Practice ECGStrips

Rhythm Identification
Copyright 2006 by Mosby In
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
83/min (sinus beats)/

Regular except for the event
Atrial rate/rhythm

PR interval
0.20 sec
QRS duration
0.08 to 0.10 sec
Identification
Sinus rhythm with two PJCs,

ST-segment elevation
This rhythm strip is from an 83-year-old

woman with syncope.
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
This rhythm strip is from an 82-year-old man

complaining of back pain.
Top = lead II, bottom = MCL1
Atrial rate/rhythm
PR interval
0.20 sec
QRS duration
0.12 sec
Identification
Sinus rhythm with a nonconducted PAC

woman who experienced a cardiopulmonary
arrest. The initial rhythm was asystole. The
following rhythm resulted after IV
administration of epinephrine and atropine.
40 bpm/regular
Atrial rate/rhythm
None
PR interval
None
QRS duration
0.18 sec
Identification
Idioventricular rhythm (IVR)

(ventricular escape rhythm)
This rhythm strip is from a 69-year-old man

complaining of shortness of breath. Lung
sounds reveal bilateral rales. Blood pressure:
160/58.
107 bpm (sinus beats)/

Regular except for the events
Atrial rate/rhythm

PR interval
0.20 sec (sinus beats)
QRS duration
Identification
Sinus tachycardia with uniform PVCs
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
214 bpm/regular
Atrial rate/rhythm
Unable to determine
PR interval
Unable to determine
QRS duration
0.14 sec
Identification
Monomorphic ventricular tachycardia
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
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
32 bpm/regular
Atrial rate/rhythm

None (junctional beats) to regular
(sinus beats)
PR interval
QRS duration
0.04 to 0.06 sec
Identification
Junctional bradycardia with STsegment depression to sinus

bradycardia, inverted T waves
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

found unresponsive, apneic, and pulseless.
88 bpm/regular
Atrial rate/rhythm
None
PR interval
None
QRS duration
0.12 to 0.14 sec
Identification
Accelerated idioventricular rhythm

(AIVR)

Regular except for the event(s)
Atrial rate/rhythm

PR interval
QRS duration
Identification

block and PACs
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
Atrial paced activity?
Yes
Ventricular paced activity? Yes

Paced interval rate
71
Identification
100% paced rhythm

AV sequential pacemaker
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.
Atrial rate/rhythm
Unable to determine
PR interval
Unable to determine
QRS duration
0.10 sec
Identification
Atrial fibrillation (controlled)
This rhythm strip is from a 97-year-old

woman after a fall.
88 bpm/regular
Atrial rate/rhythm
88 bpm/regular
PR interval
0.24 sec
QRS duration
0.06 sec
Identification

block, ST-segment depression

complaining of a sharp pain across his
shoulders. Blood pressure: 218/86.

Atrial rate/rhythm

PR interval
QRS duration
Identification

complaining of indigestion.
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

woman complaining of weakness.
No

Paced interval rate
83
Identification
100% ventricular paced rhythm

Regular except for the event (every
other beat is an ectopic beat)
Atrial rate/rhythm

PR interval
QRS duration
0.08 to 0.10 sec (sinus beats)
Identification
Sinus bradycardia with ventricular

bigeminy
This rhythm strip is from a 90-year-old woman

complaining of hip pain after a fall.
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

woman complaining of chest pain that she
rates a 4 on a scale of 0 to 10. Blood
pressure: 142/72.
60 bpm/regular
Atrial rate/rhythm
60 bpm/regular
PR interval
0.20 sec
QRS duration
0.06 sec
Identification
Sinus rhythm

complaining of palpitations. Note the point at
which the patient was defibrillated.
63 to 79 bpm (sinus beats)/

Irregular (sinus beats)
Atrial rate/rhythm
63 to 79 bpm (sinus beats)/

Irregular (sinus beats)
PR interval
QRS duration
Identification
Monomorphic ventricular
tachycardia shock ventricular
beats sinus arrhythmia

