copyright © 2006 by mosby inc. all rights reserved. chapter 4 practice rhythms strips
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Copyright © 2006 by Mosby Inc. All rights reserved.
Chapter 4Chapter 4
Practice Rhythms StripsPractice Rhythms Strips
Copyright © 2006 by Mosby Inc. All rights reserved.
Figure 4-23Figure 4-23 This rhythm strip is from at 35-year-old woman This rhythm strip is from at 35-year-old woman
complaining of chest pain and palpitations. complaining of chest pain and palpitations.
Ventricular rate/rhythmVentricular rate/rhythm
Atrial rate/rhythmAtrial rate/rhythm
PR intervalPR interval
QRS durationQRS duration
IdentificationIdentification
Copyright © 2006 by Mosby Inc. All rights reserved.
Figure 4-23Figure 4-23 This rhythm strip is from at 35-year-old woman This rhythm strip is from at 35-year-old woman
complaining of chest pain and palpitations. complaining of chest pain and palpitations.
Ventricular rate/rhythmVentricular rate/rhythm 188/min, regular188/min, regular
Atrial rate/rhythmAtrial rate/rhythm Unable to determineUnable to determine
PR intervalPR interval Unable to determine Unable to determine
QRS durationQRS duration 0.06 sec0.06 sec
IdentificationIdentification Narrow-QRS tachycardia (AVNRT) Narrow-QRS tachycardia (AVNRT) with ST-segment depressionwith ST-segment depression
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Figure 4-24Figure 4-24
Ventricular Ventricular rate/rhythmrate/rhythm
Atrial rate/rhythmAtrial rate/rhythm
PR intervalPR interval
QRS durationQRS duration
IdentificationIdentification
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Figure 4-24Figure 4-24
Ventricular rate/rhythmVentricular rate/rhythm 83 (sinus beats) / regular except for events83 (sinus beats) / regular except for events
Atrial rate/rhythmAtrial rate/rhythm 83 (sinus beats) / regular except for events83 (sinus beats) / regular except for events
PR intervalPR interval 0.16 sec 0.16 sec
QRS durationQRS duration 0.04-0.08 sec 0.04-0.08 sec
IdentificationIdentification Sinus rhythm at 83 bpm with frequent PACs Sinus rhythm at 83 bpm with frequent PACs (atrial bigeminy), ST-segment depression, (atrial bigeminy), ST-segment depression, inverted T wavesinverted T waves
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Figure 4-25Figure 4-25
Ventricular Ventricular rate/rhythmrate/rhythm
Atrial rate/rhythmAtrial rate/rhythm
PR intervalPR interval
QRS durationQRS duration
IdentificationIdentification
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Figure 4-25Figure 4-25
Ventricular rate/rhythmVentricular rate/rhythm 98 bpm/ regular 98 bpm/ regular
Atrial rate/rhythmAtrial rate/rhythm 98 bpm/ regular 98 bpm/ regular
PR intervalPR interval 0.16 sec0.16 sec
QRS durationQRS duration 0.04-0.06 sec0.04-0.06 sec
IdentificationIdentification Sinus rhythm at 98 bpm; Sinus rhythm at 98 bpm;
ST-segment elevation ST-segment elevation
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Figure 4-26Figure 4-26
Ventricular Ventricular rate/rhythmrate/rhythm
Atrial rate/rhythmAtrial rate/rhythm
PR intervalPR interval
QRS durationQRS duration
IdentificationIdentification
This rhythm strip is from a 96-year-old man complaining of chest pain and palpitations. Medications include Lanoxin and Coumadin.
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Figure 4-26Figure 4-26
Ventricular rate/rhythmVentricular rate/rhythm 88-130/min / irregular88-130/min / irregular
Atrial rate/rhythmAtrial rate/rhythm Unable to determine Unable to determine
PR intervalPR interval Unable to determine Unable to determine
QRS durationQRS duration 0.08 second0.08 second
IdentificationIdentification Atrial fibrillation at 88-130 bpm Atrial fibrillation at 88-130 bpm
This rhythm strip is from a 96-year-old man complaining of chest pain and palpitations. Medications include Lanoxin and Coumadin.
Copyright © 2006 by Mosby Inc. All rights reserved.
Figure 4-27Figure 4-27
Ventricular Ventricular rate/rhythmrate/rhythm
Atrial rate/rhythmAtrial rate/rhythm
PR intervalPR interval
QRS durationQRS duration
IdentificationIdentification
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Figure 4-27Figure 4-27
Ventricular Ventricular rate/rhythmrate/rhythm
93/min / regular except for the event 93/min / regular except for the event
Atrial rate/rhythmAtrial rate/rhythm 93/min / regular except for the event 93/min / regular except for the event
PR intervalPR interval 0.16 sec 0.16 sec
QRS durationQRS duration 0.04 sec0.04 sec
IdentificationIdentification Sinus rhythm at 93 bpm with a PACSinus rhythm at 93 bpm with a PAC
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Figure 4-28Figure 4-28
Ventricular Ventricular rate/rhythmrate/rhythm
Atrial rate/rhythmAtrial rate/rhythm
PR intervalPR interval
QRS durationQRS duration
IdentificationIdentification
This rhythm strip is from a 57-year-old man with no cardiac history.
