ECG Workout Flashcards

Atrial arrhythmias

2012 Lippincott Williams & Wilkins. All rights reserved.

Wandering atrial pacemaker

Identifying ECG features
Rhythm: Regular or irregular
Rate: Normal (60 to 100 beats/minute) or slow (less than 60 beats/minute)
P waves: Vary in size, shape, direction across rhythm strip; one P wave precedes each
QRS complex
PR interval: Usually normal duration, but may be abnormal depending on changing
pacemaker locations
QRS complex: Normal (0.10 second or less)

Wandering atrial pacemaker

Identifying ECG features
Rhythm: Regular or irregular
Rate: Normal (60 to 100 beats/minute) or slow (less than 60 beats/minute)
P waves: Vary in size, shape, direction across rhythm strip; one P wave precedes each
QRS complex
PR interval: Usually normal duration, but may be abnormal depending on changing
pacemaker locations
QRS complex: Normal (0.10 second or less)

Normal sinus rhythm with two PACs

Identifying ECG features
Rhythm: Underlying rhythm usually regular; irregular with premature beat
Rate: That of underlying rhythm
P waves: P wave associated with PAC is premature, abnormal (commonly appears small,
upright, and pointed, but may be inverted or a squiggle); abnormal P wave is often found
hidden in preceding T wave, distorting T-wave contour
PR interval: Usually normal but may be abnormal
QRS complex: Premature, normal duration QRS (0.10 second or less); followed by a
pause

Sinus bradycardia with one PAC (abnormal P wave associated with

PAC is hidden in preceding T wave, distorting T-wave contour)
Identifying ECG features
Rhythm: Underlying rhythm usually regular; irregular with premature beat
Rate: That of underlying rhythm
P waves: P wave associated with PAC is premature, abnormal (commonly appears small,
upright, and pointed, but may be inverted or a squiggle); abnormal P wave is often found
hidden in preceding T wave, distorting T-wave contour
PR interval: Usually normal, but may be abnormal
QRS complex: Premature, normal duration QRS (0.10 second or less); followed by a
pause
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Sinus tachycardia with two nonconducted PACs

Identifying ECG features
Rhythm: Underlying rhythm usually regular; irregular with nonconducted PACs
Rate: That of underlying rhythm
P waves: Premature and abnormal; often found hidden in preceding T wave, distorting
T-wave contour; a pause follows the nonconducted P wave
PR interval: Absent with nonconducted PAC
QRS complex: Absent with nonconducted PAC

Normal sinus rhythm with one nonconducted PAC (abnormal P wave

associated with PAC is hidden in preceding T wave, distorting T-wave
contour)
Identifying ECG features
Rhythm: Underlying rhythm usually regular; irregular with nonconducted PACs
Rate: That of underlying rhythm
P waves: Premature and abnormal; often found hidden in preceding T wave, distorting
T-wave contour; a pause follows the nonconducted P wave
PR interval: Absent with nonconducted PAC
QRS complex: Absent with nonconducted PAC

Paroxysmal atrial tachycardia

Identifying ECG features
Rhythm: Regular
Rate: 140 to 250 beats/minute
P waves: Abnormal (commonly pointed); usually hidden in preceding T wave so that
T wave and P wave appear as one wave defection (T-P wave); one P wave to each QRS
unless AV block is present
PR interval: Usually not measurable
QRS complex: Normal (0.10 second or less)

Paroxysmal atrial tachycardia

Identifying ECG features
Rhythm: Regular
Rate: 140 to 250 beats/minute
P waves: Abnormal (commonly pointed); usually hidden in preceding T wave so that T
wave and P wave appear as one wave defection (T-P wave); one P wave to each QRS
unless AV block is present
PR interval: Usually not measurable
QRS complex: Normal (0.10 second or less)

Atrial flutter with variable AV conduction

Identifying ECG features
Rhythm: Regular or irregular (depends on AV conduction ratios)
Rate:
Atrial: 250 to 400 beats/minute
Ventricular: Varies with number of impulses conducted through AV node; will be less
than that of the atrial rate
P waves: Sawtooth-wave deflections affecting the entire baseline
PR interval: Not measurable
QRS complex: Normal (0.10 second or less)

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Atrial flutter with 4:1 AV conduction

Identifying ECG features
Rhythm: Regular or irregular (depends on AV conduction ratios)
Rate:
Atrial: 250 to 400 beats/minute
Ventricular: Varies with number of impulses conducted through AV node; will be less
than that of the atrial rate
P waves: Sawtooth-wave deflections affecting the entire baseline
PR interval: Not measurable
QRS complex: Normal (0.10 second or less)

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Atrial flutter with 2:1 AV conduction

Identifying ECG features
Rhythm: Regular or irregular (depends on AV conduction ratios)
Rate:
Atrial: 250 to 400 beats/minute
Ventricular: Varies with number of impulses conducted through AV node; will be less
than that of the atrial rate
P waves: Sawtooth-wave deflections affecting the entire baseline
PR interval: Not measurable
QRS complex: Normal (0.10 second or less)

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Atrial fibrillation (with uncontrolled ventricular rate)

Identifying ECG features
Rhythm: Grossly irregular (unless ventricular rate is rapid, in which case the rhythm
becomes more regular)
Rate:
Atrial: 400 beats/minute or more; not measurable due to wavy baseline
Ventricular: Varies with number of impulses conducted through AV node to ventricles;
ventricular rate is controlled if rate is less than 100 beats/minute; ventricular rate is
uncontrolled if rate is greater than 100 beats/minute
P waves: Wavy deflections that affect the entire baseline
PR interval: Not measurable
QRS complex: Normal (0.10 second or less)
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Atrial fibrillation (with controlled ventricular rate)

Identifying ECG features
Rhythm: Grossly irregular (unless ventricular rate is rapid, in which case the rhythm
becomes more regular)
Rate:
Atrial: 400 beats/minute or more; not measurable due to wavy baseline
Ventricular: Varies with number of impulses conducted through AV node to ventricles;
ventricular rate is controlled if rate is less than 100 beats/minute; ventricular rate is
uncontrolled if rate is greater than 100 beats/minute
P waves: Wavy deflections that affect the entire baseline
PR interval: Not measurable
QRS complex: Normal (0.10 second or less)
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