Rhythm Criteria

Question 1

Normal Sinus Rhythm (NSR, SR)
Rhythm
Rate
P-waves
PRI
QRS

Answer 1

Rhythm: Atrial regular; Ventricular regular
Rate: A/V 60-100 BPM
P waves: Normal; each followed by QRS
PRI: 0.12 - 0.20
QRS: 0.06- 0.10

Question 2

Sinus Bradycardia (SB)

Answer 2

Rhythm: Atrial regular; Ventricular regular
Rate: A/V 40-60 BPM
P waves: Normal; each followed by QRS
PRI: 0.12 - 0.20
QRS: 0.04 - 0.10

Question 3

Sinus Tachycardia (ST)
Rhythm
Rate
P-Wave
PRI
QRS

Answer 3

Rhythm: Atrial regular; Ventricular regular
Rate: A/V 100-150 BPM
P waves: Normal; each followed by QRS
PRI: 0.12 - 0.20
QRS: 0.04 - 0.10

Question 4

Sinus Arrhythmia
Rhythm
Rate
P-wave
PRI
QRS

Answer 4

Rhythm: Atrial irregular; Ventricular irregular (d/t varying rate)
Rate: 60-100 BPM (varies with respiration)
P waves: Normal; each followed by QRS
PRI: 0.12 - 0.20
QRS: 0.04 - 0.10

Question 5

Sinus Pause or Arrest

Answer 5

Rhythm: SR,SB, or ST except for missed beat/pause
Rate: depends on the underlying sinus rhythm (40-150 BPM)
P waves: normal; each followed by QRS
PRI: 0.12 - 0.20
QRS: 0.04 - 0.10

Question 6

Premature Atrial Complex (PAC)

Answer 6

Rhythm: need to identify underlying rhythm
Rate: depends on the underlying rhythm
P waves: EARLY P wave; may look different than other P’s
PRI: 0.12 - 0.20
QRS: 0.04 - 0.10

Question 7

Types of Premature Atrial Complex (PAC)

Answer 7

• Aberrantly Conducted PAC: Early P-wave with a wide QRS (> 0.10 secs)
• Nonconductive or Blocked PAC: Early P-wave w/ no following QRS (No conduction thru ventricles)

Question 8

Narrow Complex Supraventricular Tachycardia
[NCSVT]
Rhythm
Rate
P-Wav
PRI
QRS

Answer 8

Rhythm: Ventricular regular
Rate: Ventricular > 150 BPM
P waves: usually lost in the T-waves
PRI: n/a
QRS: 0.04 - 0.10

Question 9

Atrial Flutter

Answer 9

Rhythm: Atrial regular; Ventricular regular or irregular
Rate: Atrial: 250-350 BPM
Ventricular: controlled < 100 / uncontrolled > 100 BPM
P waves: replaced with saw toothed flutter waves
PRI: n/a
QRS: 0.04 - 0.10

Question 10

Atrial Fibrillation

Answer 10

Rhythm: Ventricular irregular
Rate: Atrial: > 300 BPM or unmeasurable
Ventricular: controlled < 100 / uncontrolled > 100 BPM
P waves: none
PRI: n/a
QRS: 0.04 - 0.10

Question 11

Junctional Rhythms:
- regularity
- rate
- p-waves
- PRI
- QRS

Answer 11

Rhythm: Ventricular regular
Rate: Ventricular 40-60 BPM
P waves: absent, inverted, retrograde, b4 or after QRS
PRI: < 0.12 secs
QRS: 0.04 - 0.10

Question 12

Accelerated Junctional Rhythm
Rhythm
Rate
P-Wave
PRI
QRS

Answer 12

Rhythm: Ventricular regular
Rate: Ventricular 60-100 BPM
P waves: absent, inverted, upright, retrograde, b4 or after QRS
PRI: < 0.12 secs
QRS: 0.04 - 0.10

