Arrhythmia Recognition: The Art of Interpretation

Aorta arches over the pulmonary artery and veins. Aortic valve is at the base of the aorta in the anterior side. Right atrium and ventricle are on the right side of the heart, while left atrium and ventricle are on the left side. Superior and inferior vena cava are near the right atrium and ventricle. The ventricles are covered in a layer of fat and consist of branching veins. Right coronary artery is over the right ventricle and left coronary artery and left anterior descending artery are over the left ventricle. Descending aorta is located under the ventricles.

Aorta arches over the pulmonary artery and veins. Right atrium and ventricle are on the right side of the heart, connected to each other by tricuspid valve, while left atrium and ventricle are on the left side, connected to each other by mitral valve. The valves consist of cordae tendinae, which are connected to the papillary muscles attached to ventricle walls. A septum divides the ventricles. Left atrium leads to the aorta through the aortic valve. Superior and inferior vena cava are near the right atrium and ventricle.

Oxygenated blood from the left ventricle flows through the aorta and empties into the peripheral circulation. Deoxygenated blood from the circulation enters the right atrium, flows through right ventricle and pulmonary artery and empties into the pulmonary circulation. Oxygenated blood from the circulation passes through pulmonary veins and into the left ventricle through left atrium.

A low volume of oxygenated blood enters the left atrium from the pulmonary circulation. From the left atrium, a high volume of oxygenated blood enters the left ventricle and empties into the peripheral circulation. Deoxygenated blood from the circulation passes through one-way valves. A low volume of the blood enters the right atrium and a high volume enters the right ventricle and empties into the pulmonary circulation.

The illustration shows a drop falling in a dish from the right ventricle through multiple loops of tubing. Text reads, “3,940 additional loops of tubing are needed to complete the extra quarter mile of tubing for just 1 pound of fat.”

A. The atria are full, and the ventricles are empty. B. Blood flows from the atria to the respective ventricles through the valves. C. Both atria and ventricles are full. D. The atria contract, causing the ventricles to hold more blood.

A. The atria are full, and the ventricles are empty. B. Blood flows from the atria to the respective ventricles through the valves. C. When the ventricles are half-filled, blood begins trickling into the ventricles and then stop completely. D. The atria contract, but the ventricles continue remaining half-filled.

SA node leads to three internodal pathways, which culminate at the AV node. AV node leads to His bundle, which branches into RBB and LBB. LBB further branches into LPF and LAF. RBB, LPF, and LAF consist of Purkinje fibers.

SA node is in the right atrium wall, AV node is at the center of the heart, His bundle and LBB are in the ventricular septum, RBB is in the right ventricle, and LAF and LPF are in the left ventricle.

The illustration shows the rates as follows. SA node: approximately 70 BPM, AV node: approximately 45 to 50 BPM, His bundle: 40 to 45 BPM, RBB and LBB: 40 to 45 BPM, and Purkinje fibers: 20 to 40 BPM. The rates listed in the accompanying table are as follows. SA node: 60 to 100 BPM, atrial cells: 55 to 60 BPM, AV node: 45 to 50 BPM, His bundle: 40 to 45 BPM, bundle branch: 40 to 45 BPM, Purkinje cells: 20 to 40 BPM, and myocardial cells: 15 to 35 BPM.

The table shows four column headings: sinus, atria, nodal or bundles, and ventricles. Row entries are as follows. Row 1: Sinus bradycardia; ectopic atrial; junctional, junctional escape, and first-degree AV block; ventricular escape, idioventricular, and accelerated idioventricular. Row 2: Normal sinus rhythm; ectopic atrial; accelerated junctional and first-degree AV block; accelerated idioventricular. Row 3: Sinus tachycardia; focal atrial tachycardia and atrial flutter; first-degree AV block, junctional tachycardia, AV nodal reentry tachycardia, and AV reentry tachycardia; AV reentry tachycardia, ventricular tachycardia, torsade de pointes, polymorphic ventricular tachycardia, and ventricular fibrillation. Row 4: Sinus arrhythmia and premature atrial contraction; atrial flutter; premature junctional complex, second-degree AV block, and third-degree AV block; premature ventricular complex. Row 5: No data; atrial fibrillation, wandering atrial pacemaker, multifocal atrial tachycardia, and variable atrial flutter; no data; no data. Row 6: No data; focal atrial tachycardia with block atrial flutter; second-degree AV block and third-degree AV block; no data. Row 7: SA block and SA pause or arrest; atrial fibrillation; junctional, junctional escape, accelerated junctional, junctional tachycardia, AV nodal reentry tachycardia, and AV reentry tachycardia; asystole, ventricular escape, idioventricular, accelerated idioventricular, ventricular tachycardia, torsade de pointes, polymorphic ventricular tachycardia, and ventricular fibrillation.

The cell consists of nucleus in the center and alternating rows of endoplasmic reticulum and actin-myosin complex. The sodium-potassium ATPases are attached to the edges of the cell. A magnified view of the complex shows columns of actin extending from the upper and lower ends. Myosin is in the center and is attached to troponin-tropomyosin complex.

There are five phases. During phase 0, the graph rises sharply from the threshold potential to action potential. During phase 1, the graph dips slightly. During phase 2, the graph shows a period of plateau. During phase 3, the graph takes a sharp dip below the threshold potential. During phase 4, the graph begins increasing above the threshold potential.

A barrel consists of nucleus in the center and rows of troponin/tropomyosin complexes. When calcium ions attach to the complex, they are activated, causing them to pull closer together. This reduces the size of the barrel.

The central nervous system consists of brain and spinal cord, which interact with each other. The brain interacts with cranial nerves, while the spinal cord interacts with spinal nerves. In the peripheral nervous system, sensory nerves send information to cranial and spinal nerves, which in turn send information to somatic or voluntary nerves and autonomic or involuntary nerves.

Parasympathetic nervous system slows rate, decreases contractility, and slows conduction through the AV node. The main chemical messenger is acetylcholine. Sympathetic nervous system speeds up rate, increases contractility, and speeds conduction through the AV node. The main chemical messenger is epinephrine. Normally, the heart rate is 80, contractility is 5.5, and conduction is 50.

The paper is a strip with 3-second intervals. A magnified view of 0.20-second interval shows a five by five square grid of height 1 millimeter and width 0.04 seconds.

A. A horizontal line spans across 0.20 seconds, followed by a step of height 10 millimeters and period 0.20 seconds. B. A horizontal line spans across 0.20 seconds, followed by a half-step of height 5 millimeters and a period of 0.08 seconds, which leads to a taller step of a total height of 10 millimeters, spanning across 0.16 seconds. C. A broad box of height 10 millimeters and period 0.40 seconds.

A caliper measures the distance between two complexes in an ECG waveform. It is then placed over a clean area, and the period is determined to be 0.50 seconds. Text reads, “Use your calipers on the complex to measure the distance and then transfer the distance to a clean area of the ECG paper.”

There are three complexes in an ECG paper, A, B, and C. One pin of the calipers is placed over complex A and the other over complex B. The calipers are then rotated such that the pin on complex A moves over to complex C, while the pin over complex B remains in place. Text for the pin on complex B reads, “Don’t move this pin!”

Calipers are placed over a complex of the first waveform and the distance is measured A. The calipers are then transferred to the same complex of next waveform without being adjusted and the distance is measured B, greater than A.

A transparent ruler shows a thick horizontal line across the center. Graduations are marked in a scale above and below the line in increments of 5. A small graduated box under the scale shows that in a first-degree heart block, QRS starts from 0.30 seconds. Next to this is a tall rectangular box, corresponding to 0.12 seconds i.d. Text reads, “If the QRS complex fits inside this box, it is normal width. If it fits outside this box, it is a bundle branch block.”

In an ECG paper, a scale is positioned over the complexes. The rates corresponding to the thick lines in the paper are 300, 150, 100, 75, 60, and 50, labeled on the scale. A star at the beginning of the scale corresponds to the peak in the first complex. The second peak occurs between values 60 and 75.

The addition of vectors of magnitude 2 and pointing right and left is 0. The addition of vectors of magnitude 2 and pointing right is a vector pointing right with magnitude 4. The addition of vectors of magnitude 2 pointing upward and right and pointing upward and left is a vector pointing upward with magnitude 3.

A. When the wave travels away from the electrode, the deflection is downward. B. When the electrode is parallel to the direction of the wave, the deflection is upward and downward. C. When the wave moves toward the electrode, the deflection is upward.

The anterior view shows that RA is on the right arm, LA is on the left arm, RL is on the right leg, LL is on the left leg, V1 and V2 are on the horizontal line corresponding to the fourth intercostal space, V4 is on the vertical line corresponding to midclavicular line, V3 is to its left and slightly above, and V5 is to its right and slightly below. The side view shows that V5 is on the anterior axillary line, while V6 is on the midaxillary line.

Lead 1 is at the center of negative RA and positive LA, lead 2 is at the center of negative RA and positive LL, and lead 3 is at the center of negative LA and positive LL.

A. Three lines pass through the center of the heart. The horizontal line corresponds to lead 1, the line falling from upper left side to lower right side is lead 2, and the line rising from lower left side to upper right side is lead 3. B. Three lines pass through the center of the heart. The vertical line corresponds to lead aVF, the line falling from upper left side to lower right side is lead aVR, and the line rising from lower left side to upper right side is lead aVL. The angles of the diagonal lines in A, with respect to the horizontal lines, is greater than those of the diagonal lines in B.

Positive angles are on the lower side of the horizontal line, while vertical angles are on the upper side. The locations of positive and negative poles for different leads are as follows. Lead 1: 0 degrees, 180 degrees. Lead 2: positive 60 degrees, negative 120 degrees. Lead 3: positive 120 degrees, negative 60 degrees. Lead aVF: positive 90 degrees, negative 90 degrees. Lead aVR: positive 30 degrees, negative 150 degrees. Lead aVL: positive 150 degrees, negative 30 degrees.

The illustration shows the heart divided into top and bottom halves. A vertical line passes through the center. Lead V1 is to the left of the vertical line on the anterior side of the heart and leads V2 through V6 are on the right side of the vertical line, also on the anterior side. A top view shows that one set of poles of the leads are concentrated on the anterior right side, while the other set of poles are concentrated on the posterior left side.

The components are as follows: a curved peak of the P wave, a flat segment between the end of P wave and beginning of the QRS complex, labeled PR, a dip followed by a peak of the QRS complex, the flat segment between the end of the QRS complex and the beginning of the T wave, labeled ST, a wide and curved peak of the T wave, and the flat region between the end of the T wave and the beginning of the P wave, labeled TP interval. PR interval is between the beginning of the P wave and the QRS complex. QT interval is between the beginning of the QRS complex and the end of the T wave.

Capital letter R capital letter R prime: Peak of capital letter R is moderately tall while peak of capital letter R prime is very tall. Small letter R capital letter R prime: Peak of capital letter R is short while peak of capital letter R prime is very tall. Capital letter R capital letter R prime: Peak of capital letter R is moderately tall while peak of small letter R prime is very moderately tall. Capital letter R S capital letter R prime: Peak of capital letter R is moderately tall, followed by dip S, which in turn is followed by a very tall peak of capital letter R prime. Capital letter R S capital letter R prime S prime: Peak of capital letter R is moderately tall, followed by dip S, followed by a tall peak of capital letter R prime, followed by dip S prime.

During depolarization, the positive wave moves toward the electrode, forming the QRS complex. During repolarization, the negative wave moves away from the electrode, forming the T wave.

The paper consists of four rows. The first three rows are divided into four parts. The leads in the first row are 1, aVR, V1, and V4. The leads in the second row are 2, aVL, V2, and V5. The leads in the third row are 3, aVF, V3, and V6. The fourth row is labeled rhythm strip.

