EKG Refresh and Practice Normal Sinus Rhythm. P-Waves: PRInterval:

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1 EKG Refresh and Practice Normal Sinus. : beats per minute r Rhythrn: Atrial - - o Pwaves: Uniform in appearance Upright w/ normal shape One Preceding each QRS Nor more than.10 second o PR interval: second r QRS: 0.10 second or less P-Waves: Should be no more than 2.5 mm in height, and no more than.10 second in width PRInterval: Includes the p-wave as it leaves the baseline and ends at the betinning ofthe QRS complex : Measured from the beginning of the QRS complex (as the first wave leaves the baseline) to the end of the ers complex (when thelast wave begins to level out into the ST segment). The end of the QRS complex is called the J-Point' Normally positive in lead II ST Segment: Begins with the end of the QRS complex and ends with the onset of the T-wave. Normally flat. Coisidered elevated if it is above the baseline and depressed if it is below the baseline. An elevated ST segrnent is a sign of myocardial infarct. T-Wave: Begins as the deflection gradually slopes upward from the ST segment and ends when the waveform retums to baseline. Should be positive in a Lead II. Analyzing a StriP o What is the rate? o Is it regular or irregular? o If irregular, is there a pattem of irregularity? o Are there P-waves?...are they all the same? o If so, is the P-R interval of normal length and are they all the same? o Is there only one P-Wave for every QRS complex?

2 Normal Sinus (NSR) Sinus Bradvcardia Sinua Tachycardia ity Positive; Rounded;Normal PR Interval; One P wave for each QRS complex Lessthan60 Positive;Rounded;Normal PR Interval; One P wave for each QRS complex 100to 170 Positive;Rounded;NormalPR Interval;OneP wavefor each QRScomplex

3 Rhvthm Supraventricular Tachycardia (svr) PrematureAtrial Contraction (PAC) Sinus Anhythmia Over170 Not visible,thoughmaybe presentburriedin QRScomplex or T waves with Isolated Anomalv That of Positive; Rounded;Normal PR Interval; One P wave for each Positive;Rounded;NormalPR Interval;OneP wavefor each QRSComplex ity

4 Positive; Rounded;Normal PR Interval; May seeone nonconducting P before pause or Atrial: : Positive; Peakedor "Sawtooth" Appearanceto Baseline;Unable to measurepr Interval usuallv Atrial: No coordinated None; Wavy deflectionsaffecting systole; baselineas atria quiver usuallv ity SinusBlockor SinusArrest with SuddenPause Atrial Flutter Atrial Fibrillation

5 ity Junctional Rhvthm 40 to 60 lnverted;may occurbefore/after ORScomplexor be hidden Accelerated Junctional Inverted;May occurbefore/after QRScomplexor be hidden Junctional Tachvcardia Morethan 100 Inverted; May occur before/after QRS complex or be hidden

6 Premafure Junctional Contraction (PJC) 1' AV Block 2' AV Block, Mobitz I (Wenckebach) ity Usually with Isolated Anomaly That of That of ; PJC will have Inverted or hidden P wave ly Thatof Positive; Rounded;PR Interval more that0.20sec; One P wave ;Usually for each Positive;Rounded;PR Interval WNL at first but lengthens progressively until P doesnot conductto QRS Usually60 to 100,May be Bradycardic

7 ity 2" AV Block, Mobitz II Usually,May be Iregular Atrial: Varies, : UsuallyLess Than60 Positive;Rounded;PR Interval for conductingbeatsis always WNL; More than I P wavefor eachqrscomplex Usually Atrial and Atrial: 60 to 3' AV Block 100, (CompleteHeart but not : Block) Corresponding Usuallv20-40 Positive; Rounded;Unable to MeasurePR Interval; P:QRS Ratio variable; P waves may be hidden in QRS or T waves TypicallyWidened Thatof Rhvthm Positive; Rounded;Normal PR Interval; One P wave for each Borderline Wide: sec;Usually Notched(QRR'S) Bundle Branch Block That of Rhrrthm

8 ity Idioventricular GVR) 20 to 40 Absent Wide IVR Accelerated 40 to 100 Absent Wide L Premature Conntraction (PVC) Thatof with Isolated Anomaly Thatof Thatof ;PVC Wide andmay Have That of ; No P OppositeDeflection Wave PreceedinePVC from Rhrrthm

9 ity Wide;QRSAdjacent to QRSor Only T UsuallyAbsent;If PresentWill WavesVisible Not Correlatewith QRSComplex MaskineBaseline Tachvcardia 100to 250 Fibrillation Zero No CoordinatedSystole;Wavy Deflections Affecting Baseline as Ventrical Quiver Absent Zero Lack of ElectricalActivity; BaselineUsuallyFlat or Nearly Flat (Mild Deflections Will Be LessThan2mm in Height) Absent Asystole None