ECG Guru - Instructor Resources

A gathering place for instructors of ECG and cardiac topics.

       

Subscribe to me on YouTube

Rhythm strip

ECG Basics: High-grade AV Block

Wed, 11/22/2017 - 16:48 -- Dawn

This strip was obtained from a woman who presented to her doctor’s office with hypertension. While there is some artifact in the baseline, it is possible to determine the presence of P waves, thanks in part to having two leads to assess.  We have provided an unmarked version of the strip for you to use, and also a marked version for the sake of this discussion.

ECG Basics: Second-degree AV Block With Characteristics of Type I and Type II

Thu, 09/01/2016 - 11:51 -- Dawn

This strip shows a second-degree AV block.  During most of the strip, 2:1 conduction is present.  At the beginning, however, two consecutive p waves are conducted, revealing progressive prolongation of the PR interval.  This usually represents a Type I , or nodal, block:  progressive refractoriness of the AV node.   However, the wide QRS ( possibly left bundle branch block), and the fact that the non-conducted p waves are "out in the open" where they should have conducted, points to Type II - an intermi

ECG Basics: Sinus Bradycardia

Sat, 08/13/2016 - 23:56 -- Dawn

Sinus bradycardia.  This strip meets the criteria of:  regular rhythm, rate less than 60 bpm (40 bpm in this case), regular P waves before every QRS.  Sinus bradycardia can have many causes from a completely normal variation to a malfunction of the sinus node.  In some cases, enhanced parasympathetic tone causes sinus bradycardia.  Well-conditioned athletes typically have sinus bradycardia. Treatment depends upon the cause and the patient's response to the rate.  If the rate does not cause hemodynamic impairment, treatment may not be necessary.

ECG Basics: Sinus Tachycardia, Peaked T Waves, and Baseline Artifact

Sun, 03/13/2016 - 21:45 -- Dawn

This strip offers several good teaching opportunities.  If it were a 12-lead ECG, no doubt it would be a bonanza!  First, there is sinus tachycardia at a rate of about 138 per minute.  The P waves are all alike and regular.  The T waves are tall and narrow, with a sharp peak.  This is often a transient sign of hyperkalemia, and should be investigated with serum electrolyte tests and with a 12-lead ECG.  In addition, the baseline shows a wandering type of artifact.

ECG Basics: Atrial Fibrillation With A Rapid Ventricular Response

Fri, 12/18/2015 - 23:11 -- Dawn

This ECG rhythm strip has all the hallmarks of atrial fibrillation:  the rhythm is irregularly irregular and there are no P waves.  The rate is about 150 beats per minute. There is no P wave because the atria are being irregularly depolarized by many ectopic pacemakers at once, causing the atria to "quiver".  This patient has new-onset atrial fib, and has been medicated with a calcium channel blocker.  The rate shows signs of slowing, but has not reached the target rate for this patient of less than 80 bpm.

ECG Basics: Atrial Flutter With 2:1 Conduction And An Aberrantly-conducted Beat

Sun, 08/23/2015 - 12:20 -- Dawn

This strip was taken from a patient at rest.  It shows a regular tachycardia with a slightly-widened QRS complex at about .10 seconds duration.  It is somewhat difficult to evaluate the baseline for P waves or flutter waves.  We ALWAYS recommend multi-lead assessment for such evaluation.  The P waves (or flutter waves) here have a sharp point, and can be easily "marched out", with a rate of about 300 per minute.

ECG Basics: Atrial Fibrillation With a Rapid Ventricular Response

Sun, 07/26/2015 - 13:54 -- Dawn

This rhythm strip is recorded in two simultaneous leads, which is always preferable to one single lead.  It is a good example of atrial fibrillation with a rapid ventricular response.  Atrial fib that has not been treated will usually have a rapid ventricular rate.  This reflects the ability of the AV node to conduct a tachycardia, within limits.  The natural slow conduction of the AV node allows it to act as a "filter", preventing the huge numbers of impulses generated by the atrial fibrillation from reaching the ventricles.

ECG Basics: Sinus Tachycardia

Wed, 06/10/2015 - 20:53 -- Dawn

This is a good teaching strip on many levels.  At the BASIC level, we see a strip that clearly meets all the criteria for sinus tachycardia:  a regular rhythm over 100/min. with P waves that look normal and all look alike.  The rate is 110 per minute.  The PR interval is just at the upper limits of normal at .20 second, or 200 ms.  The QRS complex is within normal limits, but slightly wide at .10 seconds.

All our content is FREE & COPYRIGHT FREE for non-commercial use

Please be courteous and leave any watermark or author attribution on content you reproduce.

Subscribe to RSS - Rhythm strip