ECG Rhythm Criteria Flashcards by Jessica Hayward

Sinus Rhythm

Rhythm: Regular
Rate: 60-100 bpm
P waves: Upright, Matching-same shape, Preceding QRS, or notched
Lead I, II - upright
V1 – biphasic
PRI: Constant
QRS Duration: Less than 3 small boxes (0.12 sec)

How well did you know this?

Not at all

Perfectly

Sinus Bradycardia

Rhythm: Regular
Rate: Less than 60 bpm
P waves: Upright, Matching-same shape, Preceding QRS, or notched
Lead I, II - upright
V1 – biphasic

How well did you know this?

Not at all

Perfectly

Sinus Tachycardia

Rhythm: Regular
Rate: Over 100 bpm
P waves: Upright, Matching-same shape, Preceding QRS, or notched
Lead I, II - upright
V1 – biphasic

How well did you know this?

Not at all

Perfectly

Sinus Arrhythmia

Rhythm: Irregular
P waves: Upright, Matching-same shape, Preceding QRS, or notched
Lead I, II - upright
V1 – biphasic
Longest P-P or R-R interval exceeds shortest interval by 4 sm boxes.
PRI: Less than 1 Lg box., constant

How well did you know this?

Not at all

Perfectly

Multifocal Atrial Rhythm (Wandering Atrial Pacemaker)

Rhythm: Irregular or Regular
P waves: 3 or more different morphologies
PRI: varies

How well did you know this?

Not at all

Perfectly

Premature Atrial Contractions (PACs)

Timing is premature & occurs early
P waves: Morphology different than others – smaller or narrower, may be absent; Often found hidden in T-Wave
PRI: Often different than other beats
Non-compensatory pause
P Wave with no QRS following = non-conducted PAC

How well did you know this?

Not at all

Perfectly

Ectopic Atrial Rhythm (Low Atrial Rhythm)

Rhythm: Regular (most of the time)
P waves: Lead II, III, aVF, MOST leads – Inverted
Lead I, aVR, aVL - Upright
PRI: Constant, normal range

How well did you know this?

Not at all

Perfectly

Atrial Tachycardia

Rhythm: Regular
Rate: Greater than 100 bpm
P waves: Barely discernible & oddly shaped

How well did you know this?

Not at all

Perfectly

Atrial Fibrillation

Rhthm: Irregularly Irregular
Rate: Atrial very fast 400-600 bpm
Ventricular rate slow or fast
P waves: No P-waves
Baseline replaced with fibrillatory waves

How well did you know this?

Not at all

Perfectly

Atrial Flutter

Rhythm: Regular or Irregular
Rate: Atrial rate 150-350 bpm
P waves: Saw-tooth appearance
Typical: Leads II, III, aVF – negative flutter waves
V1 – positive flutter waves
Cavo-tricuspid isthmus is often the culprit

How well did you know this?

Not at all

Perfectly

Supraventricular Rhythm (SVTs)

Umbrella term for all rhythms greater than 100 bpm originating from Ventricles
Type of SVT should be specified – Sinus tachy, junctional tachy, AVNRT, AVRT, A-fib/flutter w/ fast ventricular response, etc.

How well did you know this?

Not at all

Perfectly

Paroxysmal Supraventricular Tachycardia (PSVT)

Same thing as SVT; just sudden onset and offset (what paroxysmal means)

How well did you know this?

Not at all

Perfectly

AV-nodal Re-entrant Tachycardia (AVNRT)

Rhythm: Regular
Rate: Very fast (150 bpm or greater)
P waves: Lead II, III - Blip in ST segment; retrograde P wave
V1 – pseudo R-Wave, retrograde in QRS
RP Interval shorter

How well did you know this?

Not at all

Perfectly

Junctional Rhythms

Rhythm: Regular
Can be high, mid, and low
Rate: Below 40 bpm – Junctional Bradycardia
40-60 bpm – Junctional Escape rhythm/Junctional Rhythm
61-100 bpm – Accelerated Junctional Rhythm
Greater than 100 bpm- Junctional Tachycardia
P waves: Occur before, during or after QRS
QRS Duration: Normal, altered in mid-junctional rhythm

How well did you know this?

Not at all

Perfectly

Premature Junctional Contractions & Escape Beats

Rhythm: Junctional or Sinus Rhythms
No P-wave before QRS

How well did you know this?

Not at all

Perfectly

Ventricular Arrhythmias

Rhythm: Regular when monomorphic
Rate: below 20 bpm – Agonal Rhythm
20-40 bpm – Idioventricular Rhythm
41-100 bpm – Accelerated Idioventricular Rhythm
Greater than 101 bpm – Ventricular Tachycardia
P waves: Absent or retrograde
QRSD: wide, discordant, often notched
T Wave: Discordant to QRS
Axis: RAD/ERAD; but can be normal or even LAD
AV Dissociation

How well did you know this?

