Interpretation: P wave, QRS complex, T wave present per each conducted beat
R=R
Rate- 60-100 bpm
PR interval 0.12-0.20 seconds
QRS 0.04-0.10seconds
Sinus Bradycardia (SB): Decreased rate of atrial depolarization, slowing SA node conduction
Interpretation: P wave, QRS complex, T wave present per each conducted beat
R=R
Rate <60 (usually 40-59 bpm)
PR interval 0.12-0.20 seconds
QRS 0.04-0.10seconds
Sinus Tachycardia (ST): Increased rate of discharge from the SA node, increasing HR
Interpretation: P wave, QRS complex, T wave present per each conducted beat
R=R
Rate >100 (not usually <150 bpm)
PR interval 0.12-0.20 seconds
QRS 0.04-0.10seconds
Sinus Dysrhythmia (Sinus Arrhythmia): Variation of NSR; when measured R-R off (>0.12)
Interpretation: P wave, QRS complex, T wave present per each conducted beat
RR (>0.12 second difference)
Rate 60-100 bpm (may be <60 or >100 bpm)
PR interval 0.12-0.20 seconds
QRS 0.04-0.10seconds
Premature Ventricular Contractions (PVCs): Premature impulse from either ventricle before
SA node fire and atrial conduction. Decreased or incomplete atrial filling.
Interpretation: no P wave, wide, bizarre (notched) QRS complex, ST segment and T wave
opposite direction of QRS complex
RR between sinus beat and PVC; R=R between sinus beats
Rate variable depending on underlying rhythm
QRS >0.12 seconds (of PVC complex
Runs of PVCs (Salvos or runs of V tach): May be a couplet (2 or more PVCs after one
another), Bigeminal (1 PVC after each sinus beat), Trigeminal (1 PVC for every 2 sinus beats),
Triplets (>3 in a row), Salvos (or Runs of VT) >4 PVCs in a row.
Salvo of PVCs
Trigeminal and Bigeminal PVCs
Couplet of PVCs
QRS complexes of PVCs are different morphologies (multiform), meaning they are firing from
different origins (foci) of the ventricles; or QRS complexes on the strip are all the same
(uniform); meaning they are firing from the same origin (foci) of the ventricle.
Premature Atrial Contractions (PACs): Atria fire early before the next conducted beat
Interpretation: Morphology of P wave different from sinus P wave; early, upright, peaked,
notched, slurred, or wide
RR between sinus beat and PAC; R=R between sinus beats
Rate variable depending on underlying rhythm
PR interval 0.12-0.20 seconds (but different from sinus beat)
QRS 0.04-0.10seconds
Atrial Fibrillation (AF, A-Fib): Atria firing at rapid rate with variable ventricular conduction
beats with chaotic depolarization of random atrial fibers. Decreased CO because of short
ventricular filling from atria.
Atrial Flutter (AF, A-Flutter): Atrial firing in dependently from ventricles as in A-Fib.
Interpretation: P and T waves merge to form sawtooth pattern between QRS complexes. May
be variant conduction between flutter waves and QRS complexes (1:1, 2:1, 3:1).
RR ( w/ variant conduction) or R=R (with uniform conduction)
Rate variable- (ventricular rate) usually 150 bpm
PR interval unidentifiable, unable to measure; P waves replaced by sawtooth P-T wave formation
QRS 0.04-0.10seconds (usually normal)
First Degree Atrioventricular Block (1st degree AVB): Considered a delay in conduction at
the AV junction slowing conduction time to ventricles
PRI >0.20 seconds
Interpretation: Delay in conduction is constant with each beat, PR interval longer than normal.
R=R
Rate variable depending on underlying rhythm
PR interval >0.20-0.40 seconds (constant/consistent)
QRS 0.04-0.10seconds (usually normal)
Second Degree AVB Type I (Wenckebach or Mobitz I): Conduction blocked at the AV node
(mostly); considered an incomplete block because not all atrial impulses reach ventricles.