The leads in the anterior wall are V3 to V4. The leads in the inferior wall are 2, 3, and aVF. The leads in the lateral wall are 1, aVL, and V5 to V6. The leads in the septum are V1 to V2.

The heart consists of multiple vectors oriented in different directions. The resultant vector points toward the left ventricle. The image captured from negative 30 degrees corresponds to lead aVL, positive 60 degrees corresponds to lead 2, positive 90 degrees corresponds to lead aVF, positive 120 degrees corresponds to lead 3, and negative 150 degrees corresponds to lead aVR.

In all illustrations, a circle, corresponding to the hexaxial system is divided into 12 equal parts. Three portions on either side of a lead are positive half. The isoelectric of lead 1 is aVF, 3 is aVR, 2 is aVL, aVL is 2, aVR is 3, and aVF is 1.

A. Positive lead 1 is in the right half of the circle and negative lead 1 is in the left half. B. Positive lead aVF is in the lower half of the circle and negative lead aVF is in the upper half. C. Positive lead 1 and negative lead aVF are in the upper right region, positive leads 1 and aVF are in the lower right region, negative lead 1 and positive lead aVF are in the lower left region, and negative leads 1 and aVF are in the upper left region.

The upper right quadrant is labeled, left, with tall I and deep F. The lower right quadrant is labeled, normal, with tall I and F. The lower left quadrant is labeled, right, with deep I and tall F. The upper left quadrant is labeled, extreme right, with deep I and F.

His bundle splits into right and left bundle branch. Right bundle branch enters the right ventricle. Left bundle branch splits into left anterior and posterior fascicles, which enter the left ventricle. A portion of the left bundle branch and left posterior fascicle are in the septum.

In the heart, arrow 1 points toward the right atrium, arrow 2 points out of the left ventricle, arrow 3 points out of left atrium, and arrow 4 points out of right ventricle. The ECG waveform for lead V1 shows a sharp peak of moderate height, followed by a tall, sharp peak. The ECG waveform for leads 1 and V6 shows a peak and a dip.

There are four types. The first type shows a sharp dip and a curved rise. The second type shows a sharp dip and a curved rise with a small notch at the beginning of the rise. The third type shows a sharp dip, a sharp rise, and a gentle, curved rise. The fourth type shows a V-shaped curve.

Complexes 0.12 seconds? Yes. Slurred S waves in leads I and V6? Yes. Positive complexes in lead V1? Yes. Then it’s RBBB!

There is a block at the origin of the left bundle branch, from which pulses radiate into the left ventricle. The waveform in lead V1 shows a small, negligible peak, a sharp dip, and a curved peak. The waveform in leads 1 and V6 shows a tall peak and a moderately deep dip.

In leads 1 and V6, the waveform has a tall peak and a moderately deep dip. In lead V1, the waveform has a small, negligible peak, a sharp dip, and a curved peak.

Sinus node has a short phase 4, while atrial pacemaker has a longer phase 4. When the cycles of both sinus node and atrial pacemaker are in phase, a complex occurs. When the second cycle of sinus node occurs, there is no cycle in atrial pacemaker, hence no complexes are formed. When the second cycle of atrial pacemaker occurs after a long time, the next complex occurs.

Sinus waveform occurs in the sinoatrial node and is the same as the normal ECG waveform. Ectopic atrial foci occur in the left atrium, and the P wave takes a dip. Junctional foci occur in the atrioventricular node, and there is no P wave in the waveform. Right ventricular foci occur in the right ventricle, and the T wave takes a dip. Left ventricular foci occur in the left ventricle, and an uppercase R S uppercase R prime complex is formed.

The vector from the atrioventricular node is directed toward the leads 1, 2, 3, and aVF. The morphology of junctional foci shows no P wave in the ECG waveform.

A yellow vector points toward lead aVR, while a blue vector points toward lead 2. The QRS complex is narrow. The P wave takes a dip and is either buried in the QRS complex or is in the origin of the waveform.

In the upper and outer wall of the right ventricle, the complex consists of curved peak and dip. In the lower and outer wall of the right ventricle, the complex consists of curved dip and peak. In the ventricular septum, the complex consists of sharp dip and peak, followed by a curved dip. In the lower and outer wall of the left ventricle, the complex consists of two sharp peaks, short and tall, followed by a curved dip. In the upper and outer wall of the ventricle, the complex consists of a sharp peak, followed by curved dip and peak.

In the lower left ventricle, concentric circular waves originate from the source. The waveform shows curved peak and dip. The width of the peak is usually greater than or equal to 0.14 seconds. The colors in the complex are as follows: black, red in the rising part, blue in the peak, green in the falling part, and black for the rest of the complex.

Red vector from the atrioventricular node is directed toward the right atrium, blue vector from the left ventricle points toward the left atrium, and yellow vector from the left ventricle points downward and left. At lead aVR, the complex has a short peak, a sharp dip, and another short peak. At leads 1 and aVL, the complex has a short dip, tall peak, and a short dip. The peak in lead 1 is taller than in lead aVL. In leads 2, 3, and aVF, the complex has a sharp peak and a short dip. The height of the complex increases in the following order: 3, aVF, and 2.

Complex 1 arises from left ventricle and is directed along the ventricular septum. The T wave is highlighted. Complex 2 arises from right atrium and is directed toward the atrioventricular node. The P wave is highlighted. The resultant wave shows a fused P wave and T wave between two complexes.

The first wave, from the sinoatrial node toward the atrioventricular node, is a curved peak. The second wave, from the atrioventricular node toward the sinoatrial node, is a curved dip. The fusion complex at the intersection of the two waves is a weak and fluctuating peak and dip.

The first wave, from the sinoatrial node toward the atrioventricular node, shows a small P wave, a narrow QRS complex, and a wide T wave. The second wave, from the left ventricle toward the atrioventricular node, shows a sharp peak, a curved dip, and a curved peak. The fusion complex at the intersection of the two waves includes the P wave and the first half of the QRS complex and the remaining half of the second wave.

The first wave, from the sinoatrial node toward the atrioventricular node, shows a small P wave, a narrow QRS complex, and a wide T wave. The second wave, from the left ventricle toward the atrioventricular node, shows a sharp peak, a curved dip, and a curved peak. The fusion complex at the intersection of the two waves is a wave similar in appearance to the second wave.

The questions are as follows. 1. Is the rhythm fast or slow? 2. Is it regular or irregular? 3. Do you see any P waves? 4. Are the P waves the same? 5. Are the P waves upright in lead 2? 6. Are the PR intervals normal and consistent? 7. What is the P to QRS ratio? 8. Are the QRS complexes narrow or wide? 9. Are the complexes grouped or not grouped? 10. Are there any dropped beats? Then ask yourself, how can I put it all together.

During junctional rhythm, the rate is less than 60 BPM, during accelerated junctional rhythm, the rate is 60 to 100 BPM, and during junctional tachycardia, the rate is greater than or equal to 100 BPM. Accelerated junctional rhythm is in the green zone, while junctional rhythm and junctional tachycardia are closer to the red zone.

SA node leads to three internodal pathways, which culminate at the AV node. AV node leads to bundle of His, which branches into right bundle branch and left bundle branch. Left bundle branch further divides into left posterior fascicle and left anterior fascicle. Right bundle branch, left posterior fascicle, and left anterior fascicle consist of Purkinje fibers.

In the illustration, AV node, SA node, and right atrium are highlighted. A vector from the center of the right atrium points downward and to the right. In the ECG, the pointer passes the peak of the P wave and begins the descent.

In the illustration, AV node, SA node, and right atrium are highlighted. A vector from the center of the right atrium points downward and to the right. Another vector from the center of the left atrium points directly downward. In the ECG, the pointer reaches the end of the PR interval.

In the illustration, AV node, SA node, and right atrium are highlighted. A vector from the center of the right atrium points downward and to the right. Another vector from the center of the left atrium points directly downward. These vectors point toward leads 2, 3, and aVF.

SA node conducts impulses at the end of the TP interval and atria conduct impulses in the P wave. AV node conducts impulses along a majority of the P wave and in the beginning of the PR interval. His bundle, bundle branch, and Purkinje conduct impulses along the rest of the interval in that order.

In the illustration, the upper septal area is highlighted. A vector from the area points upward and to the right. In the ECG, the pointer moves past the Q wave.

In the illustration, the ventricular septum and the base of the left ventricle, including His bundle, LBB, LAF, and Purkinje of the conduction, are highlighted. A vector from the septum points downward and to the left. In the ECG, the pointer rises up along the R wave and begins falling.

In the illustration, the ventricles and the conduction system in the region are highlighted. A vector from the center of the highlighted area points upward and to the left. In the ECG, the pointer reaches the end of the R wave.

In the illustration, the ventricles are highlighted. In the ECG, the pointer is at the end of the T wave. The region between the beginning of the QRS complex and the peak of the T wave is the absolute refractory period, whereas the region between the peak of the T wave and its end is the relative refractory period.

In each example, the event occurs closer to one complex, causing the subsequent complex to be delayed. The series of complexes between each event has a regular rate. Example 1: An event occurs for every four complexes. Example 2: An event occurs for every two complexes. Example 3: An event occurs for every other complex. Example 4: An event occurs for every five complexes.

Pacemaker A generates complexes at a regular rate, pacemaker B generates complexes at a high frequency, and pacemaker C generates complexes at a low frequency.

Pacemaker A generates complexes at a regular rate, pacemaker B generates complexes at a high frequency, and pacemaker C generates complexes at a low frequency. The final strip consists of patterns from pacemakers in the following order: Pacemakers B, C, B, B, C, A, B, A, B, B, C, A, B, C.

The strip shows two complexes: one with small and irregular fluctuations of high frequency and the other with a taller peak between two short and curved peaks. The complexes are aligned. The R-R intervals in three consecutive QRS complexes of the first complex is measured by walking the calipers.

During sinus bradycardia, the rate is less than 60 BPM, during normal sinus rhythm, the rate is 60 to 100 BPM, and during sinus tachycardia, the rate is greater than or equal to 100 BPM. Normal sinus rhythm is in the green zone, while sinus bradycardia and sinus tachycardia are closer to the red zone.

During sinus bradycardia, the rate is less than 60 BPM, during normal sinus rhythm, the rate is 60 to 100 BPM, and during sinus tachycardia, the rate is greater than or equal to 100 BPM. Normal sinus rhythm is in the green zone, while sinus bradycardia and sinus tachycardia are closer to the red zone.

There are two sets of ECGs. In the first set, the peak of the QRS complex rises and falls alternately. Text reads, “Electrical alternans occurring every other complex.” In the second set, the peaks of the QRS complex rise, reaches a maximum at the third complex, falls, and begins rising from the sixth complex in the series. Text reads, “Electrical alternans occurring over a series of complexes.”

When the vector of the wave points toward an electrode, the peak of the QRS complex is high. When the direction of the vector is away from the electrode, the peak of the QRS complex is low. Text reads, “The more directly a vector points toward an electrode, the taller the resulting wave.”

The illustration shows complexes occurring at irregular intervals. The longest P-P interval and the shortest P-P interval are measured. Text reads, “1. P waves are sinus in nature. 2. Measure longest P-P interval. 3. Measure shortest P-P interval. 4. Calculate the difference. Longest P-P interval minus shortest P-P interval equals difference. 5. If the difference between the two is greater than 0.16 seconds, then you have sinus arrhythmia.”

During inspiration, the handles of the bellows are farther apart and the air flows in. Text reads, “Negative pressure inside the bellows.” Air flows into the chest, expanding the region. The pressure is negative 5 millimeters of mercury. Text reads, “Inspiration causes a decrease in the intrathoracic pressure. The negative pressure in the chest cavity causes air and blood to enter into it.” During expiration, the handles of the bellows are closer together and the air flows out. Text reads, “Positive pressure inside the bellows.” Air flows out of the chest, contracting the region. The pressure is 5 millimeters of mercury. Text reads, “Expiration causes an increase in the intrathoracic pressure. The positive pressure in the chest cavity causes air and blood to exit.”

