ECG I Nterpretationstudent

Advanced Health Nursing
ECG Rhythm
Interpretation
Dr.Basma Salameh
Dr.Basma Salameh 1
Objectives
ECG Basics
How to Analyze a Rhythm
Normal Sinus Rhythm
Heart Arrhythmias
Dr.Basma Salameh 2
Normal Impulse Conduction
Sinoatrial node
AV node
Bundle of His
Bundle Branches
Purkinje fibers
Dr.Basma Salameh 3
Impulse Conduction & the ECG
Sinoatrial node
AV node
Bundle of His
Bundle Branches
Purkinje fibers
Dr.Basma Salameh 4
Cardiac Action Potential
09/09/17 basma salameh 5

Resting Cardiac Cell
Negatively charged or polarized

Potassium concentration is greater inside the cell
Sodium concentration is greater outside the cell
Calcium concentration is greater outside the cell
Produces intracellular electrical negativity
Refractory and Supranormal Periods
Absolute refractory period

Relative refractory period
Supranormal period
Figure 8-2 Refractory periods:
Absolute, relative, and supernormal.
Ellis, K. M, EKG Plain and simple (3rd ed). Reproduced by permission of Pearson Education, Inc.
the cardiac cells are completely or relatively resistant to

accepting a new impulse.
Dr.Basma Salameh 8
Figure 8-3 Electrical
conduction system in the heart.
Beasley, B. M., Understanding EKGS: A practical approach, 3rd ed. Reproduced by permission of Pearson Education, Inc.
Dr.Basma Salameh 9
Electrical Conduction of the Heart
Primary PacemakerSinoatrial node

(SA)
Cardiac Conduction Pathway
Figure 8-4 Normal ECG waveform
and intervals.
Dr.Basma Salameh 11
The PQRST
P wave - Atrial
depolarization
QRS - Ventricular
depolarization
T wave - Ventricular
repolarization
Dr.Basma Salameh 12
The PR Interval
Atrial depolarization
+
delay in AV junction
(AV node/Bundle of
His)
(delay allows time for the atria to
contract (empty blood)before the
ventricles contract)
Dr.Basma Salameh 13
Pacemakers of the Heart
SA Node - Dominant pacemaker with an intrinsic

rate of 60 - 100 beats/minute.
AV Node - Back-up pacemaker with an intrinsic rate

of 40 - 60 beats/minute.
Ventricular cells - Back-up pacemaker with an

intrinsic rate of 20 - 40 bpm.
Dr.Basma Salameh 14
Table 82
Summary of ECG
Waveforms and
Intervals
Dr.Basma Salameh 15
Table 82 (cont.) Summary
of ECG Waveforms and Intervals
Dr.Basma Salameh 16
Figure 8-6 Components of ECG
monitoring system.
Ellis, K. M., EKG Plain and Simple, 3rd ed. Reproduced by permission of Pearson Education, Inc.
Dr.Basma Salameh 17
Figure 8-7 Placement of electrodes.
Dr.Basma Salameh 18
Dr.Basma Salameh 19
Learning Objective 3
Basic Interpretation Guidelines

Figure 8-8 ECG paper is a graph divided into millimeter squares. Time is measured on the horizontal axis.
With a paper speed of 25 mm/sec, each small (millimeter) box equals 0.04 seconds and each larger (5-
mm) box equals 0.2 seconds. The amplitude of any wave is measured on the vertical axis in millimeters.
Beasley, B. M., Understanding EKGS: A practical approach, 3rd ed. Reproduced by permission of Pearson Education, Inc
Dr.Basma Salameh 21
The ECG Paper
Horizontally
One small box - 0.04 s
One large box - 0.20 s
Vertically
One large box - 0.5 mV
Dr.Basma Salameh 22
Rhythm Analysis
Step 1: Calculate rate.

