EKG RULES

Question 1

Normal Sinus Rhythm

Regularity, Rate, P-Wave, PRI, QRS

Answer 1

Regularity: Regular

Rate: 60-100

P Wave: Uniform shape, 1 P wave in front of every QRS

PRI: 0.12-0.20 seconds (3-5 small boxes)

QRS: Less than 0.12 seconds (3 small boxes)

Question 2

Sinus Brady

Regularity, Rate, P Wave, PRI, QRS

Answer 2

Regularity: Regular

Rate: Less than 60

P Wave: Uniform shape, 1 P wave in front of every QRS

PRI: 0.12-0.20 (3-5 small boxes)

QRS: Less than 0.12 (3 small boxes)

Question 3

Sinus Tach

Regularity, Rate, P Wave, PRI, QRS

Answer 3

Regularity: Regular

Rate: Greater than 100, usually less than 160

P Wave: Uniform, 1 P wave in front of every QRS

PRI: 0.12-0.20 Second (3-5 small boxes)

QRS: Less than 0.12 second (3 small boxes)

Question 4

Sinus Arrhythmia

Regularity, Rate, P Wave, PRI, QRS

Answer 4

Regularity: Irregular

Rate: 60-100

P Wave: Uniform, 1 P wave in front of every QRS

PRI: 0.12-0.20 second (3-5 small boxes)

QRS: Less than 0.12 second (3 small boxes)

Question 5

Wandering Atrial Pacemaker

Regularity, Rate, P Wave, PRI, QRS

Answer 5

Regularity: Slightly Irregular

Rate: 60-100

P Wave: Morphology changes from one complex to the next

PRI: Less than 0.20 seconds and may vary

QRS: Less than 0.12 seconds

Question 6

Premature Atrial Complex

Regularity, Rate, P Wave, PRI, QRS

Answer 6

Regularity: Will depend on the underlying rhythm. The regularity will be interrupted by the PAC.

Rate: Depends on the underlying rhythm.

P Wave: Can be flat, notched, peaked, or biphasic. Can be lost in the preceding T Wave.

PRI: Should be normal (0.12-0.20), but can be longer.

QRS: Normal- Less than 0.12.

Question 7

Atrial Tachycardia

Rhythm, Rate, P Wave, PRI, QRS

Answer 7

Rhythm: Regular

Rate: 150-250

P Wave: Atrial (Flattened or notched) and can be hidden in T wave

PRI: 0.12-0.20 second (3-5 small boxes) Can be hard to measure with hidden P wave.

QRS: Less than 0.12 seconds (3 small boxes)

Question 8

Atrial Flutter

Rhythm, Rate, P Wave, PRI, QRS

Answer 8

Rhythm: Atrial rhythm is regular. Ventricular is usually regular, but can be irregular if there is a variable block.

Rate: Atrial rate 250-350; Ventricular rate varies.

P Wave: Sawtooth pattern.

PRI: Unable to determine.

QRS: Less than 0.12 seconds (3 small boxes)

Question 9

Atrial Fibrillation

Rhythm, Rate, P Wave, PRI, QRS

Answer 9

Rhythm: Grossly irregular

Rate: Atrial rate more than 350bpm. Ventricular rate varies (<100=Controlled, >100=Uncontrolled)

P Wave: No discernible P waves

PRI: Unable to measure

QRS: Less than 0.12 seconds. (3 small boxes)

Question 10

All Junctional Rhythms

Answer 10

Inverted P Waves

P Wave can be before, during, or after QRS

Normal QRS duration

Shortened PRI (Less than 0.12 seconds)

Question 11

Premature Junctional Complex

Regularity, Rate, P Wave, PRI, QRS

Answer 11

Regularity: Depends on regularity of underlying arrhythmia.

Rate: Depends on rate of underlying arrhythmia.

P Wave: Will be inverted. Can be before, during, or after QRS.

PRI: Measured only if the P wave is before the QRS. If before, it will be less that 0.12 seconds. (3 small boxes)

QRS: Less than 0.12 seconds. (3 small boxes)

Question 12

Junctional Escape Rhythm

Regularity, Rate, P Wave, PRI, QRS

Answer 12

Regularity: Regular

Rate: 40-60

P Wave: Inverted; Can fall before, during, or after QRS.

PRI: Can only be measured if P wave is before QRS. Less than 0.12 seconds (3 small boxes)

QRS: Less than 0.12 seconds (3 small boxes)

Question 13

Accelerated Junctional (Irritable)

Rhythm, Rate, P Wave, PRI, QRS

Answer 13

Rhythm: Regular

Rate: 60-100

P wave: Inverted; Can be before, during, or after QRS

PRI: Only measured if P wave is before QRS; If so, less than 0.12 seconds (3 small boxes)

QRS: Less than 0.12 seconds (3 small boxes)

Question 14

Junctional Tachycardia (Irritable)

Rhythm, Rate, P Wave, PRI, QRS

Answer 14

Rhythm: Regular

Rate: 100-180

P Wave: Will be inverted. Can fall before, during, or after QRS.

PRI: Only measured if P wave falls before QRS; If so, PRI will be less than 0.12 seconds (3 small boxes)

QRS: Less than 0.12 seconds (3 small boxes)

Question 15

First Degree Block

Rhythm, Rate, P Wave, PRI, QRS

Answer 15

Rhythm: Depends on underlying rhythm

Rate: Depends on underlying rhythm

P Wave: Upright and uniform

PRI: More than 0.20 seconds (+5 small boxes), constant across the entire strip.

QRS: Less than 0.12 seconds (3 small boxes)

Question 16

2nd Degree Type 2

Rhythm, Rate, P Wave, PRI, QRS

Answer 16

Rhythm: R-R interval can be regular or irregular; P-P interval will be regular

Rate: Usually <60 (Brady)

P Wave: Upright, uniform. More Ps than QRSs

PRI: Constant across the strip, can be longer than 0.20 seconds (5 small boxes)

QRS: Less than 0.12 seconds

Question 17

2nd Degree Type 1

Rhythm, Rate, P Wave, PRI, QRS

Answer 17

Rhythm: Irregular in a pattern of grouped beats.

Rate: Slightly slower than normal

P Wave: Upright, uniform; More Ps than QRSs

PRI: Progressively lengthens until one P wave is blocked (No QRS)

QRS: Less than 0.12 seconds (3 small boxes)

Question 18

3rd Degree Block

Rhythm, Rate, P Wave, PRI, QRS

Answer 18

Rhythm: Regular

Rate: Atrial; Normal 60-100
Ventricular; 40-60 is focus is Junctional, 20-40 if ventricular

P Wave: Upright, uniform; More Ps than QRSs

PRI: No relationship between Ps and QRSs. P wave can be superimposed in QRSs.

QRS: Less than 0.12 if junctional. More than 0.12 if ventricular.

Question 19

PVCs

Rhythm, Rate, P Wave, PRI, QRS

Answer 19

Rhythm: Disrupts regularity of underlying rhythm

Rate: Depends on underlying rhythm and number of ectopics

P Wave: No P wave since the beat comes from a lower irritable site

PRI: No PRI since there is no P Wave

QRS: 0.12 seconds or longer (3+ small boxes)