A low volume of oxygenated blood enters the left atrium from the pulmonary circulation. From the left atrium, a high volume of oxygenated blood enters the left ventricle and empties into the peripheral circulation. Deoxygenated blood from the circulation passes through one-way valves. A low volume of the blood enters the right atrium and a high volume enters the right ventricle and empties into the pulmonary circulation. The right atrium, right ventricle, and a part of pulmonary circulation are in green area.

The pattern shows a sharp peak between imperceptible and curved peak and dip. The peaks occur at irregular intervals. Blue stars are placed over longer intervals between the sharp peaks. Text reads, “Use your calipers! All the P-P intervals marked by the blue stars are the same.”

Both illustrations show a normal rhythm measuring P-P intervals. In the first illustration, two beats are missing. Text reads, “SA block is 3 times the normal P-P interval.” In the second illustration, three beats are missing. Text reads, “SA block is 4 times the normal P-P interval.”

In the illustration, the atria highlighted. The ectopic focus is in the lower left atrium, from which a vector approaches the SA node. Accompanying ECG is normal, but the third complex begins earlier with inverted P wave corresponding to the early PAC.

In the illustration, the atria highlighted. The ectopic focus is in the lower left atrium, from which a vector points toward the SA node. Accompanying ECG is normal, but the complete third complex occurs earlier with inverted P wave corresponding to the early PAC.

Three illustrations, A through C, show the wave deflection recorded by the electrodes corresponding to the direction of the traveling wave.

SA node conducts impulses at the end of the TP interval and atria conduct impulses in the P wave. AV node conducts impulses along a majority of the P wave and in the beginning of the PR interval. His bundle, bundle branch, and Purkinje conduct impulses along the rest of the interval in that order. The time needed to reach the AV node is from the end of the TP interval to the point just before the peak of the P wave. PR interval is the region between the beginning of the P wave and the beginning of the Q-wave.

In the ECG pattern from lead 2, the pattern consists of a short, curved peak, a sharp peak, a sharp dip, and a wide and curved peak. In the third complex, the P wave is deflected downward with short PR interval.

In the ECG pattern from lead 2, the pattern consists of a short, curved peak, a sharp peak, a sharp dip, and a tall, wide, and curved peak. In the third complex, the P wave is shorter with longer PR interval.

There are five phases. During phase 0, the graph rises sharply from the threshold potential to action potential. During phase 1, the graph dips slightly. During phase 2, the graph shows a period of plateau. During phase 3, the graph takes a sharp dip below the threshold potential. During phase 4, the graph begins increasing above the threshold potential.

The illustration shows the rates as follows. SA node: approximately 70 BPM, AV node: 45 to 50 BPM, His bundle: 40 to 45 BPM, RBB and LBB: 40 to 45 BPM, and Purkinje fibers: 35 to 40 BPM.

The pattern consists of normal waveforms. In the third complex, the P wave is missing. In the fourth interval, the P wave occurs after a longer TP interval. Text reads, “Since this P wave does fall on an exact multiple of the P-P interval, it is a compensatory pause. Note that the rhythm was not reset after the premature complex.”

Initially, the strip shows a normal pattern occurring at regular intervals. The third complex consists of an inverted P wave and a taller and wider and T wave. The rhythm strip continues with a normal pattern, now occurring at longer intervals.

The strip shows a short, curved peak of the P wave, a short, sharp peak of the R wave, a sharp dip of the S wave, and a wide, curved peak of the T wave. In one of the complexes, the T and P waves are superimposed.

The strip shows a short, curved peak of the P wave, a short, sharp peak of the R wave, a sharp dip of the S wave, and a wide, curved peak of the T wave. In one of the complexes, the T and P waves are superimposed, causing the resulting wave to have a high amplitude.

The strip shows two sharp peaks of varying heights of the P and R waves, a small dip of the S wave, and a wide, curved peak of the T wave. When a P wave is superimposed on the previous T wave, there is a sharp and wide peak, followed by a long pause.

P wave morphology when the patient was in ectopic atrial rhythm: The peak is sharper and narrower. The end of the P wave has a slight elevation. P wave morphology when the patient was in sinus atrial rhythm: The peak is wider and more curved.

QRS complex is a sharp dip under the baseline, while P waves are small peaks that occur after the QRS complex and are labeled, buried P waves. TP segments are also labeled.

Step 1: Use your calipers to measure the P-P interval. Step 2: Use your ECG paper to calculate half the distance. Step 3: See if there is a buried P wave!

Pacemaker 1 is in the right atrium and the ECG pattern is normal. Pacemaker 2 is in the upper portion of the left atrium. The P wave in the ECG waveform shows a small peak and a small dip. Pacemaker 3 is in the lower portion of the right atrium. The P wave in the ECG waveform shows a dip.

Pacemaker 1 generates complexes at a regular rate, pacemaker 2 generates complexes at a high frequency, and pacemaker 3 generates complexes at a low frequency. The final strip consists of patterns from pacemakers in the following order: Pacemakers 2, 3, 2, 2, 3, 1, 2, 1, 2, 2, 3, 1, 2, 3. The final strip has no regular rhythm.

Pacemaker 1 generates complexes at a regular rate, pacemaker 2 generates complexes at a high frequency, and pacemaker 3 generates complexes at a low frequency. The final strip consists of patterns from pacemakers in the following order: Pacemakers 2, 3, 2, 2, 3, 1, 2, 1, 2, 2, 3, 1, 2, 3. The final strip has no regular rhythm. The ECG waveform from pacemaker 1 is normal, the P wave in the ECG waveform from pacemaker 2 shows a small peak and a small dip, and the P wave in the ECG waveform from pacemaker 3 shows a dip.

Pacemaker 1 is in the right atrium and the ECG pattern is normal. Pacemaker 2 is in the upper portion of the left atrium. The P wave in the ECG waveform shows a small peak and a small dip. Pacemaker 3 is in the lower portion of the right atrium. The P wave in the ECG waveform shows a dip.

The waveforms are from three pacemakers. The ECG waveform from pacemaker 1 is normal, the P wave in the ECG waveform from pacemaker 2 shows a small peak and a small dip, and the P wave in the ECG waveform from pacemaker 3 shows a dip.

The waveforms are from three pacemakers, hence there are three morphologies of P wave. The ECG waveform from pacemaker 1 is normal, the P wave in the ECG waveform from pacemaker 2 shows a small peak and a small dip, and the P wave in the ECG waveform from pacemaker 3 shows a dip. In strip A, there are large pauses between a group of waveforms. In few groups, the P wave follows immediately after T wave. Text for this area reads, “This area is faster than the rest of the strip.” In the rest of the groups, the P wave occurs after a short pause. In strip B, P waves follow immediately after T waves in all groups of waveforms. A short pause is between two groups. Text reads, “This area is slower than the rest of the strip.”

The ECG waveform for lead V1 shows a sharp peak of moderate height, followed by a tall, sharp peak. The ECG waveform for leads 1 and V6 shows a peak and a dip.

In the heart, a circuit of wave, passing through a small region of slow conduction, is visible in the right atrium. The depolarization vector points upward and left in the left atrium. The leads 2, 3, and aVF are highlighted. The resulting waveform is V-shaped, which forms multiple V-shaped waves as the cycle repeats, forming a sawtooth wave.

The first pattern shows sawtooth waves, corresponding to atrial rate of 300 BPM. The second pattern shows sawtooth waves, with sharp peaks occurring for every fourth wave. This corresponds to atrial flutter at 4-to-1 conduction. The third pattern shows sawtooth waves, with sharp peaks occurring for every other wave. This corresponds to atrial flutter at 2-to-1 conduction. The sharp peaks have a small notch in the lower portion of the falling side.

The waveforms comprise sawtooth waves with sharp peaks occurring at random intervals. If the tall peaks occur for every third wave, it corresponds to 3-to-1 conduction. If the tall peaks occur for every fourth wave, it corresponds to 4-to-1 conduction. If the tall peaks occur for every fifth wave, it corresponds to 5-to-1 conduction. The sharp peaks have a small notch in the lower portion of the falling side.

A. Pulse originates from the SA node and spread to the atria. Its entry into the ventricles is blocked by the AV septum. B. Pulse originates from the SA node and spread to the atria. Its entry into the ventricles is blocked by the AV septum, but passes slowly through the AV node and spreads into the ventricles. C. Pulse originates from the SA node and spread to the atria. Its entry into the ventricles is blocked by the AV septum. The waves could pass through the AV node or through the bypass tract next to the mitral valve.

In the heart, AV septum divides atria from the ventricles. A circuit takes place in the right atrium, and a vector points upward and left in the left atrium. Waves could pass through the bypass tract next to the mitral valve. Low-amplitude atrial flutter at 300 BPM plus 1-to-1 conduction through an accessory bypass tract equals high-amplitude ventricular flutter at 300 BPM.

In all waves, the sharp peaks of the QRS complexes occur at irregular intervals. In fine atrial fibrillation, the fluctuations are mild. In coarse atrial fibrillation, the fluctuations are strong. In the fibrillation between these two types, the fluctuations are moderate.

The P wave is inverted, caused by retrograde conduction to the atria. The ECG waveform for ventricular response is normal but without a P wave. Text reads, “Ventricular response giving rise to a normal appearing QRS complex.” When these two combine, the inverted P wave is fused with the QRS complex. Text reads, “Buried P wave in a junctional complex.”

In the PR interval, the normal P wave occurs before the QRS complex. In RP interval, the inverted P wave occurs after the QRS complex. PR interval is longer than RP interval.

When the complexes originate in the transition zone, the P wave occurs before the QRS complex. When the complexes originate in the compact zone, the P wave is buried in the QRS complex. When the complexes originate in the His bundle, the P wave occurs after the QRS complex.

During junctional rhythm, the rate is less than 60 BPM, during accelerated junctional rhythm, the rate is 60 to 100 BPM, and during junctional tachycardia, the rate is greater than or equal to 100 BPM. Accelerated junctional rhythm is in the green zone, while junctional rhythm and junctional tachycardia are closer to the red zone.

In both waveforms, the complexes have normal appearance. In PJC, a complex occurs prematurely. In PAC, a complex occurs prematurely, such that the T wave of the preceding complex fuses with the P wave of the premature complex.

The illustration shows the electrical conduction system of the heart with a block in the LBB. Pulses from the block radiate into the left ventricle. The structure of the impulse from lead V1 during aberrancy shows a short and sharp peak, a tall and sharp peak, and a curved dip. The tall peak and the dip are highlighted.

The QRS complex of both the waveforms is similar. The QRS complex in the normal sinus complex rises to a peak and falls sharply and smoothly to the baseline, while in aberrant complex, the QRS complex reaches a curved peak immediately, falls steeply, and then gradually. The T wave in the aberrant complex is inverted.

The first complex shows a rising QRS complex, accompanied by an upward arrow, a normal T wave, followed by a complex with a small peak, accompanied by an upward arrow, and a deep and sharp dip. The second complex shows a small dip, accompanied by a downward arrow, an inverted T wave, and a sharp dip, accompanied by a downward arrow.

The strip shows irregular P and T waves and a short peak of the QRS complex. The R-R intervals are measured. When a junctional escape complex occurs, there is a pause, the P wave fails to occur, and the length of the R-R interval increases.