Step 2: Determine regularity.
Step 3: Assess the P waves.
Step 4: Determine PR interval.
Step 5: Determine QRS duration.
Dr.Basma Salameh 23
Step 1: Calculate Rate
3 sec 3 sec
Option 1
Count the # of R waves in a 6 second rhythm strip, then multiply by 10.
Interpretation?
Dr.Basma Salameh 24
Step 2: Determine regularity
R R
Look at the R-R distances (using a caliper or

markings on a pen or paper).
Interpretation?
Dr.Basma Salameh 25
Figure 8-9 Calculation of heart rate.
Understanding EKGS: A practical approach, 3rd ed, Beasley, B. M. Reprinted by permission of Pearson Education, Inc.
hash marks
Dr.Basma Salameh 26
The ECG Paper (cont)
3 sec 3 sec
Every 3 seconds (15 large boxes) is marked by a vertical line.

This helps when calculating the heart rate.
Dr.Basma Salameh 27
Option 1
Number R in 30 large box *10( regular/irrigular)
9*10=90
Option 2 -regular
Number of large boxes between QRS complexes divided into 300
300/3.4 = 88 bpm
Option 3 -regular
Number of small boxes between QRS complex divided 1500
1500/17 = 88 bpm
Dr.Basma Salameh 28
Step 3: Assess the P waves
Are there P waves?

Do the P waves all look alike?
Do the P waves occur at a regular rate?
Is there one P wave before each QRS?
Interpretation?
Dr.Basma Salameh 29
Step 4: Determine PR interval
Normal: 0.12 - 0.20 seconds.

(3 - 5 small boxes)
Interpretation?
Dr.Basma Salameh 30
Step 5: QRS duration
Normal: 0.04 - 0.10 seconds.

(1 - 2.5 boxes)
Interpretation?
Dr.Basma Salameh 31
Rhythm Summary
Rate
Regularity
P waves
PR interval
QRS duration
Interpretation?
Dr.Basma Salameh 32
Figure 8-10 Interpretation of ECG using eight step process. 1. Measure the rate. There are 8 QRS complexes
in 6 seconds: 8 10 = Heart rate of 80. Or R-R interval = 18 small boxes. Divide 1500 by the number of small
boxes in a minute. 1500 18 = 83 bpm. 2. Examine the R-R interval. The interval is regular; therefore, the
rhythm is regular. 3. Examine the P wave. The P waves are the same configuration. 4. Measure the PR
interval. The interval is constant and measures 4 small boxes (0.4) or 0.16 seconds. 5. Check to see whether
the P waves are followed by a QRS complex: P waves are followed by QRS complex. 6. Examine and
measure the QRS complex: The complexes are the same configuration and measure 2.5 small boxes (0.04) or
0.10 seconds. 7. Measure the QT interval. The interval measures at 9 small boxes or 0.36 seconds. 8.
Diagnose the rhythm. Normal Sinus Rhythm.
Understanding EKGS: A practical approach, 3rd ed, Beasley, B. M. Reproduced by permission of Pearson Education, Inc.
Dr.Basma Salameh 33
Normal Sinus Rhythm (NSR)
Etiology: the electrical impulse is formed in the SA node

and conducted normally.
This is the normal rhythm of the heart; other rhythms that

do not conduct via the typical pathway are called
arrhythmias.
Dr.Basma Salameh 34
NSR Parameters
Rate 60 - 100 bpm

Regularity regular
P waves normal
PR interval 0.12 - 0.20 s
QRS duration 0.04 - 0.10 s
Any deviation from above is sinus tachycardia, sinus bradycardia or an
arrhythmia
Dr.Basma Salameh 35
Arrhythmias
Sinus Rhythms
Premature Beats
Atrial Arrhythmias
Ventricular Arrhythmias
AV Junctional Blocks
Junctional Dysrhythmia
Dr.Basma Salameh 36
High-Acuity Patients
High-acuity patients with electrolyte

