arrhythmia reference guide

Arrhythmia Reference Guide

Quick access library for arrhythmias

Rhythm Category o Sinus o Atrial o Junctional o Ventricular o Atrioventricular o Pacemaker o All

Recommended EKG Training o Cardiac Rhythm Analysis o Sinus Rhythms o Atrial Rhythms o Junctional Rhythms o Ventricular Rhythms o Atrioventricular Rhythms o Pacemake Rhythmsr

Welcome to our EKG arrhythmia reference guide. Select one of the titles below to view an EKG strip along with our guide to reading that EKG. To narrow your focus to a specific category, use the buttons in the right margin.

Accelerated Idioventricular Rhythm

Rhythm Regular

Rate 50-120 bpm

P Wave Absent

PR Interval Not measurable

QRS Wide (>0.10 sec), bizarre looking

Notes

Caliper Time Interval: ___ seconds

Accelerated Junctional Rhythm

Rhythm Regular

Rate Normal (60-100 bpm)

P Wave Present before, during (hidden) or after QRS, if visible it is inverted


QRS Normal (0.06-0.10 sec)

Notes

Asystole

Rhythm Not present

Rate Absent

P Wave Absent

PR Interval Absent

QRS Absent

Notes Confirm with multiple leads


Atrial Fibrillation

Rhythm Irregular

Rate Very fast (> 350 bpm) for Atrial, but ventricular rate may be slow, normal or fast

P Wave Absent - erratic waves are present

PR Interval Absent

QRS Normal but may be widened if there are conduction delays

Notes

Atrial Flutter

Rhythm Regular or irregular

Rate Fast (250-350 bpm) for Atrial, but ventricular rate is often slower

P Wave Not observable, but saw-toothed flutter waves are present

PR Interval Not measureable


Notes

Bundle Branch Block

Rhythm Regular

Rate The underlying rate

P Wave Normal

PR Interval Normal (0.12-0.20 sec)

QRS Wide (>0.12 sec)

Notes

First Degree Heart Block

Rhythm Regular


P Wave Normal

PR Interval Prolonged (>0.20 sec)


Notes A first degree AV block occurs when electrical impulses moving through the Atrioventricular (AV) node are

delayed (but not blocked). First degree indicates slowed conduction without missed beats.


Idioventricular Rhythm

Rhythm Regular

Rate Slow (20-40 bpm)

P Wave Absent


QRS Wide (>0.10 sec), bizarre appearance

Notes

Junctional Escape Rhythm

Rhythm Regular

Rate Slow (40-60 bpm)




Notes

Junctional Tachycardia

Rhythm Regular

Rate Fast (100-180 bpm)


PR Interval Absent or short


Notes

Multifocal Atrial Tachycardia

Rhythm Irregular

Rate Fast (> 100 bpm)

P Wave Often changing shape and size from beat to beat (at least three differing forms)

PR Interval Variable


Notes T wave is often distorted Also review wandering atrial pacemaker lesson

Normal Sinus Rhythm

Rhythm Regular


P Wave Normal (positive & precedes each QRS)



Notes

Pacemaker Failure to Capture

Rhythm Irregular

Rate Slow or normal

P Wave

PR Interval

QRS

Notes Pacemaker spikes are not followed by P waves or QRS complexes

Pacemaker Failure to Pace

Rhythm Irregular

Rate

P Wave

PR Interval

QRS

Notes Pacemaker spikes do not appear

Pacemaker Single Chamber Atrial

Rhythm Regular

Rate 60 bpm

P Wave Normal

PR Interval Normal

QRS Normal

Notes

Premature Atrial Complex

Rhythm Irregular

Rate Usually normal but depends on underlying rhythm

P Wave Premature, positive and shape is abnormal

PR Interval Normal or longer

QRS 0.10 sec or less

Notes

Premature Junctional Complex

Rhythm Regular with premature beats



PR Interval Absent or short


Notes

Premature Ventricular Complex

Rhythm Irregular


P Wave Absent


QRS Wide (> 0.10 sec), bizarre appearance

Notes Two PVCs together are termed a couplet while three PVCs in a row with a fast rhythm is ventricular

