EKG Pictures

Multifocal Atrial Tachycardia (MAT)

Rate: > 100 BPM Regularity: Irregularly irregular P wave: At least three different morphologies P:QRS ratio: 1:1 PR interval: Variable QRS width: Normal Grouping: None Dropped beats: None

Sinus Tachycardia

Rate: > 100 BPM Regularity: Regular P wave: Present P:QRS ratio: 1:1 PR interval: Normal to slightly short QRS width: Normal to slightly short Grouping: None Dropped beats: None

Atrial Flutter

Rate: Atrial commonly 250-350 BPM, ventricular commonly 125-175 BPM Regularity: Usually regular P wave: Saw toothed, "F waves" P:QRS ratio: Variable,  most commonly 2:1 PR interval: Variable QRS width: Normal Grouping: None Dropped beats: None

Premature Atrial Contraction (PAC)

Rate: Depends on underlying rate Regularity: Irregular P wave: Present; in the  PAC, may be different  shape P:QRS ratio: 1:1 PR interval: Varies in the PAC QRS width: Normal Grouping: Sometimes Dropped beats: None

Ventricular Escape Beat

Rate: Depends on underlying rhythm Regularity: Irregular P wave: None in PVC P:QRS ratio: None in  PVC PR interval: None QRS width: Wide (≥ 0.12 second), bizarre appearance Grouping: None Dropped beats: None

Premature Ventricular Contraction (PVC).png

Rate: Depends on underlying rhythm Regularity: Irregular P wave: Not present on  PVC P:QRS ratio: No P waves  on PVC PR interval: None QRS width: Wide (≥ 0.12 second), bizarre appearance Grouping: Usually not present Dropped beats: None

Junctional Escape Beat

Rate: Depends on underlying rhythm Regularity: Irregular P wave: Variable (none, antegrade, or retrograde) P:QRS ratio: None; or 1:1 if antegrade or retrograde PR interval: None, short, or retrograde QRS width: Normal Grouping: None Dropped beats: Yes

Premature Junctional Contraction (PJC)

Rate: Depends on underlying rhythm Regularity: Irregular P wave: Variable (none, antegrade, or retrograde) P:QRS ratio: None, or 1:1 if retrograde PR interval: None, short, or retrograde QRS width: Normal Grouping: Usually none Dropped beats: None

First-Degree Heart Block

Rate: Depends on underlying rhythm Regularity: Regular P wave: Normal P:QRS ratio: 1:1 PR interval: Prolonged  > 0.20 second QRS width: Normal Grouping: None Dropped beats: None

Mobitz II Second-Degree Heart Block

Rate: Depends on underlying rhythm Regularity: Regularly irregular P wave: Normal P:QRS ratio: X:X-1 PR interval: Normal QRS width: Normal Grouping: Present and variable Dropped beats: Yes

Mobitz I Second-Degree Heart Block

Rate: Depends on underlying rhythm Regularity: Regularly irregular P wave: Present P:QRS ratio: Variable;  2:1, 3:2, 4:3, 5:4, etc. PR interval: Variable QRS width: Normal Grouping: Present and variable Dropped beats: Yes

Ventricular Fibrillation (VFib)

Rate: Indeterminate Regularity: Chaotic  rhythm P wave: None P:QRS ratio: None PR interval: None QRS width: None Grouping: None Dropped beats: No beats at all

Sinus Bradycardia

Rate: < 60 BPM Regularity: Regular P wave: Present P:QRS ratio: 1:1 PR interval: Normal to slightly prolonged QRS width: Normal to slightly prolonged Grouping: None Dropped beats: None

VTach- Capture Beats & Fusion Beats

Occur in the middle of VTach Caused by chance timing of sinus beat to "capture" or transmit through the AV node Depolarizes ventricles through the normal Brugada's sign: In VTach, interval from the R wave to the bottom of the S wave ≥ 0.10 second Josephson's sign: Small notching at the low point of the S wave Total QRS width ≥ 0.16 second Complex negativity of all precordial leads (V