abnormalities are prone to the
development of dysrhythmias.
fluid volume abnormalities
hypoxemia
altered body temperature
hyperthermia
o increases electrical heart activity
o increases heart rate
Sinus Rhythms
Sinus Bradycardia
Sinus Tachycardia
Dr.Basma Salameh 38
: ECG
Characteristics and
Treatment
Strategies
Dr.Basma Salameh 39
Understanding EKGS: A practical approach, 3rd ed, Beasley, B. M., Reprinted by permission of Pearson Education, Inc.
Dr.Basma Salameh 40
Figure 8-14 Sinus tachycardia.
1. Rate = 120
2. R-R interval: regular
3. P wave: Regular, upright, matching
4. PR interval = 0.16
5. P wave precedes QRS: yes
6. QRS complex = 0.08
7. QT interval = 0.28
Dr.Basma Salameh 41
Sinus Node Dysfunction
Impulses originate elsewhere in atria

Decrease cardiac output
Nursing assessment
Characteristics and
Treatment
Strategies
Dr.Basma Salameh 43
. Premature atrial contraction (PAC)
Ellis, K. M., EKG Plain and Simple, 3rd ed. Reproduced by permission Pearson Education, Inc.
Dr.Basma Salameh 44
Supraventricular Tachycardia (SVT)
Rate between 150 and 250

Regular rhythm
Undistinguishable P wave
QRS complex normal
Ellis, K. M., EKG Plain and Simple, 3rd ed, Reproduced with permission Pearson Education, Inc.
Dr.Basma Salameh 46
Atrial Flutter
Atrial rate greater than 250

Ventricular rate regular or irregular
Atrial oscillations appear as sawtooth or flutter waves
Described by the number of atrial oscillations
f waves
Figure 8-17 Atrial flutter.
1. Rate: ventricular = 80; atrial = 375
3. P wave: cannot distinguish, flutter (sawtooth) waves present
4. PR interval = cannot calculate
5. P wave precedes QRS: cannot identify
7. QT interval = cannot be determined
Ellis, K. M., EKG Plain and Simple, 3rd ed. Reproduced by Permission of Pearson Education, Inc.
Dr.Basma Salameh 48
Dr.Basma Salameh 49
Atrial Fibrillation (AF)
Most common sustained arrhythmia

Atria contracting very rapidly, unable to empty,
discharging greater than 400 bpm
Unable to refill atrial chambers before contraction
Inadequate ventricular filling
Decreases stroke volume (SV) 25%
Atrial Fibrillation (AF)
Blood remaining in atria prone to form clots

Increases risk of thrombotic stroke
QRS complex normal, irregular
Absent P waves
Treatment
Atrial fibrillation.
1. Rate: atrial: unable to calculate, ventricular = about 70 in 6 second strip
2. R-R interval: irregular
3. P wave: undistinguishable
4. PR interval: cannot calculate
5. P wave precedes each QRS: cannot identify
7. QT interval = cannot be determined
Ellis, K.M., EKG Plain and Simple, 3rd ed. Reproduced by Permission of Pearson Education, Inc.
Dr.Basma Salameh 52
Junctional dysrhythmias
refer to ectopic rhythms
that originate in the
atrioventricular (AV)
junction. : ECG
Characteristics and
Treatment
Strategies
Dr.Basma Salameh 53
Dr.Basma Salameh 54
Figure 8-20 Accelerated junctional rhythm.
1. Rate: 100
3. P wave: Regular, matching, inverted
4. PR interval: 0.10-0.12
5. P wave precedes each QRS: Yes - Inverted wave
Ellis, K. M, EKG Plain and Simple, 3rd ed. Reproduced by Permission of Pearson Education, Inc.
Dr.Basma Salameh 55
Ventricular Dysrhythmias
Life-threatening
Inadequate ventricular ejection
Insufficient stroke volume
Decrease oxygen tissue perfusion.
Table 87
Ventricular
Dysrhythmias: ECG
Characteristics and
Treatment
Strategies
Dr.Basma Salameh 57
Univocal PVCs.
Beasley, B. M., Understanding EKGS: A practical approach, 3rd ed. Reproduced by permission of Pearson Education,
Inc.
Dr.Basma Salameh 58
Multifocal PVCs.
Dr.Basma Salameh 59
Ventricular bigeminy.
bigeminy is a repeated pattern of one normal SA

node-initiated beat followed by one PVC
Dr.Basma Salameh 60
Ventricular trigeminy
Ellis, K. M., EKG Plain and Simple, 3rd ed. Reproduced by permission of Pearson Education, Inc.
Dr.Basma Salameh 61
EKG Plain and Simple, 3rd ed, Ellis, K. M. Reproduced by permission of Pearson Education, Inc.
Example of the R on T phenomenon.