Atrial rate/rhythm

PR interval
QRS duration
Identification
Sinus rhythm with uniform PVCs

Atrial rate/rhythm

PR interval
0.16 sec
QRS duration
0.08 to 0.10 sec
Identification
Sinus tachycardia with PACs
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.
125 bpm/regular
Atrial rate/rhythm
125 bpm/regular
PR interval
0.12 to 0.16 sec
QRS duration
Identification
Sinus tachycardia with an

interpolated PVC

complaining of chest pain. He had a new
pacemaker implanted 5 days ago. His blood
pressure is 148/60.
79 bpm/regular
Atrial rate/rhythm
Unable to determine
PR interval
Unable to determine
QRS duration
0.08 sec
Identification

with substernal chest pain. He has a history
of COPD and mitral valve regurgitation. Blood
pressure: 140/78.
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
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
Atrial rate/rhythm
111 bpm/regular
PR interval
Lengthens
QRS duration
0.08 sec
Identification
Second-degree AV block, type I
75 bpm/regular
Atrial rate/rhythm
None
PR interval
None
QRS duration
0.08 sec
Identification
Accelerated junctional rhythm
54 bpm/regular
Atrial rate/rhythm
Unable to determine
PR interval
Unable to determine
QRS duration
0.08 sec
Identification
None
Atrial rate/rhythm
None
PR interval
None
QRS duration
None
Identification
Asystole
No

Paced interval rate
65
Identification

woman complaining of abdominal pain.

Atrial rate/rhythm

PR interval
QRS duration
Identification

with a history of heart failure.
Ventricular rate/rhythm 65 to 75 bpm (sinus beats)/Irregular

Atrial rate/rhythm
65 to 75 bpm (sinus beats)/Irregular
PR interval
QRS duration
Identification

block, wide QRS (bundle branch
block), multiform PVCs, and STsegment elevation
This rhythm strip is from a 1-month-old infant

after a 3-minute seizure.
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
45 bpm/regular
Atrial rate/rhythm
115 bpm/regular
PR interval
Varies
QRS duration
0.16 sec
Identification

complaining of chest pain.
No

Paced interval rate
60
Identification

with a congested cough.
Atrial rate/rhythm
Unable to determine
PR interval
Unable to determine
QRS duration
0.06 to 0.08 sec
Identification
Atrial fibrillation (uncontrolled)
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
83 bpm (sinus beats)/regular
Atrial rate/rhythm
PR interval
QRS duration
Identification
Atrial flutter to sinus rhythm

Atrial rate/rhythm

PR interval
QRS duration
Identification

who had a syncopal episode.
58 bpm/regular
Atrial rate/rhythm
58 bpm/regular
PR interval
0.20 sec
QRS duration
0.08 sec
Identification
Sinus bradycardia

complaining of chest pain. Blood pressure:
170/96.
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

complaining of palpitations.
214 bpm/regular
Atrial rate/rhythm
Unable to determine
PR interval
Unable to determine
QRS duration
0.08 sec
Identification
Narrow-QRS tachycardia
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.
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
Unable to determine
Atrial rate/rhythm
Unable to determine
PR interval
Unable to determine
QRS duration
Unable to determine
Identification
Ventricular fibrillation (coarse)
37 bpm/regular
Atrial rate/rhythm
75 bpm/regular
PR interval
0.28 sec
QRS duration
0.06 sec
Identification
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),

complaining of back pain. Her medical history
includes a myocardial infarction 2 years ago.
No

Paced interval rate
65
Identification

found sitting in a chair. He is unresponsive,
apneic, and pulseless.
None
Atrial rate/rhythm
None
PR interval
None
QRS duration
None
Identification
Asystole the electrical activity

shown is caused by pacemaker
spikes from the patients
permanent pacemaker (no
capture)

woman complaining of hip pain after a fall
injury.
Atrial rate/rhythm
Unable to determine
PR interval
Unable to determine
QRS duration
0.08 sec
Identification
Atrial fibrillation
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
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

found unresponsive on the side of the road.
Outdoor temperature is 112F. Blood
pressure: 238/110, respiratory rate: 60/min.
136 bpm/regular
Atrial rate/rhythm
136 bpm/regular
PR interval
0.16 sec
QRS duration
0.08 sec
Identification
Sinus tachycardia with


complaining of dizziness. He had a triple
bypass 4 days ago.