Ectopic Atrial Tachycardia

Rate: 100-180 BPM Regularity: Regular P wave: Morphology of ectopic focus is  different P:QRS ratio: 1:1 PR interval: Ectopic focus has a different interval QRS width: Normal, but aberrant at times Grouping: None Dropped beats: None

Ventricular Tachycardia (VTach)

Rate: 100-200 BPM Regularity: Regular P wave: Dissociated  atrial rate P:QRS ratio: Variable PR interval: None QRS width: Wide, bizarre Grouping: None Dropped beats: None

Idioventricular Rhythm

Rate: 20-40 BPM Regularity: Regular P wave: None P:QRS ratio: None PR interval: None QRS width: Wide (≥ 0.12 second), bizarre appearance Grouping: None Dropped beats: None

Torsade de Pointes

Rate: 200-250 BPM Regularity: Irregular P wave: None P:QRS ratio: None PR interval: None QRS width: Variable Grouping: Variable sinusoidal pattern Dropped beats: None

Ventricular Flutter

Rate: 200-300 BPM Regularity: Regular P wave: None P:QRS ratio: None PR interval: None QRS width: Wide, bizarre Grouping: None Dropped beats: None

Accelerated Idioventricular Rhythm

Rate: 40-100 BPM Regularity: Regular P wave: None P:QRS ratio: None PR interval: None QRS width: Wide (≥ 0.12 second), bizarre appearance Grouping: None Dropped beats: None

Junctional Rhythm

Rate: 40-60 BPM Regularity: Regular P wave: Variable (none, antegrade, or retrograde) P:QRS ratio: None; or 1:1 if antegrade or retrograde PR interval: None, short, or retrograde QRS width: Normal Grouping: None Dropped beats: None

Normal Sinus Rhythm

Rate: 60-100 BPM Regularity: Regular P wave: Present P:QRS ratio: 1:1 PR interval: Normal QRS width: Normal Grouping: None Dropped beats: None

Accelerated Junctional Rhythm

Rate: 60-100 BPM Regularity: Regular P wave: Variable  (none, antegrade,  or retrograde) P:QRS ratio: None; or 1:1 if antegrade or retrograde PR interval: None, short, or retrograde QRS width: Normal Grouping: None Dropped beats: None

Sinus Arrhythmia

Rate: 60-100 BPM Regularity: Varies with respiration P wave: Normal P:QRS ratio: 1:1 PR interval: Normal QRS width: Normal Grouping: None Dropped beats: None

Wandering Atrial Pacemaker (WAP)

Rate: < 100 BPM Regularity: Irregularly irregular P wave: At least three different morphologies P:QRS ratio: 1:1 PR interval: Variable depending on focus QRS width: Normal Grouping: None Dropped beats: None

Third-Degree Heart Block

Rate: Separate rates for underlying (sinus) rhythm and escape rhythm Regularity: Regular, but P  rate and QRS rates are  different P wave: Present P:QRS ratio: Variable PR interval: Variable, no pattern QRS width: Normal or wide Grouping: None Dropped beats: None

Atrial Fibrillation

Rate: Variable, ventricular response can be fast or slow Regularity: Irregularly irregular P wave: None; chaotic atrial activity P:QRS ratio: None PR interval: None QRS width: Normal Grouping: None Dropped beats: None

Sinus Pause/Arrest

Rate: Varies Regularity: Irregular P wave: Present except in areas of pause/arrest P:QRS ratio: 1:1 PR interval: Normal QRS width: Normal Grouping: None Dropped beats: Yes

Sinoatrial Block

Rate: Varies Regularity: Irregular P wave: Present except in areas of dropped beats P:QRS ratio: 1:1 PR interval: Normal QRS width: Normal Grouping: None Dropped beats: Yes