tachycardia

Premature Ventricular Complex Bigeminy

Rhythm Irregular


P Wave Absent



Notes PVC appears every second beat

Premature Ventricular Complex Quadrigeminy

Rhythm Irregular


P Wave Absent



Notes PVC appears every fourth beat

Premature Ventricular Complex Trigeminy

Rhythm Irregular


P Wave Absent



Notes PVC appears every third beat

Second Degree Heart Block Type I

Rhythm Irregular but with progressively longer PR interval lengthening


P Wave Normal

PR Interval Progressively longer until a QRS complex is missed, then cycle repeats


Notes

Second Degree Heart Block Type II

Rhythm Regular (atrial) and irregular (ventricular)

Rate Characterized by Atrial rate usually faster than ventricular rate (usually slow)

P Wave Normal form, but more P waves than QRS complexes

PR Interval Normal or prolonged

QRS Normal or wide

Notes

Sinoatrial Block

Rhythm Irregular when SA block occurs

Rate Normal or slow

P Wave Normal



Notes Pause time is an integer multiple of the P-P interval Try to identify specific type of atrial tachycardia - see

other pages

Sinus Arrest

Rhythm Irregular due to pause

Rate Normal to slow

P Wave Normal



Notes Pause time is not an integer multiple of the P-P interval

Sinus Arrhythmia

Rhythm Irregular, varying with respiration

Rate Normal (60-100 bpm) and rate may increase during inspiration

P Wave Normal



Notes Heart rate frequently increases with inspiration, decreasing with expiration

Sinus Bradycardia

Rhythm Regular

Rate Slow (< 60 bpm)

P Wave Normal



Notes


Sinus Tachycardia

Rhythm Regular

Rate Fast (> 100 bpm)

P Wave Normal, may merge with T wave at very fast rates



Notes QT interval shortens with increasing heart rate

Supraventricular Tachycardia

Rhythm Regular


P Wave Merged with T wave

PR Interval Normal (0.12 sec)

QRS Normal (.10 sec)

Notes PR interval can be difficult to measure

Third Degree Heart Block

Rhythm Regular, but atrial and ventricular rhythms are independent

Rate Characterized by Atrial rate usually normal and faster than ventricular rate

P Wave Normal shape and size, may appear within QRS complexes

PR Interval Absent: the atria and ventricles beat independently.

QRS Normal, but wide if junctional escape focus

Notes


Ventricular Fibrillation

Rhythm Highly irregular

Rate Unmeasurable

P Wave Absent


QRS None

Notes EKG tracings is a wavy line

Ventricular Tachycardia

Rhythm Regular


P Wave Absent


QRS Wide (>0.10 sec), bizarre appearance

Notes

Ventricular Tachycardia Monomorphic

Rhythm Regular


P Wave Absent



Notes

Ventricular Tachycardia Polymorphic

Rhythm Regular or irregular


P Wave Absent


QRS Normal or wide (>0.10 sec), bizarre looking

Notes


Ventricular Tachycardia Torsade de Pointes

Rhythm Irregular


P Wave Absent



Notes

Wandering Atrial Pacemaker

Rhythm May be irregular


P Wave Changing shape and size from beat to beat (at least three diffferent forms)

PR Interval Variable


Notes T wave normal. If heart rate exceeds 100 bpm, then rhythm may be multifocal atrial tachycardia (MAP)

Wolff-Parkinson-White Syndrome

Rhythm Regular unless atrial fibrillation present


P Wave Normal

PR Interval Can be short ( 0.12 sec)

Notes Look for short PR interval and/or delta wave A delta wave (positive or negative) distorts the early part of the

QRS complex

http://www.practicalclinicalskills.com/ekg-reference-guide.aspx

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http://www.practicalclinicalskills.com/abnormal-ekg.aspx

http://www.rn.org/courses/coursematerial-187.pdf

Heart Sounds, Lung Sounds Reference Guide

Quick access library featuring full and half speed playback, phonocardiograms

and listening tips.

