  Determine the heart rate using the 300, 150, 100, 75, 60,
50 method

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 Practice Makes Perfect
•  Determine the heart rate using the 300, 150, 100, 75, 60,
50 method

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 Practice Makes Perfect
•  Determine the heart rate using the 300, 150, 100, 75, 60,
50 method

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 1500 Method
•  Most accurate and requires no special tools but math calculation
must be done to determine heart rate
•  Cannot be used with irregular rhythms
•  Count the number of small squares between two consecutive R
waves and divide 1500 by that number

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 Practice Makes Perfect
•  Determine the heart rate using the 1500 method

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 Practice Makes Perfect
•  Determine the heart rate using the 1500 method

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 Practice Makes Perfect
•  Determine the heart rate using the 1500 method

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 Rate Calculators
•  Easy to use but not always available
•  Ineffective on irregular rhythms where a consistent baseline is not
present
•  Position the “start mark” on an R wave
•  Then find the next consecutive R wave – where it lines up is the
approximate heart rate
 Heart Rates
•  Average adult has a heart rate of 60-100
BPM
•  Heart rate < 60 BPM called bradycardia
•  Heart rate > 100 BPM called tachycardia

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 Sinus Bradycardia
•  Slow rate that arises
from SA node
•  May or may not have
an adverse affect on
cardiac output
•  In extreme cases it
can lead to severe
reductions in cardiac
output and eventually
deteriorate into
asystole
 Sinus Arrest
•  Transient failure of
SA node to initiate a
heart beat
•  Can lead to a slow
heart rate

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 AV Heart Blocks
•  Blockage of the
impulse traveling
through the AV node
can cause a slow
heart rate
•  2nd – degree AV heart
block
 AV Heart Blocks
•  3rd - degree AV heart block occurs with
complete blockage of AV node

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 Rapid Atrial Rates With Slow
Ventricular Rates
•  Because of the rapid rate not all atrial impulses
are conducted through to the ventricles
•  A slower than normal ventricular rate can result if
the number of atrial impulses reaching the
ventricles falls to less than normal
Atrial Flutter

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Atrial Fibrillation

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 Sinus Tachycardia
•  Fast rate, > 100 BPM, arises from the SA node
 Tachycardia From an Ectopic
Pacemaker
•  Results from rapid depolarization that overrides
the SA node
•  Supraventricular tachycardia is term used for
ectopic tachycardia arising from above the
ventricles
–  Atrial tachycardia
•  Generally 150-250 BPM
–  Junctional tachycardia
•  Generally 100-180 BPM
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Tachycardia From an
Ectopic Site
 Tachycardia From an Ectopic
Pacemaker
•  Ventricular tachycardia arises in the ventricles
and has a rate of 150-250 BPM
 Rapid Atrial Rates With Fast
Ventricular Rates
•  In addition to having either a normal or slow ventricular
rate in atria flutter the ventricular rate can also be fast

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 Rapid Atrial Rates With Fast
Ventricular Rates
•  In addition to having either a normal or slow ventricular
rate in atria fibrillation the ventricular rate can also be
fast

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 Summary
•  Approach each ECG tracing analysis in a logical and systematic
manner.

•  Some dysrhythmias are of no problem to the patient whereas

•  Five steps to analyzing an ECG rhythm are determining the:

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 Summary
•  To determine the heart rate first check to see if the rate is slow,
normal or fast.

•  The 6-second interval x 10 method multiplies by 10 the number of

•  The 300, 150, 100, 75, 60, 50 method involves locating an R wave
on a bold line on the ECG paper, then finding the next consecutive
R wave and using the 300, 150, 100, 75, 60, 50 values for
subsequent bold lines to determine the rate.

•  To use the 1500 method count the number of small squares

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 Summary
•  A heart rate less than 60 beats per minute is called bradycardia.
–  Slow heart rates are seen with sinus bradycardia, junctional
escape rhythm, idioventricular rhythm, AV heart block and atrial
flutter or fibrillation with slow ventricular response.

•  A heart rate greater than 100 beats per minute is called tachycardia.
–  Fast heart rates are seen with sinus tachycardia, atrial
tachycardia, junctional tachycardia, ventricular tachycardia and
atrial flutter or fibrillation with rapid ventricular response.