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5 IDENTIFYING COMPONENTS OF ECG STRIPS
Rhythm: Regular or Irregular
- P to P Interval: Beginning of P wave to beginning of next P wave
- QRS Complex to QRS Complex: From R wave to next R wave
- Rate: normal range 60 – 100 beat per min.
- Regular: R wave to R wave (1500/# of small boxes)
- Irregular: Count # of complete complexes within 6 second (x 10)
- P waves: Are they upright and uniform? (description)
- Are each followed by a QRS complex? (present)
- PR Interval (PRI): normal range 0.12 to 0.20
- Beginning of P wave to Beginning of QRS (# of Sm. Bx. x 0.04)
- QRS Complex: normal range 0.06 to 0.10
Beginning of Q wave to the J point (# of Sm. Bx. x 0.04)
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Sinus Rhythms
(upright, uniform P wave / PRI & QRS are in normal range)
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Atrial Dysrhythmias
(P wave changes in shape, size)
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Atrial–Junction Rhythms
(P waves are inverted, absent, or after QRS/ PRI < 0.12)
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Heart Block Rhythms
- 1st Degree : PRI > 0.20
- 2nd Degree Type II : A. rate normal; V rate slower due to blocked QRS
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Bundle Branch Block:
QRS will be 0.12 or greater
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Normal Sinus Rhythm:
all 5 steps are within normal limits
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Sinus Bradycardia
Rate is < 60
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Sinus Tachycardia:
Rate is 100 - 150
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Sinus Dysrhythmia (Sinus Arrhythmia)
P to P & R to R intervals will widen and narrow following the breathing pattern (variance > 0.08 or 2 small boxes=irregular rhythm)
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Sinus Arrest:
Complete cardiac complexes precede and follow the arrest period. Length of Pause=from R before pause to R after pause (calc: # of Sm. Bx x 0.04)
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Premature Atrial Complexes (PAC):
A beat that comes early with a positive deflected P wave.
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Wandering Atrial Pacemaker (WAP):
Changing P wave configuration with at least 3 variations. Rate is 60 - 100
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Atrial Flutter (A Flutter):
sawtooth” pattern between QRS complexes. Atrial rate is 250-350 (calc: vent. rate x F waves between QRS) (no P (or T) waves, only F waves).
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Atrial Fibrillation (A fib):
Chaotic disorder between QRS complexes. Atrial rate 375-700 (no P waves, only f waves).
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Supraventricular Tachycardia (SVT):
Rate of 150 – 250
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Wolff-Parkinson-White (WPW) Syndrome:
- QRS is > 0.10
- (QRS start on the down slop of P wave making a Delta wave)
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Junctional Escape Rhythm:
Rate 40 - 60 (P waves are inverted, absent, or after QRS/ PRI < 0.12)
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Accelerated Junctional Rhythms:
Rate 60 – 100 (P waves are inverted, absent, or after QRS/ PRI < 0.12)
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Junctional Tachycardia:
Rate 100 – 180 (P waves are inverted, absent, or after QRS/ PRI < 0.12)
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Premature Junctional Complex (PJC):
A beat that comes early with an inverted (if seen) or buried P wave.
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AV Block with Varied PRI
- 2nd Degree Type I (Wenckebach): A rate normal; V rate slower with prolonging PRI until QRS drops then cycle begins again. (recurrent prolonging pattern)
- 3rd Degree (Complete Heart Block or CHB): P-P and R-R are firing @ different rate (A rate 60 – 100, V rate 20 – 40)
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Ventricles Rhythm
(No P wave, QRS wide (>0.12) and bizarre)
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Premature Ventricular Complexes (PVC):
An early QRS complex with no P wave.
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Idioventricular Rhythm:
Ventricular rate 20-40 (No P wave, QRS wide (>0.12) and bizarre)
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Accelerated Idioventricular Rhythm:
Ventricular rate 40-100 (No P wave, QRS wide (>0.12) and bizarre)
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Ventricular Tachycardia (V Tach):
“Sharkteeth” appearance, V rate > 100 (No P wave, QRS wide (>0.12) and bizarre)
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Torsades De Pointes (Multifocal V Tach) (“twisting of the points”):
QRS morphology varies in width & shape (No P wave, QRS wide (>0.12) and bizarre)
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Agonal Rhythm:
V rate < 20 (No P wave, QRS wide (>0.12) and bizarre)
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Ventricular Fibrillation (V Fib):
Chaotic in appearance (No P wave, QRS wide (>0.12) and bizarre)
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Asystole:
No noticeable deflection in waveform. (flatline) (No P wave, QRS wide (>0.12) and bizarre)
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Pulseless Electrical Activity (PEA):
absence of a palpable pulse with organized electrical activity
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