During junctional rhythm, the rate is less than 60 BPM, during accelerated junctional rhythm, the rate is 60 to 100 BPM, and during junctional tachycardia, the rate is greater than or equal to 100 BPM. Accelerated junctional rhythm is in the green zone, while junctional rhythm and junctional tachycardia are closer to the red zone. In the rhythm, the waveforms of junctional tachycardia have higher frequency than that of accelerated junctional rhythm. In both complexes, P waves are missing.

One of the tracts has a slow, alpha, or posteroinferior approach, while the other tract has a fast, beta, or anterosuperior approach. Transitional zone leads to the compact zone, which in turn leads to the His bundle.

Depolarization wave and premature impulse arrive at the two tracts of the AV node. The former travels slowly through the alpha tract and swiftly through the beta tract. The fast waves enter the transition zone and the alpha tract. An ECG complex shows three complexes, in which the third complex, PAC, occurs immediately after the second.

An illustration shows a circus movement of the premature impulse through the alpha and beta tracts and the AV node. An ECG complex shows that after the occurrence of PAC, high-frequency AVNRT occurs. They consist of a sharp peak of the QRS complex, an indiscernible peak of the pseudo-S wave in the ST segment, and a wide and curved peak of the T wave.

The complex shows that after the occurrence of PAC, narrow, regular, and paroxysmal tachycardia occurs. They consist of a sharp peak of the QRS complex, an indiscernible peak of the pseudo-S wave in the ST segment, and a wide and curved peak of the T wave. PR interval is prolonged in PAC.

The complex shows that after the occurrence of PAC, narrow, regular, and paroxysmal tachycardia occurs. They consist of a sharp peak of the QRS complex, an indiscernible peak of the pseudo-S wave in the ST segment, and a wide and curved peak of the T wave. PR interval is prolonged in PAC. Text reads, “Make sure you measure the true QRS interval, not the pseudo-wave interval.”

In a typical AVNRT, the initiating wave enters the slow channel and makes a circuit through the fast channel. In the ECG complex, pseudo-S or buried P waves occur after the QRS complex. In an atypical AVNRT, the initiating wave enters the fast channel and makes a circuit through the slow channel. In the ECG complex, a retrograde P wave with prolonged RP interval occurs.

The impulse passes through the AV node, a slow conduction pathway, resulting in fast ventricular conduction through the electrical conduction system. When it passes through the accessory pathway, a fast conduction pathway, it results in slow ventricular conduction through the direct cell-to-cell transmission.

The illustration shows the electrical conduction system of the heart. Impulse through accessory pathway and normal depolarization wave from the left ventricle meet each other at the accessory pathway. In the ECG waveform, delta wave is formed when the P wave curves upward directly to the R wave, instead of the usual flat region leading to a dip of the Q wave.

In both illustrations, AV node and accessory pathway are in the atrioventricular septum. A. The impulse passes through the AV node, then through the accessory pathway, and back through the AV node. B. The impulse passes through the accessory pathway, then through the AV node, and back through the accessory pathway.

Original depolarization wave passes through the AV node, which then passes through the accessory pathway, and back to the AV node. Its waveform shows high-frequency complexes with a short, wide, and curved peak, a tall, narrow, and sharp peak of the QRS complex, and an inverted peak of the P wave.

Original depolarization wave passes through the accessory pathway, which then passes through the AV node, and back to the accessory pathway. Its waveform shows high-frequency complexes with a short, wide, and curved peak, a tall, wide, and sharp peak of the QRS complex, and an inverted peak of the P wave.

Narrow-complex SVT includes sinus tach, inappropriate sinus tach, SA nodal reentry tachycardia, multifocal atrial tachycardia, AVNRT, and orthodromic AVRT. Wide-complex AVRT includes SVT with preexisting BBB, antidromic AVRT, paced rhythms, and SVT with aberrancy.

The complexes show a small and curved peak of P wave, a tall, narrow, and sharp peak of the QRS complex, and a wide and curved peak of the T wave. The rate increases for every succeeding ECG complex, leading to tachycardia.

The strip from lead 2 shows a sharp peak of the QRS complex, a small dip of the pseudo S wave, and a wide and curved peak of the T wave. The strip from lead V2 shows a sharp dip of the R wave, a sharp peak of the S wave, and a wide and curved dip of the T wave. In lead V1, the P waves are discernible as small and curved peaks, while in lead 2 they are indiscernible, with mild fluctuations in its place.

Sinus tachycardia: Upright. Ectopic and multifocal atrial tachycardias: A dip and a peak. Junctional tachycardia, AVNRT, and AVRT: Inverted. Atrial flutter: Sharp oscillating waveform. Atrial fibrillation: Mild or strong fluctuations.

Lead V1 is placed on the right and anterior side of the heart. An ectopic P wave originates from the left atrium and moves toward the right atrium. The P wave is upright. An ectopic P wave originates from the right atrium and moves toward the left atrium. The P wave is inverted.

In sinus tachycardia, multifocal atrial tachycardia, and ectopic atrial tachycardia, P waves occur before the QRS complex. In junctional tachycardia and in the common form of AVNRT, P waves are buried in the QRS complex. In AVRT, P waves are buried in the T waves. In the uncommon form of AVNRT, P waves occur just after T waves. In atrial flutter, F waves occur throughout the complex. In focal atrial tachycardia with block, P waves occur throughout the complex.

There are is a long interval between R and P waves, marked with a halfway point. Text for the region before the halfway point reads, “If the retrograde P wave falls anywhere on the green half, it is considered a short RP interval.” Text for the region after the halfway point reads, “If the retrograde P wave falls anywhere on the blue half, it is considered a long RP interval.”

The start of the PR wave is labeled, “This is the spot you’re focusing on! It is the start of the P wave.” RP interval is between the start of QRS complex and start of the P wave. PR interval is between the start of the P wave and start of the QRS complex. When the RP interval is short, PR interval is longer. When the RP interval is long, PR interval is shorter.

The ECG complex from lead 2 consists of an irregular P wave, a peak of the R wave, and a dip of the S wave. A wide isoelectric segment occurs at the end of the QRS complex. The ECG complex from lead V1 consists of a curved peak of the P wave, a small and sharp peak, a tall, wide, and sharp peak of the R wave, and a wide dip of the S wave. A narrow isoelectric segment occurs at the start of the P wave. The ECG complex from lead V6 shows a curved peak of the P wave, a narrow, tall, and sharp peak of the R wave, a wide and sharp dip of the S wave, and a wide peak of the T wave. A wide isoelectric segment occurs at the start of the P wave. Text reads, “The longest interval is always the right one!”

Text reads, “1. This figure shows the heart in late systole. The atria are full but the ventricles are empty. 2. In early diastole, the AV valves open, allowing a large amount of blood to rush into the ventricles. This is the rapid filling phase of diastole. 3. In mid-diastole, the ventricles are full. Notice that the ventricular walls, however, are not distended in any way. 4. The atrial contraction allows an extra amount of blood to enter the ventricles, causing them to stretch and overfill. The slight stretch in the ventricular muscle caused by the atrial kick will maximize stroke volume and cardiac output.”

High heart rate leads to low time for diastole, decreased ventricular filling, decreased stroke volume, decreased cardiac output, and decreased blood pressure.

First-degree block is classified under delay. Mobitz 1 second-degree, Mobitz 2 second-degree, and high grade are classified under dropped beats. Delay and dropped beats are incomplete blocks. Third-degree block is complete.

Text reads, “When none of the P waves are blocked, it is a first-degree AV block. When some of the P waves are blocked, it is a second-degree AV block. When all of the P waves are blocked, it is a third-degree AV block.”

The system consists of SA node, internodal pathways, AV node, His bundle, RBB, LBB, LPF, LAF, and Purkinje. The regions in a complex conducting impulses in the PR interval are as follows. SA node conducts impulses at the end of the TP interval and atria conduct impulses in the P wave. AV node conducts impulses along a majority of the P wave and in the PR interval after the P wave. His bundle, bundle branch, and Purkinje conduct impulses along the rest of the interval in that order.

SA node conducts impulses at the end of the TP interval and atria conduct impulses in the P wave. AV node conducts impulses along a majority of the P wave and in the PR interval after the P wave. His bundle, bundle branch, and Purkinje conduct impulses along the rest of the interval in that order. When PR interval is prolonged due to first-degree AV block, the impulse conducted by AV node is also prolonged.

The ECG complexes are normal. In 3 to 2 conduction, there sets of complexes, with two complexes in each set consisting of three P waves. In 4 to 3 conduction, there are four sets of complexes, with three complexes in each set consisting of four P waves. In variable conduction, there are multiple sets of complexes, with varying number of complexes and P waves in each set. In all types of conduction, each set occurs after a short pause.

There are two sets of complexes. In the first set, the PR intervals are constant at 0.32 seconds, and the amount of change between the intervals is 0 seconds. In the second set, the consecutive PR intervals in seconds are 0.16, 0.24, 0.28, 0.31, and 0.32. The amount of change between the intervals in seconds is 0.08, 0.04, 0.03, and 0.01. The longest PR is the last interval, while the shortest is the first interval.

The PR intervals in seconds are 0.16, 0.24, and 0.28. The amount of change between the intervals in seconds is 0.08 and 0.04. The P waves occur at constant X seconds. The period between the first and the second QRS complex is X plus 0.08 seconds and between the second and third complex is X plus 0.04 seconds.

Before the pause, the PR intervals were constant at 0.20 seconds. The first interval after the pause is 0.14 seconds, while the second interval is 0.20 seconds. Text reads, “Sometimes, the first PR interval after a pause is a little shorter!”

The ECG complexes are normal. In 3-to-2 conduction, there sets of complexes, with two complexes in each set consisting of three P waves. In 4-to-3 conduction, there are sets of complexes, with three complexes in each set consisting of four P waves. In variable conduction, there are multiple sets of complexes, with varying number of complexes and P waves in each set. In all types of conduction, each set occurs after a short pause.

There are two sets of complexes. The second set occurs after a dropped beat. The P wave associated with the beat is premature with a small inversion at its end. Text for the wave reads, “Look at the timing of the P wave closely. This one is premature. Compare the morphology of this P wave with the rest of the ones on the strip. This is a PAC.”

In Mobitz 1 block, the PR interval lengthens and the nonconducted P wave occurs prematurely. In Mobitz 2 block, the PR intervals are constant and the P wave is not premature.

The sinus rhythm pattern due to the pulse generated in the right atrium consists of small and curved peaks occurring at a regular rate. The ventricular escape pattern due to the pulse generated in the ventricular septum shows a curved peak and a wide and curved dip.

In the electrical conduction system of the heart, there are three rhythms from the atria, region A, and five from the ventricles, region B. The strips in region A are as follows. 1. Sinus rhythm from the SA node: Small and curved peaks occurring at regular rate. 2. Ectopic atrial from the right atrium: Small and curved dips occurring at regular rate. 3. Ectopic atrial from the left atrium: Small bi-humped peaks occurring at regular rate. The strips in region B are as follows. 4. Nodal or Bundle of His: Sharp and narrow peaks and short and wide peaks. 5. Left bundle branch: Wide and curved peaks and wide and curved dips with notching. 6. Right bundle branch: Short and narrow peaks, a dip, and wide and curved peaks. 7. Fascicular or Purkinje: Wide and curved peaks and wide and curved dips with notching. 8. Ventricular myocardium: Wide and curved peaks and wide and curved dips. Text reads, “Take one of the supraventricular rhythms and add it to one of the ventricular rhythms.” When sinus rhythm and ventricular myocardium are combined, waveforms for third-degree AV blocks occur, in which the P waves are sometimes buried in the QRS complex and PR interval.