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Figure 4-28Figure 4-28
Ventricular rate/rhythmVentricular rate/rhythm 111 bpm / regular except for event111 bpm / regular except for event
Atrial rate/rhythmAtrial rate/rhythm 111 bpm / regular except for event111 bpm / regular except for event
PR intervalPR interval 0.18 second0.18 second
QRS durationQRS duration 0.08 sec0.08 sec
IdentificationIdentification Sinus tachycardia at 111 bpm with Sinus tachycardia at 111 bpm with a nonconducted PACa nonconducted PAC
This rhythm strip is from a 57-year-old man with no cardiac history.
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Figure 4-29Figure 4-29
Ventricular Ventricular rate/rhythmrate/rhythm
Atrial rate/rhythmAtrial rate/rhythm
PR intervalPR interval
QRS durationQRS duration
IdentificationIdentification
This rhythm strip is from a 74-year-old woman with difficulty breathing.
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Figure 4-29Figure 4-29
Ventricular rate/rhythmVentricular rate/rhythm 75-107/min / irregular75-107/min / irregular
Atrial rate/rhythmAtrial rate/rhythm Unable to determineUnable to determine
PR intervalPR interval Unable to determineUnable to determine
QRS durationQRS duration 0.08 sec0.08 sec
IdentificationIdentification Atrial flutter at 75-107/minAtrial flutter at 75-107/min
This rhythm strip is from a 74-year-old woman with difficulty breathing.
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Figure 4-30Figure 4-30
Ventricular rate/rhythmVentricular rate/rhythm
Atrial rate/rhythmAtrial rate/rhythm
PR intervalPR interval
QRS durationQRS duration
IdentificationIdentification
This rhythm strip is from a 71-year-old man complaining of shoulder pain that has been present for 3 weeks.
Copyright © 2006 by Mosby Inc. All rights reserved.
Figure 4-30Figure 4-30
Ventricular rate/rhythmVentricular rate/rhythm 115/min / regular except for events115/min / regular except for events
Atrial rate/rhythmAtrial rate/rhythm 115/min / regular except for events115/min / regular except for events
PR intervalPR interval 0.12 second (sinus beats)0.12 second (sinus beats)
QRS durationQRS duration 0.08 second (sinus beats)0.08 second (sinus beats)
IdentificationIdentification Sinus tachycardia at 115/min with Sinus tachycardia at 115/min with PACs and ST-segment elevationPACs and ST-segment elevation
This rhythm strip is from a 71-year-old man complaining of shoulder pain that has been present for 3 weeks.
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Figure 4-31Figure 4-31
Ventricular Ventricular rate/rhythmrate/rhythm
Atrial rate/rhythmAtrial rate/rhythm
PR intervalPR interval
QRS durationQRS duration
IdentificationIdentification
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Figure 4-31Figure 4-31
Ventricular Ventricular rate/rhythmrate/rhythm
180/min / regular180/min / regular
Atrial rate/rhythmAtrial rate/rhythm Unable to determineUnable to determine
PR intervalPR interval Unable to determineUnable to determine
QRS durationQRS duration 0.04 sec0.04 sec
IdentificationIdentification AVNRT at 180 bpm, ST-segment AVNRT at 180 bpm, ST-segment elevationelevation
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Figure 4-32Figure 4-32
Ventricular Ventricular rate/rhythmrate/rhythm
Atrial rate/rhythmAtrial rate/rhythm
PR intervalPR interval
QRS durationQRS duration
IdentificationIdentification
This rhythm strip is from an 82-year-old man complaining of back pain.
Lead II
Lead MCL1
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Figure 4-32Figure 4-32
Ventricular Ventricular rate/rhythmrate/rhythm
75/min / regular except for event 75/min / regular except for event
Atrial rate/rhythmAtrial rate/rhythm 75/min / regular except for event 75/min / regular except for event
PR intervalPR interval 0.20 sec0.20 sec
QRS durationQRS duration 0.12 sec0.12 sec
IdentificationIdentification Sinus rhythm at 75 bpm with a wide Sinus rhythm at 75 bpm with a wide QRS and a nonconducted PACQRS and a nonconducted PAC
This rhythm strip is from an 82-year-old man complaining of back pain.