Often d/t parasympathetic tone or drug effect.
Second Degree AVB Type II (Mobitz II): Conduction blocked at the Bundle of His or bundle
braches (most common); considered an incomplete block as well. Associated with organic
lesions along the conduction pathway, and may develop into complete HB.
Constant PRI with associated QRS complexes, and non-conducted P waves
Interpretation: Blocks in the bundle braches cause a complete block in one branch with an
intermittent block in conduction down the opposite bundle branch (QRS may be wide). In the
bundle of HIS the QRS will be normal because ventricular conduction is not disturbed.
RR
Rate- ventricular rate < atrial rate
PR interval remains the same, with intermittent non-conducted P waves
QRS 0.04-0.10seconds (usually normal), but may be >0.10 seconds
Third Degree AVB (Complete HB): No impulses travel between the atria and ventricles. AV
junction takes over as ventricular pacemaker and atria fire on their own time with slowing
ventricular tempo. Patient may die if AV junction does not kick in, or stops conduction.
Multiple P waves dissociated from QRS complexes
Interpretation: Lack of relationship between P waves and QRS complexes; each maintains own
rhythm without regard for the other (atria and ventricles). AV junction rhythm will have normal
QRS, below AVJ will have wide QRS. Causes: Parasympathetic tone, AMI, Drug toxicity).
R=R (usually)
Rate- ventricular rate < atrial rate ( junctional rate 40-60 bpm, ventricle rate 20-40 bpm)
PR interval varies; P too close or far to be associated with QRS
QRS 0.04-0.10seconds (usually normal), but may be >0.10 seconds
Narrow VT
Interpretation: Ventricles generating in a rapid rhythm, usually regular, and can be sustained
(non self-terminating) or non-sustained (self-terminating). If there is a abrupt onset and
termination it is a run of VT or Salvo of VT. ST-T wave are opposite direction of QRS complex.
R=R (usually)
Rate >100 bpm, but <220 bpm
PR interval not detectable b/c of no P waves or P waves not associated with QRS complexes
QRS wide and bizarre; >0.12 seconds
Course VF
Fine VF
Interpretation: Normal looking waveform(s) are absent, No definable P, QRS, T waves. Course
or Fine VF. Course VF suggests recent onset- better outcomes with immediate defibrillation.
RR and chaotic looking
Rate undetectable
PR interval not detectable
QRS not detectable
Interpretation: If the next beat follows shortly thereafter, there is a good chance that this third
beat falls within the QT interval, resulting in the R on T phenomenon and subsequent Torsades
de pointes. During Torsades de pointes the ventricles depolarize in a circular fashion resulting in
QRS complexes with a continuously turning heart axis around the baseline (flipping axes).
Paced Rhythms (Atrial, Ventricular, AV pacing): Present when patient has a permanent,
temporary pacer or is being transcutaneous paced.
Junctional Rhythms: Originates in the AV node; SA fails to fire or conduction has been
blocked
Accelerated Junctional and Junctional Tachycardia: Origin same as junctional rhythm; rate
faster
Treatment: Try vagal maneuvers first (valsalva, coughing, suctioning), then administer
adenosine. If medication and vagal maneuvers unsuccessful= cardioversion needed. IF WPW
syndrome present; treat as would for VT if unstable.
Pulseless Electrical Activity (PEA): electrical tracing will be present and may include ALL
elements of conduction but ventricles are still and persona has NO PULSE!!
Interpretation: Will be dependent on conduction deficit; may look like NSR but most often will
be ventricular-based
R-R depends on rhythm conducted
Rate= 0you have no pulse but you may be able to count rate on strip
PR= depends on conducted rhythm
QRS= depends on conducted rhythm
Treatment: CPR and epinephrine. Atropine if ventricular rate is slow. Treat underlying
causehypoxia, metabolic acidosis, hypothermia, hypo/hyperkalemia, drug overdose, PE.