There are five columns: First-degree, Mobitz 1 second-degree, Mobitz 2 second-degree, 2 to 1 or untypable second-degree, and third-degree or complete. Row entries are as follows. Rate: Variable, Variable, Variable, Variable, Variable. Regularity: Regular, Regular, Regularly irregular, Regular, Regular. P Wave: Present, Present, Present, Present, Present. Morphology: Normal, Normal or ectopic, Normal or ectopic, Normal or ectopic, Normal or ectopic. Upright in leads 2, 3 and aVF: Sometimes, Sometimes, Sometimes, Sometimes, Sometimes. P to QRS Ratio: 1 to 1, X to X 1, Variable, 2 to 1, Variable. PR Interval: Prolonged, Variable, Normal or prolonged, Normal or prolonged, Variable. QRS Width: Normal or wide, Normal or wide, Normal or wide, Normal or wide, Normal or wide. Grouping: None, Yes, Variable, Yes, None. Dropped Beats: None, Yes, Yes, Yes, Yes.

In the lower left ventricle, concentric circular waves originate from the source. The color of the waves from the center are red, blue, and green. The waveform shows curved peak and dip. The colors in the complex are as follows: black, red in the upstroke, blue in the peak, green in the downstroke, and black for the rest of the complex.

In the upper and outer wall of the right ventricle, the complex consists of curved peak and dip. In the lower and outer wall of the right ventricle, the complex consists of curved dip and peak. In the ventricular septum, the complex consists of sharp dip and peak, followed by a curved dip. In the lower and outer wall of the left ventricle, the complex consists of two sharp peaks, short and tall, followed by a curved dip. In the upper and outer wall of the ventricle, the complex consists of a sharp peak, followed by curved dip and peak.

Red vector from the atrioventricular node is directed toward the right atrium, blue vector from the left ventricle points toward the left atrium, and yellow vector from the left ventricle points downward to the left. At lead aVR, the complex has a short peak, a sharp dip, and another short peak. At leads 1 and aVL, the complex has a short dip, tall peak, and a short dip. The peak in lead 1 is taller than in lead aVL. In leads 2, 3, and aVF, the complex has a sharp peak and a short dip. The height of the complex increases in the following order: 3, aVF, and 2.

The interval of the QRS complex is 0.16 seconds in lead V1 and 0.11 seconds in lead V2. Text reads, “Question: Which is the correct measurement? Answer: The widest one! The bottom measurement or lead 2 does not take the isoelectric segment into account.” A flat line is in lead 2 in place of the short peak in lead V1.

The sinus rhythm pattern due to the pulse generated in the right atrium consists of small and curved peaks occurring at a regular rate. The ventricular escape pattern due to the pulse generated in the ventricular septum shows a curved peak and a wide and curved dip.

The rates are as follows. Ventricular escape or idioventricular: less than 45 BPM, accelerated idioventricular rhythm: 40 to less than 100 BPM, ventricular tachycardia and ventricular flutter: more than or equal to 100 BPM, and ventricular fibrillation: undiscernible.

The ectopic ventricular depolarization wave does not pass through the septum. The sinus node sends pulses toward the AV node. A PVC occurs in an ECG complex. The R-R interval remains unchanged after the occurrence of the PVC.

The ectopic ventricular depolarization wave passes through the septum and into the atria. A PVC occurs in an ECG complex. The R-R interval changes after the occurrence of the PVC.

PVCs occur at irregular timings in an ECG complex. When the focus is in the right ventricle, the PVC consists of a sharp peak, a curved dip, and a curved peak. When the focus is in the left ventricle, the PVC consists of a sharp dip, a curved dip, and a curved peak. When the focus is in the upper ventricular septum, the PVC consists of a sharp peak, a curved and narrow dip, and a wide and curved peak. When the focus is in the lower left ventricle, the PVC consists of a flat peak and a curved dip. When the focus is in the central ventricular septum, the PVC consists of a sharp peak and a curved peak.

PVC 1 consists of a sharp dip, a curved dip, and a curved peak. PVC 2 consists of a sharp peak, a curved dip, and a curved peak. PVC 3 consists of a flat peak and a curved dip.

Complex 1 is formed when the impulse from sinus node passes through the AV node into the ventricles. It consists of a small P wave, a sharp peak of the QRS complex, and a wide and curved T wave. Complex 2 is formed when the impulse from the left ventricle moves upward. It consists of a sharp dip, a curved peak, and a curved dip. The fusion complex consists of a small peak, a sharp dip, a small and curved peak, and a curved dip.

The P-P intervals are constant throughout. The P waves are labeled P1 through P8. The first three complexes are labeled F1, F2, and F3. They show a small peak of the P wave, a tall and sharp peak of the R wave, a dip of the S wave, and a wide and curved peak of the T wave. In every succeeding complex, the PR intervals decrease, and the depth of the S wave increases. The fourth complex is a captured beat with a normal appearance. The fifth through eighth complexes are labeled V1, V2, V3, and V4, and show a sharp peak, a curved dip, and a wide and curved peak. P waves are buried at various locations in the dip.

There are four complexes occurring at a high rate. The first complex shows wide and curved peaks and sharp dips of high amplitude. The second complex shows sharp and curved peaks. The third complex shows a sharp and narrow peak, a curved dip, and a wide, small, and curved peak. The fourth complex shows a tall and narrow peak with a flat tip and a wider and curved dip.

The R-R and P-P intervals are constant. The ventricular tachycardia consists of wide and curved peaks and sharp dips of high amplitude. The captured beat consists of a small peak of the P wave, a sharp and narrow peak of the QRS complex, and a wide and curved peak of the T wave. The fusion beat consists of a peak and a curved dip. P waves are buried in the fusion beat and in the complexes of ventricular tachycardia.

Normal is between positive 100 degrees and negative 20 degrees, left axis deviation is between negative 30 and negative 90 degrees, and right axis deviation is between negative 90 and positive 100 degrees. In the normal quadrant, QRS complexes are positive in leads 1 and aVF. In the left quadrant, the QRS complex is positive in lead 1 and negative in lead aVF. In pathologic LAD, the complex is positive in lead 1 and negative leads 2 and aVF. In the extreme right quadrant, QRS complexes are negative in leads 1 and aVF. In the right quadrant, the QRS complex is negative in lead 1 and positive in lead aVF.

The strip shows a small and curved peak of the P wave, a sharp and narrow peak of the QRS complex leading to a plateau region, and a small and curved peak of the T wave immediately before the P wave. A caliper is made to walk on the complex for measuring the QT interval. Caliper A measures the first QT interval, and caliper B measures the second interval. A star is placed over the second QRS complex in the measurement. The text reads, “This pin should be before the starred QRS complex. Caliper B is way past the QRS complex with the star. This is an example of QT prolongation.”

The complexes show that in a normal QT interval, the PVC consists of a sharp dip, a wide and curved peak, and a curved dip. When the QT interval is prolonged, the T wave is superimposed on the dip of the PVC. The text reads, “PVC occurs during the relative refractory period.”

The illustration shows that the base of the arrow, corresponding to the electrical axis and superimposed on the heart, moves from 150 degrees to 200 degrees, and its tip moves from 330 degrees to 25 degrees. There are three groups of complexes. In each complex, the high-frequency oscillating waves peak and fall. The peak in the first group corresponds to 60 degrees, the lowest amplitude between the first and the second group corresponds to 150 degrees, the peak in the second group corresponds to 240 degrees, the lowest amplitude between the second and the third group corresponds to 330 degrees, and the peak in the third group corresponds to 60 degrees again.

WCT includes VTach and SVTs-A. SVTs-A includes SVT with rate-related aberrancy, SVT with preexisting BBB, SVT with aberrancy or MP3, and SVT with aberrancy of accessory path.

The terms on all fingers, except the thumb, correspond to SVTs-A. They are labeled as follows. Thumb, T: Ventricular tachycardia; Index, I: Preexisting IVCD or BBB; Middle, M: MP3s; Ring, R: Rate-related; Pinky, P: APs.

Supraventricular complexes occur when the septal branch breaks off from the left bundle branch. There are three types of supraventricular complexes, with a curved peak of the P wave, a sharper peak of the QRS complex, and a wide and curved peak of the T wave. The complexes are normal sinus rhythm with positive or negative QRS complex and normal sinus rhythm with aberrant conduction, consisting of a dip for the S wave. Ventricular complex arises from the left ventricle, consisting of a sharp and wide dip with a notching in the downstroke, and a sharp peak.

Strip 1 shows a small and curved peak of the P wave, a sharp peak of the R wave, a short and sharp dip of the S wave, and a small peak of the T wave. Strip 2 is the same as strip 1 occurring at a high rate. Strip 3 consists of wide and sharp peaks with a notching in the downstroke.

If the rhythm has a heart rate greater than 100 BPM and if the QRS complexes are greater than or equal to 0.12 seconds, there is an 80 percent probability of VTach. If the patient has a history of CAD, AMI, or structural heart disease, there is a 90 percent probability of VTach.

The text reads, “Thumb: Take a quick history, perform the physical exam, and look at the ECG. Index: If it’s a WCT, then there’s an 80% chance it is VTach! Middle: MI or structural cardiac abnormalities equal 90%. Ring: Rx, treat the patient. Pinky: Proceed to the nonurgent evaluation.”

The illustration shows a depolarization wave originating from the lower left ventricle. The ECG complex from lead V1 shows the QRS complex with a small peak rising to a taller peak and the T wave with a wide dip. The period of the QRS complex is usually greater than or equal to 0.14 seconds.

The illustration shows a depolarization wave originating from the upper right ventricle. The ECG complex from lead V1 shows a curved dip of the QRS complex and a wide and curved peak of the T wave. The period of the QRS complex is usually greater than or equal to 0.16 seconds.

QRS is greater than or equal to 0.12 seconds. When the lever is moved up to go right, the pulses from the right bundle branch block are detected. The ECG complex from lead V1 shows a small and curved peak, two sharp and narrow peaks, in which the second is taller than the first, and a wide and curved dip. The ECG complex from leads 1 and V6 shows a small and curved peak, a narrow and sharp peak, a sharp dip, and a wide and curved peak. When the lever is moved down to go left, the pulses from the left bundle branch block are detected. The ECG complex from lead V1 shows a small and curved peak, a wide and sharp dip, and a wide and sharp peak. The ECG complex from leads 1 and V6 shows a small and curved peak, a wide and curved peak, and a wide and curved dip.

Both complexes show two peaks, one tall and the other short. In the first complex, R is shorter than R prime. The text reads, “Typical morphology of RSR prime wave in a right bundle branch block.” In the second complex, R is taller than R prime. The text reads, “Typical morphology of RSR prime wave from an ectopic ventricular focus.”

Monomorphic R: A tall, wide, and sharp peak. Lowercase qR complex: a small and sharp dip and a tall, wide, and sharp peak. Uppercase QR complex: A deep and sharp dip and a tall, wide, and sharp peak.

There are two morphologies under RBBB. The first shows a small and sharp peak and a wide, deep, and sharp dip. The second shows a tall, wide, and sharp peak, and a deep, sharp, and wide dip. The QRS complex under LBBB shows a small and sharp dip and a wide, tall, and curved peak.

The complex consists of wide and sharp dips and wide and curved peaks. In the first complex, R wave is greater than 30 milliseconds. In the second complex, there is a notching on the downstroke of the S wave. In the third complex, there is an onset of R wave to the nadir of S wave greater than 60 milliseconds.

The sinus rhythm pattern due to the pulse generated in the right atrium consists of small and curved peaks occurring at a regular rate. The ventricular escape pattern due to the pulse generated in the ventricular septum shows a curved peak and a wide and curved dip.

The R-R and P-P intervals are constant. The ventricular tachycardia consists of wide and curved peaks and sharp dips of high amplitude. The captured beat consists of a small peak of the P wave, a sharp and narrow peak of the QRS complex, and a wide and curved peak of the T wave. The fusion beat consists of a peak and a curved dip. P waves are buried in fusion beat and in the complexes of ventricular tachycardia.