Lead II
Lead MCL1
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Figure 4-33Figure 4-33
Ventricular Ventricular rate/rhythmrate/rhythm
Atrial rate/rhythmAtrial rate/rhythm
PR intervalPR interval
QRS durationQRS duration
IdentificationIdentification
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Figure 4-33Figure 4-33
Ventricular Ventricular rate/rhythmrate/rhythm
88/min / regular88/min / regular
Atrial rate/rhythmAtrial rate/rhythm Unable to determine Unable to determine
PR intervalPR interval Unable to determine Unable to determine
QRS durationQRS duration 0.06 sec0.06 sec
IdentificationIdentification Atrial flutter at 88 bpm Atrial flutter at 88 bpm
with ST-segment depressionwith ST-segment depression
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Figure 4-34Figure 4-34
Ventricular Ventricular rate/rhythmrate/rhythm
Atrial rate/rhythmAtrial rate/rhythm
PR intervalPR interval
QRS durationQRS duration
IdentificationIdentification
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Figure 4-34Figure 4-34
Ventricular Ventricular rate/rhythmrate/rhythm
70/min / regular 70/min / regular
Atrial rate/rhythmAtrial rate/rhythm 70/min (sinus beats) / Unable to determine70/min (sinus beats) / Unable to determine
PR intervalPR interval Varies Varies
QRS durationQRS duration VariesVaries
IdentificationIdentification Underlying rhythm is sinus but pacemaker site varies; ventricular rate approx 70 bpm;
patient with known WPW; note delta waves
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Figure 4-35Figure 4-35
Ventricular Ventricular rate/rhythmrate/rhythm
Atrial rate/rhythmAtrial rate/rhythm
PR intervalPR interval
QRS durationQRS duration
IdentificationIdentification
These rhythm strips are from a 78-year-old man complaining of shortness of breath. He has a history of COPD, coronary artery disease, and hypertension.
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Figure 4-35Figure 4-35
Ventricular rate/rhythmVentricular rate/rhythm 55-94/min / irregular55-94/min / irregular
Atrial rate/rhythmAtrial rate/rhythm Unable to determine Unable to determine
PR intervalPR interval Unable to determine Unable to determine
QRS durationQRS duration 0.10 sec0.10 sec
IdentificationIdentification Controlled atrial fibrillation at 55-94 bpm Controlled atrial fibrillation at 55-94 bpm
These rhythm strips are from a 78-year-old man complaining of shortness of breath. He has a history of COPD, coronary artery disease, and hypertension.
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Figure 4-36Figure 4-36
Ventricular rate/rhythmVentricular rate/rhythm
Atrial rate/rhythmAtrial rate/rhythm
PR intervalPR interval
QRS durationQRS duration
IdentificationIdentification
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Figure 4-36Figure 4-36
Ventricular rate/rhythmVentricular rate/rhythm 29/min / regular29/min / regular
Atrial rate/rhythmAtrial rate/rhythm Unable to determineUnable to determine
PR intervalPR interval Unable to determineUnable to determine
QRS durationQRS duration 0.10 sec0.10 sec
IdentificationIdentification Controlled atrial fibrillation at 29/minControlled atrial fibrillation at 29/min
Note: This patient was diagnosed with Note: This patient was diagnosed with digitalis toxicity.digitalis toxicity.
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Figure 4-37Figure 4-37
Ventricular Ventricular rate/rhythmrate/rhythm
Atrial rate/rhythmAtrial rate/rhythm
PR intervalPR interval
QRS durationQRS duration
IdentificationIdentification
This rhythm strip is from a 67-year-old woman complaining of dizziness and a “funny feeling” in her chest. She denies chest pain and is not short of breath.
Copyright © 2006 by Mosby Inc. All rights reserved.
Figure 4-37Figure 4-37
Ventricular Ventricular rate/rhythmrate/rhythm
186/min / regular186/min / regular
Atrial rate/rhythmAtrial rate/rhythm Unable to determineUnable to determine
PR intervalPR interval Unable to determineUnable to determine
QRS durationQRS duration 0.06 sec0.06 sec
IdentificationIdentification AVNRT at 186 bpm with AVNRT at 186 bpm with
ST-segment depression ST-segment depression
This rhythm strip is from a 67-year-old woman complaining of dizziness and a “funny feeling” in her chest. She denies chest pain and is not short of breath.
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Figure 4-38Figure 4-38
Ventricular Ventricular rate/rhythmrate/rhythm
Atrial rate/rhythmAtrial rate/rhythm
PR intervalPR interval
QRS durationQRS duration
IdentificationIdentification
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Figure 4-38Figure 4-38
Ventricular rate/rhythmVentricular rate/rhythm 170/min / regular170/min / regular
Atrial rate/rhythmAtrial rate/rhythm 170/min / regular170/min / regular
PR intervalPR interval 0.08 sec0.08 sec
QRS durationQRS duration 0.06 sec0.06 sec
IdentificationIdentification Atrial tachycardia at 170 bpmAtrial tachycardia at 170 bpm
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Figure 4-39Figure 4-39
Ventricular Ventricular rate/rhythmrate/rhythm
Atrial rate/rhythmAtrial rate/rhythm
PR intervalPR interval
QRS durationQRS duration
IdentificationIdentification
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Figure 4-39Figure 4-39
Ventricular Ventricular rate/rhythmrate/rhythm
78/min / regular except for the event 78/min / regular except for the event
Atrial rate/rhythmAtrial rate/rhythm 78/min / regular except for the event 78/min / regular except for the event
PR intervalPR interval 0.16 sec0.16 sec
QRS durationQRS duration 0.06 sec0.06 sec
IdentificationIdentification Sinus rhythm at 78 bpm with a PACSinus rhythm at 78 bpm with a PAC
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