Not at all

Perfectly

Premature Ventricular Contractions (PVCs)

Study These Flashcards

Early w/ compensatory pause
P waves: Absent, if present, not associated with PVC
QRSD: 3 sm boxes or wider, discordant, often notched
T Wave: Discordant to QRS

Ventricular Tachycardia (VT)

Study These Flashcards

Rhythm: Regular
Rate: 100 bpm or greater
P waves: AV dissociation or retrograde
QRS: Notched, 3 sm boxes or wider
T Wave: Discordant to QRS
Axis: RAD or ERAD
Precordial concordance

Idioventricular Rhythm

Study These Flashcards

Rhythm: Regular
Rate: 30-40 bpm
P waves: Absent
QRSD: Wide, greater than 3 sm boxes

Accelerated Idioventricular Rhythm

Study These Flashcards

Rhythm: Regular
Rate: 50-100 bpm
P waves: Absent
QRSD: Wide, greater than 3 sm boxes

Ventricular Fibrillation

Study These Flashcards

Rhythm: Irregular
P waves: No
No normal wave forms, chaotic, variable shapes

Ventricular Flutter

Study These Flashcards

Saw-tooth
Rate: 200-300 bpm

Torsades de Pointes (Polymorphic VT)

Study These Flashcards

Twisting of Points
Rhythm: Irregular

Sinus Pause (Sinus Arrest)

Study These Flashcards

Sinus Pause – Less than 3 sec
Sinus Arrest – 3 sec or greater
P waves: No P Wave during pause
Length of pause irregular
Terminated by Escape beat – atrial, junction, ventricular

Sinus Pauses and Sinus Arrests DO NOT HAVE extra P-waves present during the pause.
AV blocks HAVE P-waves present during the pause.

Sinus Exit Block

Looks like Sinus Arrest R-R Interval: Direct multiple

1st Degree AV Block

PRI: Constant followed by QRS, longer than 0.20 sec

2nd Degree AV Block Type I (Mobitz I, Wenckebach)

PRI: Gradually prolonged until dropped P-wave (non-conducted)

2nd Degree AV Block Type II (Mobitz II)

P waves: Sudden, unexpected non-conducted P-Wave Drop of QRS complex

3rd Degree AV Block (Complete Heart Block)

AV Dissociation P waves: Constant but not “married” to QRS – firing separately on their own

Sick Sinus Syndrome

Rhythm: Irregular – Brady-Tachy Arrhythmia Transition occurs with a pause

2:1 AV Block

Rhythm: Regular P waves: Constant, 2 P-Waves fire before 1 QRS complex

Left Anterior Fascicular Block

Rate: Dependent on underlying rhythm P waves: Dependent on underlying rhythm Axis: Between -45 to -90 LAD QRS: Leads II, III, aVF – Small R-Waves, deep S-Waves

Left Posterior Fascicular Block

Rhythm: Dependent on underlying rhythm P waves: Dependent on underlying rhythm Axis: Greater than +90 RAD QRS: Lead I, aVL – small R-Waves Lead II, III, aVF – small Q-Waves

Right Bundle Branch Block (RBBB)

R-Wave: V1- Positive, Wider & Notched QRS Duration: V1 – greater than 3 sm boxes(0.12sec), discordant Lead I, aVL, V5, V6 – S-Wave Slurred, sometimes

Left Bundle Branch Block (LBBB)

Discordance in all leads Lead I, aVL, V5, V6 – R-Waves are Tall, broad, often notched V1 & V2 – Deep QS-Wave QRS\D: All Leads - Greater than 3 sm boxes (0.12 sec) – prolonged T-Waves: Discordant

Aberrant Beats

P waves: Abnormal P wave PRI: Often shorter or longer than the intrinsic QRSD: V1 – Greater than 3 sm boxes, Resembles IRBBB or RBBB morphology, discordant

SVT w/ Aberrancy

QRSD: Wide – greater than 3.5 sm boxes (0.14sec) RBBB morphology

Right Atrial Enlargement

P waves: Leads I, II, III – PEAKED, Tall Greater than 2.5 sm boxes V1 – Diphasic – Distal portion smaller than

Right Ventricular Hypertrophy (RVH)

V1, V2 – TALL R-Waves (R-wave is as large or larger than S-wave) V5, V6 – Deep S-Waves RAD

Left Atrial Enlargement (LAE)

P waves: Lead II – Wide, notched (M shaped) V1 – diphasic, proximal portion shallower than terminal portion

Left Ventricular Hypertrophy (LVH)

Deep S-Wave V2 – deepest S-Wave + V5 – Highest R-Wave = 35mm high or greater V1, V2 – ST elevation & Arc shaped smile

Accessory Pathway – Bundle of Kent

Delta Wave (slurred upstroke of R-Wave; or slurred downstroke of S-wave) PRI: Shortened QRSD: Wide

ECG Rhythm Criteria Flashcards

(42 cards)