Complex 1 is formed when the impulse from the sinus node passes through the AV node into the ventricles. It consists of a small P wave, a sharp peak of the QRS complex, and a wide and curved T wave. Complex 2 is formed when the impulse from the left ventricle moves upward. It consists of a sharp dip, a curved peak, and a curved dip. The fusion complex consists of a small peak, a sharp dip, a small and curved peak, and a curved dip.

Normal is between positive 100 degrees and negative 20 degrees, left axis deviation is between negative 30 and negative 90 degrees, and right axis deviation is between negative 90 and positive 100 degrees. In the normal quadrant, QRS complexes are positive in leads 1 and aVF. In the left quadrant, the QRS complex is positive in lead 1 and negative in lead aVF. In pathologic LAD, the complex is positive in lead 1 and negative in leads 2 and aVF. In the extreme right quadrant, QRS complexes are negative in leads 1 and aVF. In the right quadrant, the QRS complex is negative in lead 1 and positive in lead aVF.

The ECG complex shows a sharp peak and a sharp dip, followed by a tall peak leading to a shorter peak. This results in VT. 1. An ECG complex shows that the upright peak and dip tilt slightly in the clockwise direction. The text reads, “If you cannot find any precordial lead with an RS morphology, then you are dealing with a VT! If not, move on to question 2.” 2. An ECG complex shows a sharp peak and a sharp dip. The distance between the beginning and the end of the peak is 100 milliseconds. The text reads, “In the leads with RS morphology, measure the distance from the beginning of the R wave to the nadir of the S wave. If any of them measure over 100 milliseconds, then the rhythm is a VT! If not, move on to question 3.” 3. An ECG complex shows a peak and a dip. The text reads, “If AV dissociation is present, then you are dealing with a VT! If not, move on to question 4.” 4. An ECG complex shows a tall peak leading to a shorter peak. The text reads, “If the morphology of the QRS complexes in V1 or V2 and V6 match VT criteria, then you are dealing with a VT! If not, the rhythm is an SVT-A.”

An ECG complex shows a sharp peak, a small dip and peak, a sharp and wide dip with a notching in the downstroke, and a small dip with a curved peak. 1. An ECG complex shows a sharp peak. The text reads, “1. Do the QRS complexes in aVR begin with a large R wave? If they do, then you are dealing with a VT! If not, move on to question 2.” 2. An ECG complex shows a small dip and peak. The text reads, “Do the QRS complexes in aVR begin with smaller q or r waves that are over 40 milliseconds wide, one small block? If they do, then the rhythm is a VT! If not, move on to question 3.” 3. An ECG complex shows a wide and sharp dip with a notching in the downstroke. The text reads, “Are the complexes in aVR negative and do they start off being negative? If yes, is there a notch in the initial descending limb? If you answer yes to both, then you are dealing with a VT! If not, move on to question 4.” 4. An ECG complex shows a small dip with a curved peak. The accompanying illustration shows two stick figures on a seesaw. One side is SVT, where V subscript i over V subscript t is greater than or equal to 1. The other side is VT, where V subscript i over V subscript t is less than or equal to 1. The seesaw is tipped toward the side VT. The text reads, “If the V subscript t is bigger, you have a VT! If not, the rhythm is an SVT-A.”

The QRS complex consists of a dip, which rises and takes a small dip again. It measures 0.16 seconds. The first downstroke is the initial section and measures 0.8 millivolts. The second downstroke is the final section and measures 0.175 millivolts. V subscript i over V subscript t equals 0.8 over 0.175, which is less than 1.

The checkboxes under history are history of MI, structural or ischemic HD, prior hx of arrhythmia, age greater than 35 years, family hx of sudden cardiac death, cardiomyopathy, and congestive heart failure. The checkboxes under CV status are hemodynamically unstable and hemodynamically stable. QRS width is blank line seconds. Rate is blank line BPM. Atrial rate is blank line BPM. Ventricular rate is blank line BPM. The checkboxes under regularity are regular, regularly irregular, and irregularly irregular. There are five sections under morphology. The checkboxes under RBBB-like V1 are lowercase r S uppercase R prime, uppercase R S lowercase r prime, lowercase q R, and monomorphic R. The checkboxes under RBBB-like V6 are RS ratio less than 1. The checkboxes under LBBB-like V1 are initial R greater than or equal to 30 milliseconds, notching on S, and R to nadir of S greater than 70 milliseconds. The checkboxes under LBBB-like V6 are any Q wave in V6. The checkboxes under morphology of associated PVCs are same and different. The checkboxes under AV dissociation are present, absent, capture beats, and fusion beats. The checkboxes under concordance of QRS complexes in the precordials are present and absent. The checkboxes under axis are positive leads 1 and aVF or normal, positive lead 1 and negative lead aVF or left, negative lead 1 and positive lead aVF or right, and negative leads 1 and aVF or extreme right. The checkboxes under Brugada algorithm are as follows. Look for RS complexes in all the precordial leads. If you can’t find one, then you are dealing with a VTach! In the leads with RS morphology, measure the distance from the beginning of the R wave to the nadir of the S wave, the RS interval. If any of them measure over 100 milliseconds, then the rhythm is a VTach. Look for evidence of AV dissociation. If there is AV dissociation, then it is a VTach. Look at the morphology of the rhythm in leads V1 or V2 and V6. If it matches the criteria outlined above, then it is a VTach. If not, SVT with aberrancy. The checkboxes under Vereckei aVR algorithm are as follows. Do the QRS complexes in aVR begin with a large R wave? If they do, it’s VTach. Do the QRS complexes in aVR start off with smaller q or r waves that are over 40 milliseconds wide? If they do, it’s VTach. Is there a notch on the descending limb of a completely negative QS complex in lead aVR? If there is, it’s VTach. If the Vt is bigger, you have a VTach. V subscript i over V subscript t less than or equal to 1. If not, SVT with aberrancy. The checkboxes at the end of the checklist are favors VTach and favors SVT-A.

Leads 1, aVL, and V6 consist of a sharp and narrow peak of the R wave, a small and curved dip of the S wave, and a wide curve of the T wave. Lead 2 consists of small peaks and bihumped peaks. Leads 3, aVF, and V5 consist of a sharp and narrow dip of the R wave, a curved peak of the S wave, and a curved dip of the T wave. Lead aVL consists of a sharp and narrow dip of the QRS complex and a curved dip of the T wave. Lead V1 consists of a sharp and narrow dip and a tall and sharp peak. Leads V2 and V3 consist of a small peak and a tall peak. Lead V4 consists of a peak between fluctuations. In lead 1, the last peak is taller than the rest, and in leads 2 and 3, the last dip is deeper than the others. The complexes from lead 2 are displayed at the bottom of the rhythm strip.

QRS is greater than or equal to 0.12 seconds. When the lever is moved up to go right, the pulses from the right bundle branch block are detected. The ECG complex from lead V1 shows a small and curved peak, two sharp and narrow peaks, in which the second is taller than the first, and a wide and curved dip. The ECG complex from leads 1 and V6 shows a small and curved peak, a narrow and sharp peak, a sharp dip, and a wide and curved peak. When the lever is moved down to go left, the pulses from the left bundle branch block are detected. The ECG complex from lead V1 shows a small and curved peak, a wide and sharp dip, and a wide and sharp peak. The ECG complex from leads 1 and V6 shows a small and curved peak, a wide and curved peak, and a wide and curved dip.

The checkboxes under history are history of MI, structural or ischemic HD, prior hx of arrhythmia, age greater than 35 years, checked, family hx of sudden cardiac death, cardiomyopathy, and congestive heart failure. The checkboxes under CV status are hemodynamically unstable and hemodynamically stable, checked. QRS width is 0.14 seconds. Rate is 150 BPM. Atrial rate is 300 BPM. Ventricular rate is 150 BPM. The checkboxes under regularity are regular, checked, regularly irregular, and irregularly irregular. There are five sections under morphology. The checkboxes under RBBB-like V1 are lowercase r S uppercase R prime, checked, uppercase R S lowercase r prime, lowercase q R, and monomorphic R. The checkboxes under RBBB-like V6 are RS ratio less than 1. The checkboxes under LBBB-like V1 are initial R greater than or equal to 30 milliseconds, notching on S, and R to nadir of S greater than 70 milliseconds. The checkboxes under LBBB-like V6 are any Q wave in V6. The checkboxes under morphology of associated PVCs are same and different. The checkboxes under AV dissociation are present, absent, checked, capture beats, and fusion beats. The checkboxes under concordance of QRS complexes in the precordials are present and absent, checked. The checkboxes under axis are positive leads 1 and aVF or normal, positive lead 1 and negative lead aVF or left, checked, negative lead 1 and positive lead aVF or right, and negative leads 1 and aVF or extreme right. The checkboxes under Brugada algorithm are as follows. Look for RS complexes in all the precordial leads. If you can’t find one, then you are dealing with a VTach! In the leads with RS morphology, measure the distance from the beginning of the R wave to the nadir of the S wave, the RS interval. If any of them measure over 100 milliseconds, then the rhythm is a VTach. Look for evidence of AV dissociation. If there is AV dissociation, then it is a VTach. Look at the morphology of the rhythm in leads V1 or V2 and V6. If it matches the criteria outlined above, then it is a VTach. If no, SVT with aberrancy, checked. The checkboxes under Vereckei aVR algorithm are as follows. Do the QRS complexes in aVR begin with a large R wave? If they do, it’s VTach. Do the QRS complexes in aVR start off with smaller q or r waves that are over 40 milliseconds wide? If they do, it’s VTach. Is there a notch on the descending limb of a completely negative QS complex in lead aVR? If there is, it’s VTach. If the Vt is bigger, you have a VTach. V subscript i over V subscript t less than or equal to 1. If not, SVT with aberrancy, checked. The checkboxes at the end of the checklist are favors VTach and favors SVT-A, checked.

Leads 1, aVL, and V6 consist of a sharp and narrow peak of the R wave, a small and curved dip of the S wave, and a wide curve of the T wave. Lead 2 consists of small peaks and bihumped peaks. Leads 3, aVF, and V5 consist of a sharp and narrow dip of the R wave, a curved peak of the S wave, and a curved dip of the T wave. Lead aVL consists of a sharp and narrow dip of the QRS complex and a curved dip of the T wave. Lead V1 consists of a sharp and narrow dip and a tall and sharp peak. Leads V2 and V3 consist of a small peak and a tall peak. Lead V4 consists of a peak between fluctuations. In lead 1, the last peak is taller than the rest, and in leads 2 and 3, the last dip is deeper than the others, labeled PJC. The complexes from lead 2 are displayed at the bottom of the rhythm strip. Hidden and visible F waves are labeled in these complexes.

Lead 1 consists of a dip and a small and curved peak. Leads 2, 3, aVF, V4, V5, and V6 consists of sharp peaks and wide and sharp dips. In leads 2 and 3, the fourth complex is replaced with a dip and a peak. Leads aVR and aVL consist of wide and curved peaks and sharp dips. The peaks in aVR fluctuate. Leads V1, V2, and V3 consist of a peak and dip, followed by a deep and sharp dip and a wide and curved peak. The complexes from lead 2 are displayed at the bottom of the rhythm strip.

Lead 1 consists of a dip and a small and curved peak. Leads 2, 3, aVF, V4, V5, and V6 consist of sharp peaks and wide and sharp dips. In leads 2 and 3, the fourth complex is replaced with a dip and a peak. The complexes from lead 2 consist of fusion complexes and capture beats with regular P-P interval. Leads aVR and aVL consist of wide and curved peaks and sharp dips. The peaks in aVR fluctuate. V subscript i equals 1.25 and V subscript t equals 5. V subscript i over V subscript t is less than or equal to 1, hence VTach. Leads V1, V2, and V3 consist of a peak and dip, followed by a deep and sharp dip and a wide and curved peak. The complexes from lead 2 are displayed at the bottom of the rhythm strip.