Note the beginning of the ectopic beat on
the downstroke of the T wave.
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Close Observation
of Premature
Ventricular
Contractions
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Ventricular Tachycardia
Classified as three or more consecutive PVCs occurring

at a rapid rate, usually greater than 100 bpm
Support (ACLS) by trained interdisciplinary team
members
May deteriorate into ventricular fibrillation
Figure 8-27 Ventricular tachycardia.
1. Rate: atrial: unable to calculate Ventricular = 180-190
3. P wave: undistinguishable
4. PR interval: none
5. P wave precedes each QRS: no
7. QT interval = unmeasurable
Understanding EKGS: A practical approach, 3rd ed, Beasley, B. M. Reproduced by permission of Pearson Education, Inc.
Dr.Basma Salameh 65
Ventricular Fibrillation
Is the most common cause of sudden cardiac arrest

Defibrillation is the treatment of choice (AHA, 2011)
Pharmacotherapy includes a bolus of epinephrine
Algorithm AHA 2015
Figure 8-28 Ventricular fibrillation.
1. Rate: atrial: none, Ventricular: none
2. R-R interval: undeterminable
3. P wave: none
4. PR interval: none
5. P wave precedes each QRS: no
6. QRS complex: none
7. QT interval: none
Understanding EKGS: A practical approach, 3rd ed, Beasley, B. M., Reproduced by permission of Pearson Education, Inc.
Dr.Basma Salameh 67
Asystole
Represents complete cessation of electrical

impulses
Ventricular fibrillation can mimic asystole.
Asystole is a terminal rhythm.
Figure 8-29 Asystole.
Understanding EKGS: A practical approach, 3rd ed, Beasley, B. M., Reproduced by permission of Pearson Education, Inc.
Asystole represents complete cessation of electrical impulses. The

patient is unconscious and pulseless. It is imperative that the
nurse check that the rhythm is verified in two separate leads as
fine ventricular fibrillation can mimic asystole and requires
different interventions.
Dr.Basma Salameh 69
Characteristics and
Treatment
Strategies
Dr.Basma Salameh 70
Figure 8-30 First-degree AV block.
1. Rate: = 88
3. P wave: Upright, regular, matching, precedes every QRS
5. P wave precedes QRS: yes, on 1:1 basis
EKG Plain and Simple, 3rd ed., Ellis, K. M. Reproduced by permission of Pearson Education, Inc.
Dr.Basma Salameh 71
Figure 8-31 Mobitz Type I (Wenckebach) second-degree block.
1. Rate: = 37-68
2. R-R interval: irregular
3. P wave: Regular, upright, matching. One per QRS except for 5th QRS, which has two P waves preceding QRS.
4. PR interval = Variable. Progressively prolongs until QRS is lost for one beat
5. P wave precedes QRS: yes
Ellis, K. M., EKG Plain and Simple, 3rd ed. Reproduced by permission Pearson Education, Inc.
Dr.Basma Salameh 72
Figure 8-32 Mobitz type II second-degree AV block (3:1 conduction).
1. Rate: = Atrial: 100, ventricular: 33
2. R-R interval: Regular
3. P wave: Upright, matching, regular.
5. P wave precedes QRS: Yes, three for each QRS.
Ellis, K. M., EKG Plain and Simple, 3rd ed. Reproduced with permission Pearson Education, Inc.
Dr.Basma Salameh 73
Third Degree (complete)
Atrioventricular Block
Requires emergency treatment
Atria and ventricles are contracting independently
Cardiac output greatly diminished
Impulse are not conducted through the AV node
Atria and ventricles fire at regular rate, but not as a
single unit
P-P and R-R wave interval are regular
PR interval varies
No relationship between the P wave and QRS complex
Wide QRS complex
Associated with myocardial infarction
Can progress to ventricular fibrillation
Treatment
Figure 8-33 Third-degree (complete) heart block.
1. Rate: = Ventricular: 40; atrial: 80
2. R-R interval: Regular
3. P wave: Regular, upright, matching
4. PR interval: Variable.
5. P wave precedes each QRS: Yes, multiple. No relationship with QRS.
7. QT interval = 0.36.
Beasley, B. M., Understanding EKGS: A practical approach, 3rd ed. Reproduced with permission Pearson Education, Inc.
Dr.Basma Salameh 77
Rhythm #1
Rate? 30 bpm
Regularity? regular
P waves? normal with one per QRS
PR interval? 0.12 s
QRS duration? 0.10 s
Interpretation?
Dr.Basma Salameh 78
Sinus Bradycardia
Deviation from NSR