Atrial rate/rhythm

PR interval
QRS duration
Identification
Sinus rhythm with ventricular

bigeminy, ST-segment depression

woman with an altered level of
responsiveness. blood pressure: 160/70,
blood sugar: 114.
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
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.
Atrial rate/rhythm
Unable to determine
PR interval
Unable to determine
QRS duration
0.08 sec
Identification

complaining of chest pain and difficulty
breathing.
Atrial rate/rhythm
Unable to determine
PR interval
Unable to determine
QRS duration
0.10 sec
Identification
Atrial fibrillation with


woman complaining of numbness in her legs.
48 bpm/regular
Atrial rate/rhythm
48 bpm/regular
PR interval
0.16 sec
QRS duration
0.08 sec
Identification
Sinus bradycardia

who complained of sudden weakness in her
legs and fell to the floor in her kitchen.
Atrial rate/rhythm
Unable to determine
PR interval
Unable to determine
QRS duration
0.12 sec
Identification

with ST-segment elevation

woman with vomiting x 2 days.
115 bpm/regular
Atrial rate/rhythm
115 bpm/regular
PR interval
0.18 sec
QRS duration
0.06 sec
Identification
Sinus tachycardia

complaining of chest pain. Her blood
pressure is 146/104, respirations are 20.
Breath sounds are clear.
167 bpm/regular
Atrial rate/rhythm
Unable to determine
PR interval
Unable to determine
QRS duration
0.06 sec
Identification
Narrow-QRS tachycardia (SVT)

This rhythm strip is from a 6-year-old boy

immediately after a seizure.
Atrial rate/rhythm
PR interval
0.12 sec
QRS duration
0.08 sec
Identification
Sinus arrhythmia

who was playing golf and experienced a
syncopal episode.
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

woman complaining of chest pain.
176 bpm/regular
Atrial rate/rhythm
None
PR interval
None
QRS duration
0.12 to 0.14 sec
Identification
tachycardia
29 bpm/regular
Atrial rate/rhythm
71 bpm/regular
PR interval
Varies
QRS duration
0.16 sec
Identification


woman complaining of chest pain.
76 bpm/regular
Atrial rate/rhythm
None
PR interval
None
QRS duration
0.12 to 0.14 sec
Identification

(AIVR)

complaining of weakness.
No

Paced interval rate
68
Identification
Ventricular demand pacemaker
Atrial rate/rhythm
Unable to determine
PR interval
Unable to determine
QRS duration
0.08 sec
Identification
Atrial flutter

Atrial rate/rhythm

PR interval
QRS duration
Identification

ventricular bigeminy
42 bpm/regular
Atrial rate/rhythm
None
PR interval
None
QRS duration
0.24 sec
Identification

(AIVR)
These rhythm strips are from a 63-year-old woman

who experienced a syncopal episode. Blood
pressure is 200/90, blood sugar is 98.
44 bpm/regular
Atrial rate/rhythm
88 bpm/regular
PR interval
0.20 sec
QRS duration
0.10 sec
Identification

woman with a nosebleed. Blood pressure:
250/74.
68 bpm/regular
Atrial rate/rhythm
68 bpm/regular
PR interval
0.16 sec
QRS duration
0.08 sec
Identification
Sinus rhythm

complaining of palpitations. His initial blood
pressure was 112/84. His second blood
pressure, 8 minutes after the first, was 78/P.
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)

No

Paced interval rate
60
Identification

complaining of weakness and dizziness.
Blood pressure is 160/98, blood sugar is 88.
Atrial rate/rhythm
Unable to determine
PR interval
Unable to determine
QRS duration
0.08 to 0.10 sec
Identification
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

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.