Question 13

Junctional Tachycardia
Rhythm
Rate
P-Wave
PRI
QRS

Answer 13

Rhythm: Ventricular regular
Rate: Ventricular 100-150 BPM
P waves: absent, inverted, upright, retrograde, b4 or after QRS
PRI: < 0.12 secs
QRS: 0.04 - 0.10

Question 14

Premature Junctional complex (PJC)

Answer 14

Rhythm: need to identify the underlying rhythm
Rate: depends on the underlying rhythm
P waves: absent, inverted, upright, retrograde, b4 or after QRS
PRI: < 0.12 secs
QRS: 0.04 - 0.10

Question 15

Premature Ventricular Complex (PVC)

Answer 15

Rhythm: identify the underlying rhythm (usually NSR)
Rate: depends on the underlying rhythm
P waves: ABSENT
PRI: n/a
QRS: > 0.12 secs; wide and bizarre
T-wave: opposite of QRS

Question 16

Idioventricular Rhythm (IVR)
Rhythm
Rate
P-Wave
PRI
QRS

Answer 16

Rhythm: Atrial unrelated to Ventricular which is regular
Rate: Ventricular 20-40 BPM
P-waves: absent
PRI: n/a
QRS: ≥ 0.12 secs; wide and bizarre

Question 17

Accelerated Idioventricular Rhythm (AIVR

Answer 17

Rhythm: Ventricular regular
Rate: Ventricular 40-100 BPM
PRI: n/a
QRS: ≥ 0.12 secs; wide and bizarre

Question 18

Ventricular Fibrillation (VF, V-Fib)

Answer 18

Rhythm: Atrial n/a; Ventricular n/a
Rate: Atrial n/a; Ventricular n/a
PRI: n/a
QRS: n/a

Question 19

Asystole

Answer 19

There is no electrical pacemaker to initiate electrical flow
All electrical activity lost.
Atrial and Ventricular rate, rhythm, PRI & QRS: N/A

Question 20

Pulseless Electrical Activity (PEA):
Rhythm
Rate
P-Wave
PRI
QRS

Answer 20

Rhythm: need to identify the underlying rhythm
Rate: depends on the underlying rhythm
P waves: Normal
PRI: 0.12 – 0.20 secs
QRS: ≥ 0.12 secs

Question 21

Bundle Branch Block (BBB):
Rhythm
Rate
P Waves
PRI
QRS

Answer 21

Rhythm: need to identify the underlying rhythm
Rate: depends on the underlying rhythm
P waves: Normal
PRI: 0.12 – 0.20 secs
QRS: ≥ 0.12 secs

Question 22

1st degree AV Heart Block

Answer 22

Rhythm: Atrial regular; Ventricular regular
Rate: A/V same; 60-100 BPM
P-wave: normal
PRI: Prolonged > 0.20, but constant
QRS: 0.04 – 0.10 secs

Question 23

2nd degree AV Heart Block Type I (Wenckebach):
Rhythm
Rate
P-Wave
PRI
QRS

Answer 23

Rhythm: Atrial regular; Ventricular irregular
Rate: Atrial > Ventricular
P-wave: normal, not always followed by QRS
PRI: lengthens until QRS is dropped
QRS: 0.04 – 0.10 secs, may be dropped

Question 24

2nd degree AV Heart Block Type II (Mobitz II)

Answer 24

Rhythm: Atrial regular; Ventricular irregular
Rate: A > V
V: 20-40 (BB level); 40-60 (AV node level)
P-wave: normal, not always followed by QRS
PRI: > 0.20 secs and CONSTANT (Key Identifier)
QRS: 0.04 – 0.10 (AV level); >0.10 (BB level)

Question 25

3rd degree or Complete AV Heart Block

Answer 25

Rhythm: Atrial regular; Ventricular regular
Rate: A > V
P-wave: normal, can be hidden in QRS
PRI: n/a; atria and ventricles are working independently)
QRS: 0.04 – 0.10 secs, may be dropped

Question 26

BBB where the last 0.04 of the QRS is a positive deflection?

Answer 26

Right BBB

Question 27

BBB where the last 0.04 of the QRS is a negative deflection?

Answer 27

Left BBB