- Rate < 60 bpm
Etiology: SA node is depolarizing slower than normal, impulse is
conducted normally (i.e. normal PR and QRS interval).
Dr.Basma Salameh 79
Rhythm #2
Rate? 130 bpm

Regularity? regular
P waves? normal
PR interval? 0.16 s
Interpretation?
Dr.Basma Salameh 80
Sinus Tachycardia
Etiology: SA node is depolarizing faster than normal, impulse is

conducted normally.
Remember: sinus tachycardia is a response to physical or
psychological stress, not a primary arrhythmia.
Dr.Basma Salameh 81
Rhythm #3
Rate? 70 bpm
Regularity? occasionally irreg.
P waves? 2/7 different contour
PR interval? 0.14 s (except 2/7)
Interpretation?
Dr.Basma Salameh 82
Premature Atrial Contractions
Deviation from NSR

These ectopic beats originate in the atria
(but not in the SA node), therefore the
contour of the P wave, the PR interval, and
the timing are different than a normally
generated pulse from the SA node.
Dr.Basma Salameh 83
Premature Atrial Contractions
Etiology: Excitation of an atrial cell forms an impulse that is then

conducted normally through the AV node and ventricles.
Dr.Basma Salameh 84
Rhythm #4
Rate? 60 bpm
Regularity? occasionally irreg.
P waves? none for 7th QRS
PR interval? 0.14 s
QRS duration? 0.08 s (7th wide)
Interpretation?
Dr.Basma Salameh 85
PVCs
Deviation from NSR

Ectopic beats originate in the ventricles resulting in wide
QRS complexes.
When there are more than 1 premature beats and look
alike, they are called unifocal. When they look different,
they are called multifocal .
Dr.Basma Salameh 86
PVCs
Etiology: One or more ventricular cells are depolarizing and the

impulses are abnormally conducting through the ventricles.
Dr.Basma Salameh 87
Rhythm #5
Rate? V :100 bpm A: more 350

Regularity? irregular
P waves? None-fibrillatory baseline
PR interval? none
Interpretation?
Dr.Basma Salameh 88
Atrial Fibrillation
Deviation from NSR

No organized atrial depolarization, so no
normal P waves (impulses are not
originating from the sinus node).
Atrial activity is unorganized (resulting in an
irregular rate).
Dr.Basma Salameh 89
Atrial Fibrillation
Etiology: multiple re-entrant wavelets conducted between the R & L

atria.
The AV node allows some of the impulses to pass through at
variable intervals (so rhythm is irregular).
Dr.Basma Salameh 90
Rhythm #6
Rate? V :70 bpm A:250-300

Regularity? regular
P waves? flutter waves(sawtooth )
PR interval? none
Interpretation?
Dr.Basma Salameh 91
Atrial Flutter
Deviation from NSR