This reference guide is organized by auscultatory location. This comprehensive online library of heart and lung sounds offers playback at both normal and half speeds. Listening tips are available along with a phonocardiogram (or waveform for lung sounds).

Aortic Sclerosis (Musical Murmur)

Acute Pericarditis

Aortic Regurgitation (Decrescendo Diastolic Murmur)

Aortic Regurgitation - Mild

Aortic Regurgitation - Moderate

Aortic Regurgitation - Severe

Aortic Stenosis (Diamond Shaped Systolic Murmur)

Aortic Stenosis - Mild

Aortic Stenosis - Mod Regur. Mild

Aortic Stenosis - Severe


Aortic Stenosis Moderate and Regurgitation Mild - Rheumatic Origin

Arrhythmogenic RV Dysplasia

Atrial Septal Defect

Bronchial

Bronchophony - Abnormal

Bronchophony - Healthy

Bronchovesicular

Cardiomyopathy - Congestive Moderate

Coarctation of the Aorta

Commotio Cordis

Crackles - Coarse (Rales)

Crackles - Early Inspiratory (Rales)

Crackles - Fine (Rales)

Crackles - High Pitched (Rales)

Crackles - Late Inspiratory (Rales)

Crackles - Low Pitched (Rales)

Ebstein's Anomaly

Egophony - a

Egophony - e

Exercise - Heart Rate 120

First and Second Heart Sounds - Normal and Unsplit

First and Second Heart Sounds - Reduced Intensity

First Heart Sound (Markedly Split)

First Heart Sound (Minimally Split)

First Heart Sound - Decreased Intensity

First Heart Sound - Loud

First Heart Sound plus Aortic Ejection Click

Fourth Heart Sound

Fourth Heart Sound Gallop

Hypertrophic Cardiomyopathy

Innocent Murmur

Innocent Systolic Ejection Murmur - Standing

Innocent Systolic Ejection Murmur - Supine

Mediastinal Crunch

Mid-Systolic Click

Mitral Regurgitation

Mitral Regurgitation (Pan-systolic Murmur)

Mitral Regurgitation - Severe

Mitral Regurgitation and Aortic Regurgitation

Mitral Stenosis (Diastolic Murmur)

Mitral Stenosis - Mild

Mitral Stenosis - Moderate

Mitral Stenosis - Severe

Mitral Stenosis Severe and Regurgitation Mild - Rheumatic Origin

Mitral Valve Leaflet Prolapse

Mitral Valve Prolapse (Click with late systolic murmur)

