This review demonstrates how to analyze an EKG strip to interpret a heart rhythm. Before reviewing this material, be sure to check out the lecture on how to analyze an ECG strip.
To do this, you can use a 6 second ECG strip. The strip should be made up of 30 large squares.
Anytime you analyze a rhythm you want to always ask yourself the following questions and based on the answer to those questions you can identify the rhythm.
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To help you with those questions remember: PQRST
First, is the P:
P-wave: think of the 3 R’s (Regularity, Rate, Resemblance)
Regularity: are the p-waves occurring at the same regularity as the consecutive p-waves on the strip (this represents ATRIAL)…use a pair calipers to help with this
Atrial rate should be regular to be a normal sinus rhythm and means it is originating in the SA node
Rate: Count the p-waves within that 6 second strip and multiple by 10…this is the atrial rate
ATRIAL RATE should be AROUND 60-100 BPM for normal sinus rhythm
Resemblance: How do they look?
Only one p-wave in front of every QRS complex? Are they all identical in how they are round and pointing up and less than 0.12 seconds…less than 3 squares?
Now the QRS:
QRS complex: 3 R’s (Regularity, Rate, Resemblance)
Regularity: are the QRS complexes occurring at the same regularity as the consecutive QRS complexes on the strip (this represents the VENTRICULAR rate)…use calipers to go from R wave to R wave.
Both the atrial and ventricular rhythm should be regular to be a normal sinus rhythm
Rate: Count QRS complex within that 6 second strip and multiply by 10…this is the ventricular rate
ATRIAL RATE AND VENTRICULAR RATE SHOULD BE THE SAME (AROUND 60-100 BPM) for normal sinus rhythm
Resemblance: How do they look?
A QRS complex is present after each p-wave, no more than 0.12 seconds (less than 3 boxes)..measure at the start of the q wave and end of the s wave
Next, the T-wave:
T-wave: should come after the QRS complex and be round and in the upright position in most leads
PQRST Extra: (intervals and segments)
PR interval: what is its measurement? starts at the beginning of the p wave and extends to the beginning of the QRS complex
0.12-0.20 seconds and the measurement should be uniform throughout the rhythm
ST segment: demonstrate the ventricles are starting to relax.
ST segment: starts at the end of the s-wave and stops at the start of the t-wave, should be flat, no elevation or depression of more than 1 mm
QT interval: starts at the beginning of the QRS complex and ends at the end of the t-wave. Should measure: 0.35-0.44 seconds.
Analyze this Rhythm:
Use the questions above to guide you in analyzing this rhythm:
P-wave:
- Regularity: regular
- Rate: 80 bpm
- Resemblance: yes (p wave measurement: 0.10 seconds)
QRS complex:
- Regularity: regular
- Rate: 80 bpm
- Resemblance: yes (QRS measurement: 0.10 seconds)
T-wave:
- Normal
Extras:
PR Interval: 0.14 seconds
ST segment: flat
QT interval: 0.36 seconds
This is Normal Sinus Rhythm with a rate of 80 bpm.
Now test your knowledge with this ECG Interpretation Quiz.