Atrial rate/rhythm

PR interval
QRS duration
Identification
Sinus rhythm with uniform PVCs,


complaining of palpitations and shortness of
breath.
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)

breath after administration of adenosine 6 mg
IV.
Atrial rate/rhythm
Unable to determine
PR interval
Unable to determine
QRS duration
0.08 sec
Identification
Atrial fibrillation

breath 1 minute after administration of
adenosine 12 mg IV.
Atrial rate/rhythm
Unable to determine
PR interval
Unable to determine
QRS duration
0.08 sec
Identification
Atrial fibrillation

breath two minutes after administration of
adenosine 6 mg IV.
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)
30 bpm (junctional beats)/irregular
Atrial rate/rhythm
None (junctional beats)/irregular
PR interval
QRS duration
0.06 sec
Identification
Sinus beat, two junctional beats,

sinus beat; ST-segment depression

with shortness of breath.
No

Paced interval rate
60
Identification

Atrial rate/rhythm

PR interval
QRS duration
Identification
100 bpm (sinus beats) to 150 bpm

(VT)/Regular
Atrial rate/rhythm

Regular to unable to determine
PR interval
QRS duration
Identification

block to monomorphic ventricular
tachycardia (VT)
47 bpm/regular
Atrial rate/rhythm
115 bpm/regular
PR interval
Varies
QRS duration
0.08 sec
Identification

Atrial rate/rhythm
Unable to determine
PR interval
Unable to determine
QRS duration
0.06 to 0.08 sec
Identification
Atrial fibrillation
None
Atrial rate/rhythm
94 bpm/regular
PR interval
None
QRS duration
None
Identification
P-wave asystole

with chest pain. Blood pressure: 192/90. She
rates her pain as a 9 on a scale of 0 to 10.
136 bpm/regular
Atrial rate/rhythm
136 bpm/regular
PR interval
0.14 sec
QRS duration
0.08 sec
Identification
Sinus tachycardia
91 bpm/
Atrial rate/rhythm
91 bpm/
PR interval
0.16 sec
QRS duration
0.06 sec
Identification
Sinus rhythm with a nonconducted PAC
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


with chest pain.
Yes

Paced interval rate
60
Identification
AV sequential pacemaker with

failure to capture

woman with an altered level of
responsiveness. Blood pressure: 136/78,
blood sugar is 96.

Atrial rate/rhythm

PR interval
QRS duration
Identification
Sinus tachycardia with a PVC and

a ventricular couplet

complaining of chest pain that he rates as a 6
on a scale of 0 to 10. Blood pressure: 170/80.

Atrial rate/rhythm

PR interval
0.16 sec
QRS duration
0.08 sec
Identification
Sinus tachycardia with PACs
29 bpm/essentially regular
Atrial rate/rhythm
None
PR interval
None
QRS duration
0.04 to 0.06 sec
Identification
Junctional bradycardia
Ventricular rate/rhythm 88 bpm/regular

Atrial rate/rhythm
88 bpm/regular
PR interval
0.28 sec
QRS duration
0.08 sec
Identification

block; ST-segment elevation
This rhythm strip is from a 44-year-old construction

worker with a sudden onset of chest pressure.
Atrial rate/rhythm
PR interval
0.12 sec
QRS duration
0.08 sec
Identification
Sinus arrhythmia at 52 to 94 bpm
Atrial pacing?
No
Ventricular pacing?
Yes
Paced interval
80
Identification
Ventricular-paced rhythm with

pacemaker malfunction
(failure to capture)