No P waves. Instead flutter waves (note
sawtooth pattern) are formed at a rate of
250 - 350 bpm.
Only some impulses conduct through the AV
node (usually every other impulse).
Dr.Basma Salameh 92
Atrial Flutter
Etiology: Reentrant pathway in the right atrium with every 2nd, 3rd
or 4th impulse generating a QRS (others are blocked in the AV node
as the node repolarizes).
Dr.Basma Salameh 93
Rhythm #7
Rate? 74 150 bpm

Regularity? Regular regular
P waves? Normal none
PR interval? 0.16 s none
Interpretation?
Dr.Basma Salameh 94
PSVT
Deviation from NSR

The heart rate suddenly speeds up, and the
P waves are lost.
Dr.Basma Salameh 95
PSVT
Etiology: There are several types of PSVT but all originate above the
ventricles (therefore the QRS is narrow).
Most common: abnormal conduction in the AV node (reentrant circuit

looping in the AV node).
Dr.Basma Salameh 96
Rhythm #10
Rate? 160 bpm

Regularity? regular
P waves? none
PR interval? none
QRS duration? wide (> 0.12 sec)
Interpretation?
Dr.Basma Salameh 97
Classified as three or more consecutive PVCs occurring

at a rapid rate, usually greater than 100 bpm
Support (ACLS) by trained interdisciplinary team
members
May deteriorate into ventricular fibrillation
Deviation from NSR

Impulse is originating in the ventricles (no P
waves, wide QRS).
Dr.Basma Salameh 99
Etiology: There is a re-entrant pathway looping in a ventricle (most

common cause).
Ventricular tachycardia can sometimes generate enough cardiac
output to produce a pulse; at other times no pulse can be felt.
Dr.Basma Salameh 100

Rhythm #11
Rate? none
Regularity? irregular
P waves? none
PR interval? none
QRS duration? wide, if recognizable, F wave
Interpretation?
Is the most common cause of sudden cardiac arrest

Defibrillation is the treatment of choice (AHA, 2011)
Pharmacotherapy includes a bolus of epinephrine or
vasopressin
Deviation from NSR Completely abnormal.

Etiology: The ventricular cells are excitable and depolarizing randomly.
Rapid drop in cardiac output and death occurs if not quickly reversed

AV Nodal Blocks
1st Degree AV Block

2nd Degree AV Block, Type I
2nd Degree AV Block, Type II
3rd Degree AV Block

Rhythm #13
Rate? 60 bpm
Regularity? regular
P waves? Normal 1 P for QRS
PR interval? 0.36 s
Interpretation?
1st Degree AV Block
Deviation from NSR

PR Interval > 0.20 s
Etiology: Prolonged conduction delay in the AV node or Bundle of His

Rhythm #14
Rate? 50 bpm
Regularity? Regularly- irregular
P waves? nl, but 4th no QRS
PR interval? lengthens
Interpretation?
Dr.Basma Salameh
108
2nd Degree AV Block, Type I
Deviation from NSR

PR interval progressively lengthens, then the
impulse is completely blocked (P wave not
followed by QRS).
Etiology: Each atrial impulse encounters a longer and longer delay in the AV node until
one impulse (usually the 3rd or 4th) fails to make it through the AV node.

Rhythm #15
Rate? 40 bpm
Regularity? regular
P waves? nl, 2 of 3 no QRS
PR interval? 0.14 s
Interpretation?
2nd Degree AV Block, Type II
Deviation from NSR

P waves are completely blocked (P wave not
followed by QRS).
Etiology: Conduction is all or nothing (no prolongation of PR interval); typically
block occurs in the Bundle of His.

Rhythm #16
Rate? 38 bpm
Regularity? regular
P waves? no relation to QRS
PR interval? none
QRS duration? wide (> 0.12 s)
Interpretation?
3rd Degree AV Block
Deviation from NSR

The P waves are completely blocked in the
AV junction; QRS complexes originate
independently from below the junction.

3rd Degree AV Block
Etiology: There is complete block of conduction in the AV junction, so

the atria and ventricles form impulses independently of each other.
Without impulses from the atria, the ventricles own intrinsic
pacemaker kicks in at around 20 - 40 beats/minute.