Mitral Valve Prolapse with Mid Systolic Click - Standing

Myocarditis

Opening Snap and Second Heart Sound

Patent Ductus Arteriosus

Pleural Rubs

Prosthetic Heart Sound - Aortic

Prosthetic Heart Sound - Mitral

Pulmonary Stenosis

Pulmonic Regurgitation - Mild

Rhonchi - Low Pitched Wheezes

Second Heart Sound - Physiologically Split

Second Heart Sound - Fixed Splitting

Second Heart Sound - Physiologic Split

Second Heart Sound - Splitting

Second Heart Sound and a Tumor Plop

Second Heart Sound and Late Systolic Click

Second Heart Sound with Fixed Splitting

Second Heart Sound with Persistent Splitting

Second Heart Sound: Fixed Splitting, Decreased Aortic Intensity

Second Heart Sound: Fixed Splitting, Increased Aortic Intensity

Stridor

Summation Gallop at 120 beats per minute

Tetralogy of Fallot

Third and Fourth Heart Sound Gallop

Third Heart Sound - Physiologic

Third Heart Sound Gallop - Abnormal

Tricuspid Regurgitation - Severe

Tricuspid Stenosis - Moderate

Ventricular Septal Defect

Vesicular - Diminished

Vesicular - Normal

Wheeze

Wheezes - Expiratory

Wheezes - High Pitched

Wheezes - Low Pitched

Wheezes - Monophonic

Wheezes - Polyphonic

Whispered Pectoriloquy - Abnormal

Whispered Pectoriloquy - Healthy

http://www.practicalclinicalskills.com/heart-lung-sounds-reference-guide.aspx

Basics of Lung Sounds

Course Overview and Lesson Access

Table of Contents o

1 Vesicular - Normal

2 Crackles - Fine (Rales)

3 Crackles - Coarse (Rales)

4 Wheeze

5 Rhonchi - Low Pitched Wheezes

6 Bronchial

7 Pleural Rubs

8 Bronchovesicular

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Auscultation Course Overview The goal of this basic course in lung sounds is to improve auscultation observational skills. We focus on describing important breath

sounds and in providing recordings of each. Many students find that waveform tracings aid in learning lung sounds; we have included

dynamic (moving cursor) waveforms with each lesson. The anatomy pages use illustrations to reveal an example of each lung sound

(anatomy not yet available on smartphones).

About the author:

Diane Wrigley , Physician Assistant and national educator for continuing education.

How To Use Course Lessons Please use good quality headphones or earphones.

Each lesson consists of multiple pages: text description with audio recording and dynamic waveform pages. Most lessons include a cardiac or lung animation as well. To navigate pages within a lesson, use the navigation bar which will appear on each lesson page.

After completing a lesson, use the blue arrows to view the next lesson. Lessons can also be accessed by using the Table of Contents found in the left margin.

Quick Quiz

Test your knowledge! Try our Quick Quiz.

http://www.practicalclinicalskills.com/auscultation-course-contents.aspx?courseid=201

Intermediate Lung Sounds

Course Overview and Lesson Access

Table of Contents o

1 Vesicular - Diminished

2 Bronchophony - Healthy

3 Bronchophony - Abnormal

4 Egophony - e

5 Egophony - a

6 Whispered Pectoriloquy - Healthy

7 Whispered Pectoriloquy - Abnormal

8 Wheeze - Expiratory

9 Wheeze - Monophonic

10 Wheeze - Polyphonic

11 Crackles - Early Inspiratory (Rales)

12 Crackles - Late Inspiratory (Rales)

13 Stridor

Auscultation Course Overview The goal of this intermediate course is to expand your observational skills when auscultating breath sounds. The course lessons include

voiced sounds: bronchophony, egophony and whispered pectoriloquy. We also provide auscultation lessons on several types of wheezes,

crackles and stridor. Each of these lung sound lessons includes audio, text and dynamic waveform. The anatomy pages use illustrations to

reveal an example of each lung sound (anatomy not yet available on smartphones).

About the author:

Diane Wrigley , Physician Assistant and national educator for continuing education.

How To Use Course Lessons Please use good quality headphones or earphones.

Each lesson consists of multiple pages: text description with audio recording and dynamic waveform pages. Most lessons include a cardiac or lung animation as well. To navigate pages within a lesson, use the navigation bar which will appear on each lesson page.

After completing a lesson, use the blue arrows to view the next lesson. Lessons can also be accessed by using the Table of Contents found in the left margin.

Quick Quiz

Test your knowledge! Try our Quick Quiz.



Auscultation Areas o Aortic o Pulmonic o Erb's Point o Tricuspid o Mitral o Breath Sounds o All Sounds

Course(s) covering this sound:

Systolic Murmurs

Erbs-Point Auscultation Reference Guide


and listening tips.

Auscultation Location o Aortic Area o Pulmonic Area o Erb's Point o Tricuspid Area o Mitral Area

o Breath Sounds o All Sounds

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Acute Pericarditis

Aortic Regurgitation (Decrescendo Diastolic Murmur)

Aortic Regurgitation - Mild

Aortic Regurgitation - Moderate

Aortic Regurgitation - Severe

Mediastinal Crunch

http://www.practicalclinicalskills.com/heart-lung-sounds-reference-guide-area.aspx?Position=Erbs-Point

Pulmonic Auscultation Reference Guide


and listening tips.