complaining of back pain.
Top = lead II, bottom = MCL1.
Atrial rate/rhythm
PR interval
0.20 sec
QRS duration
0.12
Identification
Sinus rhythm at 41 to 73 bpm

with a nonconducted PAC
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
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

except for the event
Atrial rate/rhythm

except for the event
PR interval
QRS duration
Identification
Sinus tachycardia with a PJC

complaining of chest pain.
245 bpm/regular
Atrial rate/rhythm
245 bpm/regular
PR interval
None
QRS duration
0.28 sec
Identification
tachycardia
21 bpm/irregular
Atrial rate/rhythm
21 bpm/irregular
PR interval
0.36 sec
QRS duration
0.08 to 0.10 sec
Identification

junctional escape beats
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;

Atrial rate/rhythm
Unable to determine/irregular
PR interval
Varies
QRS duration
0.04 to 0.06 sec
Identification
Multifocal atrial tachycardia

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,

Ventricular rate/rhythm 94 (sinus beats)/irregular

Atrial rate/rhythm
94 (sinus beats)/irregular
PR interval
QRS duration
Identification
Sinus rhythm with an episode of

couplets and a run of VT
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.
U wave
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.

Atrial rate/rhythm
111 bpm/regular
PR interval
Lengthens
QRS duration
0.08 sec
Identification
Second-degree AV block type I;

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.
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

complaining of chest pain and palpitations.
188/min/regular
Atrial rate/rhythm
Unable to determine
PR interval
Unable to determine
QRS duration
0.06 sec
Identification
Narrow-QRS tachycardia (AVNRT)

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
This rhythm strip is from an 82-year-old man complaining of
back pain.
Lead II
Lead MCL1
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

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.
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


Atrial rate/rhythm
Unable to determine
PR interval
Unable to determine
QRS duration
0.16 sec
Identification
Polymorphic VT
Atrial pacing?
No
Ventricular pacing? Yes

Paced interval
74
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.
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

Atrial rate/rhythm
167 bpm/regular
PR interval
Varies
QRS duration
0.06 sec
Identification
Third-degree AV block;
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.
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
This rhythm strip is from an 81-year-old woman

complaining of weakness. BP: 122/59, R: 12. Blood
sugar is 109 mg/dL.
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
71 bpm/regular
Atrial rate/rhythm
71 bpm/regular
PR interval
0.14 sec
QRS duration
0.08 sec
Identification
Accelerated junctional rhythm;

This rhythm strip is from a 26-year-old man after a
seizure.
Atrial rate/rhythm
PR interval
0.16 sec
QRS duration
0.06 to 0.08 sec
Identification
Sinus arrhythmia at 64 to 94 bpm
This rhythm strip is from an 18-year-old man with a

gunshot wound to his chest.
Ventricular rate/rhythm Unable to determine

Atrial rate/rhythm
None
PR interval
None
QRS duration
None
Identification
Coarse ventricular
fibrillation
Atrial pacing?
Yes
Ventricular pacing?
Yes
Paced interval
71
Identification
100% paced rhythm

AV sequential pacemaker
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

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 physicians office and then to the emergency
department.
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;

This rhythm strip is from a 57-year-old man with no cardiac
history.
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
Two ventricular complexes to none
Atrial rate/rhythm
None
PR interval
None
QRS duration
0.14 sec to none
Identification
Agonal rhythm/asystole
Ventricular rate/rhythm 30 bpm (sinus beats)/regular except for events

Atrial rate/rhythm
30 bpm (sinus beats)/regular except for events
PR interval
QRS duration
Identification
Sinus bradycardia with ventricular bigeminy,

inverted T waves, horizontal ST-segments
These rhythm strips are from a 52-year-old man with

syncope.
Atrial pacing?
Yes
Ventricular pacing? No
Paced interval
79
Identification
Atrial pacemaker
This rhythm strip is from a 79-year-old woman with a nosebleed.
Blood pressure is 222/118.
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