The checkboxes under history are history of MI, checked, structural or ischemic HD, checked, prior hx of arrhythmia, age greater than 35 years, checked, family hx of sudden cardiac death, cardiomyopathy, and congestive heart failure. The checkboxes under CV status are hemodynamically unstable, checked, and hemodynamically stable. QRS width is 0.18 seconds. Rate is 136 BPM. Atrial rate is 94 BPM. Ventricular rate is 143 BPM. The checkboxes under regularity are regular, regularly irregular, checked, and irregularly irregular. There are five sections under morphology. The checkboxes under RBBB-like V1 are lowercase r S uppercase R prime, uppercase R S lowercase r prime, lowercase q R, and monomorphic R, checked. The checkboxes under RBBB-like V6 are RS ratio less than 1. The checkboxes under LBBB-like V1 are initial R greater than or equal to 30 milliseconds, notching on S, and R to nadir of S greater than 70 milliseconds. The checkboxes under LBBB-like V6 are any Q wave in V6. The checkboxes under morphology of associated PVCs are same and different. The checkboxes under AV dissociation are present, checked, absent, capture beats, checked, and fusion beats, checked. The checkboxes under concordance of QRS complexes in the precordials are present, checked, and absent. The checkboxes under axis are positive leads 1 and aVF or normal, positive lead 1 and negative lead aVF or left, negative lead 1 and positive lead aVF or right, checked, and negative leads 1 and aVF or extreme right. The checkboxes under Brugada algorithm are as follows. Look for RS complexes in all the precordial leads. If you can’t find one, then you are dealing with a VTach! Checked. In the leads with RS morphology, measure the distance from the beginning of the R wave to the nadir of the S wave, the RS interval. If any of them measure over 100 milliseconds, then the rhythm is a VTach. Look for evidence of AV dissociation. If there is AV dissociation, then it is a VTach. Checked. Look at the morphology of the rhythm in leads V1 or V2 and V6. If it matches the criteria outlined above, then it is a VTach. If not, SVT with aberrancy. The checkboxes under Vereckei aVR algorithm are as follows. Do the QRS complexes in aVR begin with a large R wave? If they do, it’s VTach. Do the QRS complexes in aVR start off with smaller q or r waves that are over 40 milliseconds wide? If they do, it’s VTach. Is there a notch on the descending limb of a completely negative QS complex in lead aVR? If there is, it’s VTach. Checked. If the Vt is bigger, you have a VTach. V subscript i over V subscript t less than or equal to 1. Checked. If not, SVT with aberrancy. The checkboxes at the end of the checklist are favors VTach, checked, and favors SVT-A.

Lead 1 consists of a short peak and a taller peak. Lead 2 consists of a curved dip, a sharp peak, and a small dip. Leads 3 and aVF consist of a sharp peak, a sharp dip, and a wide and curved peak. Lead aVR consists of a small dip and a wide and curved peak. Lead aVL consists of small peaks. Leads V1, V2, V3, and V4 consist of a wide and curved peak and a narrow, deep, and sharp dip. Leads V5 and V6 consist of bihumped peaks between regions of fluctuations. The complexes from lead 2 are displayed at the bottom of the rhythm strip.

Lead 1 consists of a short peak and a taller peak. Lead 2 consists of a curved dip, a sharp peak, and a small dip. Leads 3 and aVF consist of a sharp peak, a sharp dip, and a wide and curved peak. Lead aVR consists of a small dip and a wide and curved peak. Lead aVL consists of small peaks. Leads V1, V2, V3, and V4 consist of a wide and curved peak and a narrow, deep, and sharp dip. Leads V5 and V6 consist of bihumped peaks between regions of fluctuations. The complexes from lead 2 are displayed at the bottom of the rhythm strip. T waves and QRS complexes are marked in this strip. QT interval is 0.30 seconds and QTc equals 401 milliseconds.

The checkboxes under history are history of MI, structural or ischemic HD, prior hx of arrhythmia, age greater than 35 years, checked, family hx of sudden cardiac death, cardiomyopathy, and congestive heart failure. The checkboxes under CV status are hemodynamically unstable and hemodynamically stable, checked. QRS width is 0.12 seconds. Rate is 143 BPM. Atrial rate is 143 BPM. Ventricular rate is 143 BPM. The checkboxes under regularity are regular, checked, regularly irregular, and irregularly irregular. There are five sections under morphology. The checkboxes under RBBB-like V1 are lowercase r S uppercase R prime, uppercase R S lowercase r prime, lowercase q R, and monomorphic R. The checkboxes under RBBB-like V6 are RS ratio less than 1. The checkboxes under LBBB-like V1 are initial R greater than or equal to 30 milliseconds, notching on S, and R to nadir of S greater than 70 milliseconds. The checkboxes under LBBB-like V6 are any Q wave in V6. The checkboxes under morphology of associated PVCs are same and different. The checkboxes under AV dissociation are present, absent, checked, capture beats, and fusion beats. The checkboxes under concordance of QRS complexes in the precordials are present and absent, checked. The checkboxes under axis are positive leads 1 and aVF or normal, positive lead 1 and negative lead aVF or left, checked, negative lead 1 and positive lead aVF or right, and negative leads 1 and aVF or extreme right. The checkboxes under Brugada algorithm are as follows. Look for RS complexes in all the precordial leads. If you can’t find one, then you are dealing with a VTach! In the leads with RS morphology, measure the distance from the beginning of the R wave to the nadir of the S wave, the RS interval. If any of them measure over 100 milliseconds, then the rhythm is a VTach. Look for evidence of AV dissociation. If there is AV dissociation, then it is a VTach. Look at the morphology of the rhythm in leads V1 or V2 and V6. If it matches the criteria outlined above, then it is a VTach. If not, SVT with aberrancy, checked. The checkboxes under Vereckei aVR algorithm are as follows. Do the QRS complexes in aVR begin with a large R wave? If they do, it’s VTach. Do the QRS complexes in aVR start off with smaller q or r waves that are over 40 milliseconds wide? If they do, it’s VTach. Is there a notch on the descending limb of a completely negative QS complex in lead aVR? If there is, it’s VTach. If the Vt is bigger, you have a VTach. V subscript i over V subscript t less than or equal to 1. If not, SVT with aberrancy, checked. The checkboxes at the end of the checklist are favors VTach and favors SVT-A, checked.

Lead 1 consists of complexes with different morphologies. A portion of the strip is highlighted. The first complex in lead 2 consists of a small peak; a tall, sharp, and narrow peak; and a curved dip. The second complex consists of a tall and sharp peak and a wide and curved dip, followed by complexes with deep dips and notching in the downstroke and a wide and curved peak. This is followed by capture beats. Lead V1 initially consists of a small dip, a sharp dip, and a small peak, followed by regions of small peaks and wide and curved dips.

Lead 1 consists of complexes with different morphologies. A portion of the strip is highlighted. The first complex, labeled 1, consists of a small peak, a sharp peak, and a sharp dip. The second complex, labeled 2, consists of a notched dip and a wide and curved peak. The third complex, labeled 3, consists of a peak and an indiscernible dip. A set of complexes, labeled 4, consist of bihumped peaks and curved dips. The complex labeled 5 consists of a peak and a dip. The complex labeled 6 consists of a bihumped peak and a small peak. The complex labeled 7 consists of a tall and sharp peak and a curved peak. The complex labeled 8 consists of a bihumped peak and a wide and curved peak. The complex labeled 9 consists of a sharp peak, a sharp dip, and a wide and curved peak. The complex labeled 10 consists of a peak that leads to a fluctuating dip. The first complex in lead 2 consists of a small peak; a tall, sharp, and narrow peak; and a curved dip. The second complex consists of a tall and sharp peak and a wide and curved dip, followed by complexes with deep dips and notching in the downstroke and a wide and curved peak. An arrow points toward the notching. This is followed by capture beats. Lead V1 initially consists of a small dip, a sharp dip, and a small peak, pointed by an arrow, followed by regions of small peaks, pointed by an arrow, and wide and curved dips.

The checkboxes under history are history of MI, structural or ischemic HD, prior hx of arrhythmia, age greater than 35 years, checked, family hx of sudden cardiac death, cardiomyopathy, and congestive heart failure. The checkboxes under CV status are hemodynamically unstable and hemodynamically stable, checked. QRS width is blank line seconds. Rate is 125 BPM. Atrial rate is blank line BPM. Ventricular rate is blank line BPM. The checkboxes under regularity are regular, regularly irregular, checked, and irregularly irregular. There are five sections under morphology. The checkboxes under RBBB-like V1 are lowercase r S uppercase R prime, checked, uppercase R S lowercase r prime, lowercase q R, and monomorphic R. The checkboxes under RBBB-like V6 are RS ratio less than 1. The checkboxes under LBBB-like V1 are initial R greater than or equal to 30 milliseconds, notching on S, and R to nadir of S greater than 70 milliseconds. The checkboxes under LBBB-like V6 are any Q wave in V6. The checkboxes under morphology of associated PVCs are same and different. The checkboxes under AV dissociation are present, checked, absent, capture beats, checked, and fusion beats. The checkboxes under concordance of QRS complexes in the precordials are present and absent. The checkboxes under axis are positive leads 1 and aVF or normal, positive lead 1 and negative lead aVF or left, negative lead 1 and positive lead aVF or right, and negative leads 1 and aVF or extreme right. The checkboxes under Brugada algorithm are as follows. Look for RS complexes in all the precordial leads. If you can’t find one, then you are dealing with a VTach! In the leads with RS morphology, measure the distance from the beginning of the R wave to the nadir of the S wave, the RS interval. If any of them measure over 100 milliseconds, then the rhythm is a VTach. Look for evidence of AV dissociation. If there is AV dissociation, then it is a VTach. Checked. Look at the morphology of the rhythm in leads V1 or V2 and V6. If it matches the criteria outlined above, then it is a VTach. If not, SVT with aberrancy. The checkboxes under Vereckei aVR algorithm are as follows. Do the QRS complexes in aVR begin with a large R wave? If they do, it’s VTach. Do the QRS complexes in aVR start off with smaller q or r waves that are over 40 milliseconds wide? If they do, it’s VTach. Is there a notch on the descending limb of a completely negative QS complex in lead aVR? If there is, it’s VTach. If the Vt is bigger, you have a VTach. V subscript i over V subscript t less than or equal to 1. If not, SVT with aberrancy. The checkboxes at the end of the checklist are favors VTach, checked, and favors SVT-A.

Leads 1, aVL, and V6 consist of a sharp and narrow peak and a wide and curved peak. Leads 2 and aVF consist of a sharp and narrow peak with a wide base. Lead 3 consists of sharp peaks that gradually fall downward. Leads aVR, V1, and V2 consist of a sharp and narrow dip, and a sharp peak that falls to another smaller peak. The amplitude of the peaks varies in each lead. Leads V3, V4, and V5 consist of two peaks. The complexes from lead 2 are displayed at the bottom of the rhythm strip.

Leads 1, aVL, and V6 consist of a sharp and narrow peak and a wide and curved peak. The upstroke of the peak in lead V6 is not a P wave. Leads 2 and aVF consist of a sharp and narrow peak with a wide base. In lead 2, the beginning of the upstroke is an ectopic P wave, while the end of the downstroke is not a P wave. Lead 3 consists of sharp peaks that gradually fall downward. Leads aVR, V1, and V2 consist of a sharp and narrow dip, and a sharp peak that falls to another smaller peak. The sharp peak in lead aVR is not a P wave. The amplitude of the peaks varies in each lead. Leads V3, V4, and V5 consist of two peaks. The complexes from lead 2 are displayed at the bottom of the rhythm strip, in which ectopic P waves are labeled.