Junctional Dysrhythmia
Junctional rhythm occurs when the AV node, instead of the sinus node,
becomes the pacemaker of the heart
1-Junctional escape rhythm
2-Accelerated junctional rhythm
3-Junctional tachycardia

Junctional escape rhythm(17)
Rate : 40-60 BPM

Rhythm :regular
P WAVE :may be present or absent :inverted in lead 2
-PR interval : less than 0.12 seconds
-QRS : 0.06 -.010 seconds

Accelerated junctional rhythm(18)

Junctional tachycardia(19)
-Rate :>100 BPM

-Rhythm :regular
-P WAVE :may be present or absent
inverted in lead 2
-PR interval : less than 0.12 seconds
-QRS : 0.06 - 0.10 seconds
Electrical impulses that cause your heart to beat (contract) originate
in the upper right chamber (right atrium) of the heart and travel to
the lower chambers (ventricles). In bundle branch block, the pathway
that these impulses travel on is delayed or blocked. The pathway
includes a bundle with two branches the left and right bundles.

Nurse Assessment of Baseline Data
Vital signs
ECG interpretation
Physical assessment
Countershock
Cardioversion
Nurse's responsibilities
Defibrillation
An unsynchronized electric shock that usually

administers a larger number of joules than
cardioversion does
Figure 8-34 Placement of paddles
for defibrillation.

ECG I Nterpretationstudent

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Advanced Health Nursing

09/09/17 basma salameh 5

Negatively charged or polarized

Absolute refractory period

the cardiac cells are completely or relatively resistant to

Primary PacemakerSinoatrial node

SA Node - Dominant pacemaker with an intrinsic

AV Node - Back-up pacemaker with an intrinsic rate

Ventricular cells - Back-up pacemaker with an

Basic Interpretation Guidelines

Step 1: Calculate rate.

Look at the R-R distances (using a caliper or

Every 3 seconds (15 large boxes) is marked by a vertical line.

Are there P waves?

Normal: 0.12 - 0.20 seconds.

Normal: 0.04 - 0.10 seconds.

Etiology: the electrical impulse is formed in the SA node

This is the normal rhythm of the heart; other rhythms that

Rate 60 - 100 bpm

High-acuity patients with electrolyte

Impulses originate elsewhere in atria

Rate between 150 and 250

Atrial rate greater than 250

Most common sustained arrhythmia

Blood remaining in atria prone to form clots

bigeminy is a repeated pattern of one normal SA

Example of the R on T phenomenon.

Classified as three or more consecutive PVCs occurring

Is the most common cause of sudden cardiac arrest

Represents complete cessation of electrical

Asystole represents complete cessation of electrical impulses. The

Deviation from NSR

Rate? 130 bpm

Etiology: SA node is depolarizing faster than normal, impulse is

Deviation from NSR

Etiology: Excitation of an atrial cell forms an impulse that is then

Deviation from NSR

Etiology: One or more ventricular cells are depolarizing and the

Rate? V :100 bpm A: more 350

Deviation from NSR

Etiology: multiple re-entrant wavelets conducted between the R & L

Rate? V :70 bpm A:250-300

Deviation from NSR

Rate? 74 150 bpm

Deviation from NSR

Most common: abnormal conduction in the AV node (reentrant circuit

Rate? 160 bpm

Classified as three or more consecutive PVCs occurring

Deviation from NSR

Etiology: There is a re-entrant pathway looping in a ventricle (most

Dr.Basma Salameh 100

Is the most common cause of sudden cardiac arrest

Deviation from NSR Completely abnormal.

Dr.Basma Salameh 103

1st Degree AV Block

Dr.Basma Salameh 105

Deviation from NSR

Etiology: Prolonged conduction delay in the AV node or Bundle of His

Dr.Basma Salameh 107

Deviation from NSR

Dr.Basma Salameh 109

Deviation from NSR

Dr.Basma Salameh 111

Deviation from NSR