Auscultation Location o Aortic Area o Pulmonic Area o Erb's Point o Tricuspid Area o Mitral Area o Breath Sounds o All Sounds

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Atrial Septal Defect

Innocent Murmur

Patent Ductus Arteriosus

Pulmonary Stenosis

Pulmonic Regurgitation - Mild

Second Heart Sound - Physiologically Split

Second Heart Sound - Fixed Splitting

Second Heart Sound - Physiologic Split

Second Heart Sound - Splitting

Second Heart Sound with Fixed Splitting

Second Heart Sound with Persistent Splitting

Second Heart Sound: Fixed Splitting, Decreased Aortic Intensity

http://www.practicalclinicalskills.com/heart-lung-sounds-reference-guide-area.aspx?Position=Pulmonic

Aortic Auscultation Reference Guide


and listening tips.




Aortic Stenosis (Diamond Shaped Systolic Murmur)

Aortic Stenosis - Mild

Aortic Stenosis - Mod Regur. Mild



Aortic Stenosis Moderate and Regurgitation Mild - Rheumatic Origin

Coarctation of the Aorta

First Heart Sound plus Aortic Ejection Click

Prosthetic Heart Sound - Aortic

Second Heart Sound: Fixed Splitting, Increased Aortic Intensity

http://www.practicalclinicalskills.com/heart-lung-sounds-reference-guide-area.aspx?Position=Aortic

Tricuspid Auscultation Reference Guide


and listening tips.


This reference guide is organized by auscultatory location. This comprehensive online library of heart and lung sounds offers playback at

both normal and half speeds. Listening tips are available along with a phonocardiogram (or waveform for lung sounds).

Arrhythmogenic RV Dysplasia

Ebstein's Anomaly

First Heart Sound (Markedly Split)

First Heart Sound (Minimally Split)

Innocent Systolic Ejection Murmur - Standing

Innocent Systolic Ejection Murmur - Supine

Tetralogy of Fallot

Tricuspid Regurgitation - Severe

Tricuspid Stenosis - Moderate

Ventricular Septal Defect

http://www.practicalclinicalskills.com/heart-lung-sounds-reference-guide-area.aspx?Position=Tricuspid

Mitral Auscultation Reference Guide


and listening tips.


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Cardiomyopathy - Congestive Moderate

Commotio Cordis

Exercise - Heart Rate 120

First and Second Heart Sounds - Normal and Unsplit

First and Second Heart Sounds - Reduced Intensity

First Heart Sound - Decreased Intensity

First Heart Sound - Loud

Fourth Heart Sound

Fourth Heart Sound Gallop

Hypertrophic Cardiomyopathy

Mid-Systolic Click

Mitral Regurgitation

Mitral Regurgitation (Pan-systolic Murmur)

Mitral Regurgitation - Severe

Mitral Regurgitation and Aortic Regurgitation

Mitral Stenosis (Diastolic Murmur)

Mitral Stenosis - Mild

Mitral Stenosis - Moderate

Mitral Stenosis - Severe

Mitral Stenosis Severe and Regurgitation Mild - Rheumatic Origin

Mitral Valve Leaflet Prolapse

Mitral Valve Prolapse (Click with late systolic murmur)

Mitral Valve Prolapse with Mid Systolic Click - Standing

Myocarditis

Opening Snap and Second Heart Sound

Prosthetic Heart Sound - Mitral

Second Heart Sound and a Tumor Plop

Second Heart Sound and Late Systolic Click

Summation Gallop at 120 beats per minute

Third and Fourth Heart Sound Gallop

Third Heart Sound - Physiologic

Third Heart Sound Gallop - Abnormal

http://www.practicalclinicalskills.com/heart-lung-sounds-reference-guide-area.aspx?Position=Mitral

http://www.practicalclinicalskills.com/breath-sounds-reference-guide.aspx


arrhythmia reference guide

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