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Cardiac Rhythm and ECG Interpretation Guide, Exams of Cardiology

West Coast UniversityCardiology

A concise guide to understanding and interpreting various cardiac rhythms and ecg patterns. It covers atrial flutter, atrial fibrillation, junctional rhythms, av blocks, ventricular tachycardia, and pacemaker rhythms. Each rhythm is described with key characteristics, such as p wave presence, qrs complex appearance, and heart rate, making it a valuable resource for medical students and healthcare professionals studying electrocardiography. The guide also includes information on st segment changes and premature ventricular complexes (pvcs).

Typology: Exams

2025/2026

Available from 11/13/2025

KelvinBrooks
KelvinBrooks ๐Ÿ‡บ๐Ÿ‡ธ

4.6

(9)

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1.
Atrial Flutter -has a "saw tooth or picket fence" atrial
pattern (no P waves, F-waves in stead that may be in a
ratio) between the QRS complexes.
2.
Atrial Fibrillation-Has "chaotic" atrial electrical activity
(no P waves, f-waves instead) with irregular R-R
intervals.
3.
PJCs cause the rhythm to be irregular. The P wave is
inverted if it can be seen. It may occur before, during
or after the QRS. The P wave will not be seen due to its
low voltage.
4.
Junctional Rhythm may have an inverted or absent P
wave. The P wave may occur before, during or after the
QRS complex. The rate for this rhythm is 40-60 bpm.
5.
Accelerated Junctional Rhythm may have an inverted
or absent P wave. The P wave may occur before, during
or after the QRS complex. The rate for this rhythm is
60-100 bpm.
6.
Junctional Tachycardia Rhythm may have an inverted
or absent P wave. The P wave may occur before, during
or after the QRS complex. The rate for this rhythm is
100-180 bpm
7.
Supraventricular Tachycardia presents with a "nor-
mal-narrow" appearing QRS complex and a rate of
greater than 150 bpm. Remember for heart rates
ap
proaching 150 or higher, it will be very likely that the
P wave will be buried. Be prepared to increase the paper
speed for this rhythm.
pf3
pf4
pf5

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  1. Atrial Flutter - has a "saw tooth or picket fence" atrial pattern (no P waves, F-waves in stead that may be in a ratio) between the QRS complexes.
  2. Atrial Fibrillation-Has "chaotic" atrial electrical activity (no P waves, f-waves instead) with irregular R-R intervals.
  3. PJCs cause the rhythm to be irregular. The P wave is inverted if it can be seen. It may occur before, during or after the QRS. The P wave will not be seen due to its low voltage.
  4. Junctional Rhythm may have an inverted or absent P wave. The P wave may occur before, during or after the QRS complex. The rate for this rhythm is 40-60 bpm.
  5. Accelerated Junctional Rhythm may have an inverted or absent P wave. The P wave may occur before, during or after the QRS complex. The rate for this rhythm is 60 - 100 bpm.
  6. Junctional Tachycardia Rhythm may have an inverted or absent P wave. The P wave may occur before, during or after the QRS complex. The rate for this rhythm is 100 - 180 bpm
  7. Supraventricular Tachycardia presents with a "nor- mal-narrow" appearing QRS complex and a rate of greater than 150 bpm. Remember for heart rates approaching 150 or higher, it will be very likely that the P wave will be buried. Be prepared to increase the paper speed for this rhythm.
  1. First Degree AV Block, The PR Interval Is Constant And Measures Greater Than 0.20 Second.
  2. Second Degree AV Block Mobitz I (Wenckebach) Has A Cyclical Prolonging PR Interval Until The QRS Is Dropped. Then The Cycle Begins Again. ***Remember The Clue "Lengthen, Lengthen Drop Wenckebach.
  3. Second Degree (AV) Block Has A Constant PR Interval With Blocked QRS Complexes
  4. Second Degree (AV) Block Has A Constant PR Interval With Blocked QRS Complex (2)
  5. Third Degree (Complete) Heart Block, The P-P And R- R Intervals Are Regular (Constant) But Firing At Different Rates.
  6. T Wave Inversion, Or Negatively Deflected T Wave Indicates Ischemia And Is Usually Seen With ST Segment Elevation.
  7. T Wave Inversion With ST Elevation On A 12-Lead ECG Is Considered Myocardial Injury, Acute Injury Pattern, Or Acute
  8. Physiologic Q Wave Is Normal And The Width Measures Less Than 0.04 Second And The Depth Measures Less Than One-Third Of The Height Of The R Wave In That Lead.
  9. Pathologic Q Wave Indicates Tissue Death

A Rhythm Containing Bundle Branch Block Will Retain Its Own Usual Features With The Only Change Being The QRS Complex Now Measure 0.12 Second Or Greater

  1. An ST Segment Below The Isoelectric Line Is Known As ST Segment Depression And May Indicate Myocardial Ischemia
  2. A PVC Is An Early QRS Complex That Is Wide (0. Second Or Greater) And Has A Bizarre Appearance. There Is No P Wave. PVC's May Come In Different Shapes - Describe Them Appropriately. Remember To Identify The Under- Lying Rhythm When Providing The Interpretation.
  3. Agonal Rhythm Has An Absence Of P Waves, A Ventricular Rate Of Less Than 20 Bpm And Wide- Bizarre QRS Complexes
  4. Idioventricular Rhythm Has An Absence Of P Waves, Slow Ventricular Rate Of 20 To 40 Bpm, And Wide- Bizarre QRS Complexes
  5. Accelerated Idioventricular Rhythm Has An Absence Of P Waves, A Ventricular Rate Of 40 To 100 Bpm, And Wide-Bizarre QRS Complexes.
  6. Sinus Dysrhythmia, The P-P And R-R Intervals Will Progressively Widen Then Narrow Following The Patient's Breathing Pattern.
  7. Sinus Arrest Has Regularly Occurring PQRST's Both

Be- Fore And After The Arrest Period. No Electrical Activity During The Arrest Period. Remember To Report Frequency And Duration Of Sinus Arrest!

  1. A Premature Atrial Complex (PAC) Is A Complex That Occurs Sooner Than It Should With A Positively Deflected P Wave. Remember To Analyze And Report The Underlying Rhythm Along With The PAC.
  2. Wandering Atrial Pacemaker (WAP) Has At Least Three Different Shaped P Waves. The Rhythm May Be Regular Or Irregular. Rate Is Typically Between 60 - 100 Bpm
  3. Sinus Rhythm Is The Only Rhythm For Which All Five Steps Are Within Normal Limits.
  4. Sinus Bradycardia, The Heart Rate Is Less Than 60 And All Other Measurements Are Within Normal Limits.
  5. Sinus Tachycardia, The Heart Rate Is Greater Than 100 And All Other Measurements Are Within Normal Limits.