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Prepared by : ANWAR ISSA
RN-BSN-CCRT-ICU
How to analyze a rhythm strip ?
•
•
•
•
P wave : is P wave normal ?
PR interval : is PR interval normal ?
QRS complex : is QRS normal ?
P-QRS relation : what is the relation
between P wave and QRS ?
• Rate : what is the rate ?
P WAVE
• Are the P waves regular ?
• Is the P wave normal and
upright in lead II ?
• Do all P waves look alike
?
PR INTERVAL
• Are all the PRI ‘s constant?
• Is the PRI measurement
within normal range?
• If the PRI varies, is there a
pattern to the changing
measurements?
QRS COMPLEX
• Are all the QRS complexes of
equal duration?
• What is the measurement of the
QRS complex?
• Is the QRS measurement within
normal limits?
• Do all the QRS complexes look
alike?
• Are the unusual QRS complexes
associated with ectopic beats?
P-QRS RELATION
• Is there a P for every
QRS and vice versa?
• Are they related to each
other?
• More P’s? More QRS’s
?
HEART RATE
• What is the exact rate?
• Is the atrial rate the same as the ventricular rate?
- If the rhythm is regular--- 300/# of big squares between RR.
-
-If the rhythm is irregular --- count the R waves on a 6 second strip and
multiply by 10.
Normal sinus rhythm
* Condition where SA node stops firing, causing pause in electrical activity.
* During the pause, atrial and ventricularcontraction do not occur.
MAT
Multifocal Atrial Tachycardia
Multifocal atrial tachycardia: narrow-complex tachycardia at
140 to 160 bpm with multiple P-wave morphologies (arrows)
Atrial fibrillation / flutter
Atrial fibrillation
Atrial flutter
Junctional Tachycardia
Rate > 100/min
SVT
(SupraVentricular Tachycardia)
PSVT
(Paroxysmal Supraventricular Tachycardia)
Sinus rhythm with paroxysmal onset (arrow) of supraventricular tachycardia (PSVT)
Wolff-Parkinson-White
Wolff-Parkinson-White syndrome: normal sinus rhythm with delta wave notching
of positive upstroke of QRS complex
Premature Ventricular Contractions
(PVC’s)
Ventricular Tachycardia
Monomorphic ventricular tachycardia
Polymorphic Ventricular Tachycardia:
Torsades de pointes
Polymorphic ventricular tachycardia: QRS complexes display multiple morphologies (“polymorphic”)
Ventricular fibrillation
Coarse VF
Fine VF
Pacing Rhythms
Pacing attempted: note pacing stimulus indicator (arrow) which is below threshold; no capture
Pacing above threshold (60 mA): with capture (QRS complex broad and ventricular; T wave opposite QRS)
Idio-Ventricular Rhythm
1
2
Asystole / Stand still
RATE
SINUS
AV NODE
VENTRICULAR
> 100
Sinus
tachycardia
Junctional
tachycardia
Ventricular tachycardia
60-100
Normal
Sinus
Accelerated
Junctional
40-60
Sinus
Bradycardia
Junctional
rhythm
20-40
Accelerated ventricular
Rhythm
Idioventricular rhythm