All 4-Leads Flashcards
Rate: 60-100 bpm
Regularity: Regular
P Wave: Present
P:QRS Ratio: 1:1
PR Interval: Normal
QRS Width: Normal
Grouping: None
Dropped Beats: None
Normal Sinus Rhythm
Rate: 60-100 bpm
Regularity: Varies with respiration
P Wave: Normal
P:QRS Ratio: 1:1
PR Interval: Normal
QRS Width: Normal
Grouping: None
Dropped Beats: None
Sinus Arrhythmia
Rate: < 60 bpm
Regularity: Regular
P Wave: Present
P:QRS Ratio: 1:1
PR Interval: Normal to slightly prolonged
QRS Width: Normal to slightly prolonged
Grouping: None
Dropped Beats: None
Sinus Bradycardia
Rate: > 100 bpm
Regularity: Regular
P Wave: Present
P:QRS Ratio: 1:1
PR Interval: Normal to slightly shortened
QRS Width: Normal to slightly shortened
Grouping: None
Dropped Beats: None
Sinus Tachycardia
Rate: Varies
Regularity: Irregular
P Wave: Present except in areas of pause/arrest
P:QRS Ratio: 1:1
PR Interval: Normal
QRS Width: Normal
Grouping: None
Dropped Beats: Yes
Note: Pause is NOT in a multiple of R-R interval
Sinus Pause/Arrest
Rate: Varies
Regularity: Irregular
P Wave: Present except in areas of dropped beats
P:QRS Ratio: 1:1
PR Interval: Normal
QRS Width: Normal
Grouping: None
Dropped Beats: Yes
Notes: Pause is a multiple of R-R interval
Sinoatrial Block
Rate: Depends on the underlying rate
Regularity: Irregular
P Wave: Present in it, maybe a different shape
P:QRS Ratio: 1:1
PR Interval: Varies in it, otherwise normal
QRS Width: Normal
Grouping: Sometimes
Dropped Beats: No
Premature Atrial Contraction (PAC)
Rate: 100-180 bpm
Regularity: Regular
P Wave: Morphology of ectopic focus is different
P:QRS Ratio: 1:1
PR Interval: Ectopic focus has a different interval
QRS Width: Normal, but can be aberrant at times
Grouping: None
Dropped Beats: None
Ectopic Atrial Tachycardia
Rate: <100 bpm
Regularity: Irregularly irregular
P Wave: At least three different morphologies
P:QRS Ratio: 1:1
PR Interval: Variable depending on the focus
QRS Width: Normal
Grouping: None
Dropped Beats: None
Wandering Atrial Pacemaker (WAP)
Rate: 100 bpm or greater
Regularity: Irregularly irregular
P Wave: At least 3 different morphologies
P:QRS Ratio: 1:1
PR Interval: Variable
QRS Width: Normal
Grouping: None
Dropped Beats: None
Multifocal Atrial Tachycardia (MAT)
Rate: 250-350 bpm
Regularity: Usually regular, but may be variable
P Wave: Saw-toothed appearance, “F waves”
P:QRS Ratio: Variable, most commonly 2:1
PR Interval: Variable
QRS Width: Normal
Grouping: None
Dropped Beats: None
Atrial Flutter
Rate: Variable, ventricular response can be fast or slow
Regularity: Irregularly irregular
P Wave: None; chaotic atrial activity
P:QRS Ratio: None
PR Interval: None
QRS Width: Normal
Grouping: None
Dropped Beats: None
Atrial Fibrillation
Rate: Depends on underlying rhythm
Regularity: Irregular
P Wave: Variable (none, antegrade or retrograde)
P:QRS Ratio: None; or 1:1 if antegrade or retrograde
PR Interval: None, short or retrograde; if present does not represent atrial stimulation of the ventricles
QRS Width: Normal
Grouping: Usually none, but can occur
Dropped Beats: None
Premature Junctional Contraction (PJC)
Rate: Depends on underlying rhythm
Regularity: Irregular
P Wave: Variable (none, antegrade or retrograde)
P:QRS Ratio: None, or 1:1 if antegrade or retrograde
PR Interval: None, short, or retrograde; if present does not represent atrial stimulation of the ventricles
QRS Width: Normal
Grouping: None
Dropped Beats: Yes
Junctional Escape Beat