Atrial rate/rhythm
None
PR interval
None
QRS duration
0.06 sec
Identification
Sinus beat to junctional escape

rhythm with inverted T waves
Ventricular rate/rhythm 54 bpm/regular (sinus beats)

Atrial rate/rhythm
54 bpm/regular (sinus beats)
PR interval
QRS duration
0.06-0.08 sec (sinus beats)
Identification

ventricular bigeminy

Atrial rate/rhythm
83 bpm/regular
PR interval
0.24 sec
QRS duration
0.10 sec
Identification
2:1 AV block, probably type I;


Atrial rate/rhythm
72 bpm/regular
PR interval
0.32 sec
QRS duration
0.10 sec
Identification
2:1 AV block, probably type 1
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
This rhythm strip is from an 83-year-old woman with syncope.
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
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
Atrial pacing?
No
Ventricular pacing?
Yes
Paced interval
79
Identification
100% ventricular-paced rhythm
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
QRS duration
Identification
Sinus rhythm with PJCs
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
This rhythm strip is from a 61-year-old woman complaining

of shortness of breath. Blood pressure 176/110.
Ventricular rate/rhythm 125 bpm/essentially regular except for

events
Atrial rate/rhythm
125 bpm/essentially regular except for

events
PR interval
QRS duration
Identification
Sinus tachycardia with multiform PVCs
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
71 bpm/regular
Atrial rate/rhythm
Unable to determine
PR interval
Unable to determine
QRS duration
0.12 sec
Identification

(AIVR) with ST-segment elevation

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Rhythm Identification

Copyright 2006 by Mosby In

0.06 to 0.08 sec

Sinus rhythm with first-degree

Copyright 2006 by Mosby In

Copyright 2006 by Mosby In

83/min (sinus beats)/

83/min (sinus beats)/

0.08 to 0.10 sec

Sinus rhythm with two PJCs,

Copyright 2006 by Mosby In

This rhythm strip is from an 83-year-old

Copyright 2006 by Mosby In

0.06 to 0.08 sec

Second-degree AV block, type I

Copyright 2006 by Mosby In

This rhythm strip is from an 82-year-old man

Top = lead II, bottom = MCL1

Copyright 2006 by Mosby In

Sinus rhythm with a nonconducted PAC

Copyright 2006 by Mosby In

This rhythm strip is from an 86-year-old

Copyright 2006 by Mosby In

Idioventricular rhythm (IVR)

Copyright 2006 by Mosby In

This rhythm strip is from a 69-year-old man

Copyright 2006 by Mosby In

107 bpm (sinus beats)/

107 bpm (sinus beats)/

0.20 sec (sinus beats)

0.08 sec (sinus beats)

Sinus tachycardia with uniform PVCs

Copyright 2006 by Mosby In

Copyright 2006 by Mosby In

Sinus rhythm with first-degree AV

Copyright 2006 by Mosby In

Copyright 2006 by Mosby In

Monomorphic ventricular tachycardia

Copyright 2006 by Mosby In

Copyright 2006 by Mosby In

214 bpm (VT) to 71 bpm (atrial fib)/

0.12 to 0.16 sec (VT) to 0.06 sec

Monomorphic VT to atrial fibrillation

Copyright 2006 by Mosby In

Copyright 2006 by Mosby In

Atrial flutter with ST-segment

Copyright 2006 by Mosby In

Copyright 2006 by Mosby In

32 bpm (sinus beats)/

0.14 sec (sinus beats)

0.04 to 0.06 sec

Junctional bradycardia with STsegment depression to sinus

Copyright 2006 by Mosby In

Copyright 2006 by Mosby In

Complete (third-degree) AV block

Copyright 2006 by Mosby In

This rhythm strip is from a 52-year-old man

Copyright 2006 by Mosby In

0.12 to 0.14 sec

Accelerated idioventricular rhythm