Rate: 40-60 bpm
Regularity: Regular
P Wave: Variable (none, antegrade, retrograde)
P:QRS Ratio: None, or 1:1 if antegrade or retrograde
PR Interval: None, short, or retrograde; if present does not represent atrial stimulation of the ventricles
QRS Width: Normal
Grouping: None
Dropped Beats: None
Junctional Rhythm
Rate: 60-100 bpm
Regularity: Regular
P Wave: Variable (none, antegrade, retrograde)
P:QRS Ratio: None, or 1:1 if antegrade or retrograde
PR Interval: None, short or retrograde; if present, does not represent atrial stimulation of the ventricles
QRS Width: Normal
Grouping: None
Dropped Beats: None
Accelerated Junctional Rhythm
Rate: Depends on the underlying rhythm
Regularity: Irregular
P Wave: Not present on it
P:QRS Ratio: No P waves on it
PR Interval: None
QRS Width: Wide (≥ 0.12 seconds), bizarre appearance
Grouping: Usually not present
Dropped Beats: None
Premature Ventricular Contraction (PVC)
Rate: Depends on the underlying rhythm
Regularity: Irregular
P Wave: None in the PVC
P:QRS Ratio: None in the PVC
PR Interval: None
QRS Width: Wide (≥0.12 seconds), bizarre appearance
Grouping: None
Dropped Beats: None
Ventricular Escape Beat
Rate: 20-40 bpm
Regularity: Regular
P Wave: None
P:QRS Ratio: None
PR Interval: None
QRS Width: Wide (≥0.12 seconds), bizarre appearance
Grouping: None
Dropped Beats: None
Idioventricular Rhythm
Rate: 40-100 bpm
Regularity: Regular
P Wave: None
P:QRS Ratio: None
PR Interval: None
QRS Width: Wide (≥ 0.12 seconds), bizarre appearance
Grouping: None
Dropped Beats: None
Accelerated Idioventricular Rhythm
Rate: 100-200 bpm
Regularity: Regular
P Wave: Dissociated atrial rate
P:QRS Ratio: Variable
PR Interval: None
QRS Width: Wide, bizarre
Grouping: None
Dropped Beats: None
Ventricular Tachycardia (VTach)
Rate: 200-250 bpm
Regularity: Irregular
P Wave: None
P:QRS Ratio: None
PR Interval: None
QRS Width: Variable
Grouping: Variable sinusoidal pattern
Dropped Beats: None
Torsade de Pointes (Polymorphic VTach)
Rate: 200-300 bpm
Regularity: Regular
P Wave: None
P:QRS Ratio: None
PR Interval: None
QRS Width: Wide, bizarre
Grouping: None
Dropped Beats: None
Ventricular Flutter
Rate: Indeterminate
Regularity: Chaotic rhythm
P Wave: None
P:QRS Ratio: None
PR Interval: None
QRS Width: None
Grouping: None
Dropped Beats: No beats at all
Ventricular Fibrillation (VFib)
Rate: Depends on underlying rhythm
Regularity: Regular
P Wave: Normal
P:QRS Ratio: 1:1
PR Interval: Prolonged (>0.20 seconds)
QRS Width: Normal
Grouping: None
Dropped Beats: None
First-Degree Heart Block
Rate: Depends on underlying rhythm
Regularity: Regularly irregular
P Wave: Present
P:QRS Ratio: Variable; 2:1, 3:2, 4:3, 5:4, etc
PR Interval: Variable
QRS Width: Normal
Grouping: Present and variable
Dropped Beats: Yes
Second-Degree Heart Block Type I
Rate: Depends on underlying rhythm
Regularity: Regularly irregular
P Wave: Normal
P:QRS Ratio: x:x-1 ; eg: 3:2, 4:3, 5:4, etc. The ratio can also be variable on rare occasions
PR Interval: Normal
QRS Width: Normal
Grouping: Present and variable
Dropped Beats: Yes
Second-Degree Heart Block Type II
Rate: Separate rates for the underlying (sinus) rhythm and the escape rhythm. They are dissociated from one another.
Regularity: Regular, but P rate and QRS rate are different.
P Wave: Present
P:QRS Ratio: Variable
PR Interval: Variable; no pattern
QRS Width: Normal or wide
Grouping: None
Dropped Beats: None
Third-Degree Heart Block