Leads 1, 2, aVL, aVF, V4, V5, and V6 consist of a sharp peak and a curved peak of varying amplitudes. Leads 3 and V1 consist of a peak and dip. Lead aVR consists of a sharp and narrow dip and a wide and curved peak. Leads V2 and V3 consist of a tall and sharp peak, a short and sharp peak, and a wide and curved peak. The complexes from lead 2 are displayed at the bottom of the rhythm strip.

Leads 1, 2, aVL, aVF, V4, V5, and V6 consist of a sharp peak and a curved peak of varying amplitudes. Leads 3 and V1 consist of a peak and dip. Lead aVR consists of a sharp and narrow dip and a wide and curved peak. Leads V2 and V3 consist of a tall and sharp peak, a short and sharp peak, and a wide and curved peak. QRS and QT intervals at the end of each complex are highlighted. The complexes from lead 2 are displayed at the bottom of the rhythm strip. Blue arrows point toward buried P waves.

The checkboxes under history are history of MI, checked, structural or ischemic HD, checked, prior hx of arrhythmia, checked, age greater than 35 years, checked, family hx of sudden cardiac death, checked, cardiomyopathy, and congestive heart failure. The checkboxes under CV status are hemodynamically unstable and hemodynamically stable, checked. QRS width is 0.17 seconds. Rate is blank line BPM. Atrial rate is 250 BPM. Ventricular rate is 125 BPM. The checkboxes under regularity are regular, checked, regularly irregular, and irregularly irregular. There are five sections under morphology. The checkboxes under RBBB-like V1 are lowercase r S uppercase R prime, uppercase R S lowercase r prime, lowercase q R, checked, and monomorphic R. The checkboxes under RBBB-like V6 are RS ratio less than 1. The checkboxes under LBBB-like V1 are initial R greater than or equal to 30 milliseconds, notching on S, and R to nadir of S greater than 70 milliseconds. The checkboxes under LBBB-like V6 are any Q wave in V6. The checkboxes under morphology of associated PVCs are same and different. The checkboxes under AV dissociation are present, absent, checked, capture beats, and fusion beats. The checkboxes under concordance of QRS complexes in the precordials are present, checked, and absent. The checkboxes under axis are positive leads 1 and aVF or normal, checked, positive lead 1 and negative lead aVF or left, negative lead 1 and positive lead aVF or right, and negative leads 1 and aVF or extreme right. The checkboxes under Brugada algorithm are as follows. Look for RS complexes in all the precordial leads. If you can’t find one, then you are dealing with a VTach! In the leads with RS morphology, measure the distance from the beginning of the R wave to the nadir of the S wave, the RS interval. If any of them measure over 100 milliseconds, then the rhythm is a VTach. Look for evidence of AV dissociation. If there is AV dissociation, then it is a VTach. Look at the morphology of the rhythm in leads V1 or V2 and V6. If it matches the criteria outlined above, then it is a VTach. If not, SVT with aberrancy, checked. The checkboxes under Vereckei aVR algorithm are as follows. Do the QRS complexes in aVR begin with a large R wave? If they do, it’s VTach. Do the QRS complexes in aVR start off with smaller q or r waves that are over 40 milliseconds wide? If they do, it’s VTach. Is there a notch on the descending limb of a completely negative QS complex in lead aVR? If there is, it’s VTach. If the Vt is bigger, you have a VTach. V subscript i over V subscript t less than or equal to 1. If not, SVT with aberrancy, checked. The checkboxes at the end of the checklist are favors VTach and favors SVT-A, checked.

Leads 1, 3, aVL, aVL, aVF, V2, V3, V4, V5, and V6 consist of sharp peaks occurring at a high rate. Lead V2 has a notching in the downstroke. Lead 2 consists of curved and fluctuating peaks of low amplitude. Lead V1 consists of bihumped and fluctuating peaks.

All complexes show fluctuations. In fine ventricular fibrillation, the fluctuations are mild. In coarse ventricular fibrillation, the fluctuations are strong. In the fibrillation between these two types, the fluctuations are moderate.

Ventricular fibrillation occurs when pulses from an ectopic focus in the ventricular septum are modified by pulses from other foci. The complex consists of irregular fluctuation. Defibrillation occurs when all foci are depolarized instantaneously. The complex consists of a square wave. Normal sinus rhythm when a normally conducted depolarization wave emerges from a focus.

Position 1, chamber paced: A equals atrium, V equals ventricle, D equals dual A plus V, and O equals none. Position 2, chamber sensed: A equals atrium, V equals ventricle, D equals dual A plus V, and O equals none. Position 3, response to sensing: T equals triggered, I equals inhibited, D equals dual D plus I, and O equals none. Position 4, programmability rate modulation: P equals triggered, M equals inhibited, C equals dual D plus I, R equals rate modulation, and O equals none. Position 5, antitachyarrhythmia functions: P equals pacing, S equals shock, D equals dual P plus S, and O equals none.

Atrial escape intervals 1 and 2 are between the beginning of the P wave and the end of QRS complex in the first through third complex. Atrial escape intervals 3 and 4 are between the P wave in the third complex and the pacemaker spike in the fourth complex, and between the pacemaker spikes in the fourth and fifth complexes.

Ventricular escape interval 1 is between the beginning of the QRS complex in the first complex and the end of the T wave in the second complex. Ventricular escape interval 2 is between the beginning of the QRS complex in the second complex and the pacemaker spike in the third complex. Ventricular escape interval 3 is between the pacemaker spikes in the third and fourth complexes.

Ventricular escape interval 1 is between the beginning of the QRS complex in the first complex and the end of the T wave in the second complex. Ventricular escape interval 2 is between the beginning of the QRS complex in the second complex and the pacemaker spike in the third complex. After this spike, there is no ventricular activity, and the pacemaker fires again. Ventricular escape interval 3 is between this spike and the sequential spike.

The complex consists of two normal complexes. Then the pacemaker fires twice sequentially, leading to two complexes with a wide peak, a small dip, and a curved peak. An ectopic atrial complex is between the other two complexes. The fifth complex, labeled PVC, consists of a wide dip and a wide and curved peak. Atrial escape interval 1 is between the beginning of the P wave in the first complex and the peak of the T wave in the second complex. Atrial escape interval 2 is between the beginning of the P wave in the second complex and the first pacemaker spike. Atrial escape interval 3 is between the pacemaker spikes in the third and fourth complexes. Atrial escape interval 4 is between the ectopic atrial complex and the center of the curved peak in the PVC. Ventricular escape interval 1 is between the beginning of the PVC and the succeeding pacemaker spike.

In a normal ECG complex, the beginning of the complex is labeled 1 and 2; the P wave is labeled 3, 4, and 5; the PR interval is labeled 6; the QRS complex is labeled 7, 8, and 9; the T wave is labeled 10; and the end of the complex is labeled with two stars. The questions are as follows. 1. Is the rhythm fast or slow? 2. Is it regular or irregular? 3. Do you see any P waves? 4. Are the P waves the same? 5. Are the P waves upright in lead 2? 6. Are the PR intervals normal and consistent? 7. What is the P to QRS ratio? 8. Are the QRS complexes narrow or wide? 9. Are the complexes grouped or not grouped? 10. Are there any dropped beats? Have I mined for gold? Then ask yourself, how can I put it all together?

If the PR interval is short, it may be due to Wolff-Parkinson-White, Lown-Ganong-Levine, or junctional rhythms. If the PR interval is constantly prolonged, it may be due to first-degree heart block. If the PR interval is occasionally prolonged, it may be due to Mobitz 1 second-degree heart block, premature atrial contractions, wandering atrial pacemaker, multifocal atrial tachycardia, or third-degree heart block.

There are six columns. The first column lists all heart conditions. The second column lists the filtered conditions corresponding to a rate of 150 BPM: ST, Focal AT, Focal AT c B, MAT, AFlut, AFib, AVNRT, AVRT, M VTach, P VTach, and TdP. The third column lists the filtered conditions for regular rhythm: ST, Focal AT, Focal AT c B, AFlut, AVNRT, AVRT, and M VTach. The fourth column lists the filtered conditions for P waves: ST, Focal AT, Focal AT c B, and AFlut. The fifth column lists the filtered conditions for conduction ratio 2 to 1: Focal AT c B and AFlut. The sixth column shows the final diagnosis, Atrial flutter.

The shows a noncompensatory pause after a QRS complex. The pause includes approximately one beat, and the next complex occurs after a delay. A complex with curved peak and curved dip is in the pause.

The strip shows a sharp and tall rise to a curved peak, a short fall followed by a plateau for a short period, and a steep fall. Irregularities in morphology, such as notching and mild fluctuations, occur near the peak of the rising region, the base of the falling region, at the peak, and in the plateau. Sinus beat corresponds to peaks, dips, and plateaus.

In between two beats of a ventricular tachycardia, fusion beat and capture beat occurs. Fusion beat consists of a tall, curved peak and short, curved dip. Capture beat is a normal ECG complex.

Brugada’s sign is the distance between the end of the R wave and the bottom of the S wave. Josephon’s wave is the notch in the low point of the falling region of the S wave.

For every third ECG complex, a dropped beat occurs, corresponding to a missing QRS complex. The TP interval occurring before the dropped beat is shorter than the rest.

The strip shows a sharp peak of the QRS complex, a combined P and T wave, forming a double hump or a large complex, and is labeled, “P wave is in here!” This is followed by two small peaks. The distance between the consecutive QRS complexes is the ventricular rate. The distance between two peaks and between P wave and the consecutive peak is the atrial rate.

The strip shows a subtle and curved peak of the P wave, a sharp peak of the R wave, a sharp dip of the S wave, and a wide, curved peak of the T wave. The third complex arrives earlier, in which the P wave is taller. The rhythm then continues with the same rate.

The strip shows a short, curved peak of the P wave, a sharp peak of the R wave, a sharp dip of the S wave, and a curved peak of the T wave. There are long pauses between each complex. The third complex occurs immediately and its P wave is smaller.

The strip shows a short, curved peak of the P wave followed by a tall, sharp peak of the QRS complex, which leads to a moderately sized curved peak of the T wave. The third complex occurs earlier, in which the P wave is inverted.

The strip shows a wide, short, curved peak of the P wave, a sharp peak of the QRS complex, and a curved peak of the T wave. In the third complex, the P wave is narrower.

The strip shows a short, sharp peak of the P wave, a short, sharp, and narrow peak of the QRS complex, and a sharp dip of the T wave. Every fourth complex has inverted P wave and either a pause or wide and curved peak of T wave.

The strip shows a short, sharp, and narrow peak of the P wave, a wide, curved peak of the QRS complex, and a short, curved peak of the T wave. When PACs occur, the sharpness of the P wave and the width and height of the QRS complex decrease.

The strip shows a short, sharp, and narrow peak of the P wave, a sharp peak of the QRS complex, and a short, curved peak of the T wave. PACs occur earlier in the strip for every third complex.

The strip shows a short, sharp, and narrow peak of the P wave, a sharp peak of the QRS complex, and a short, curved peak of the T wave. PACs occur earlier in the strip for every other complex.

The strip shows a sharp peak corresponding to the QRS complex and a wide, sharp peak, corresponding to the T wave. There are three morphologies for P waves: a broad peak, a curved and small peak, and a small and sharp peak.

The strip shows three morphologies for P waves: a broad and irregular peak, a sharp peak, and a dip. The strip also shows a sharp peak corresponding to the QRS complex and a broad and sharp peak, corresponding to the T wave.

The strip shows three morphologies for P waves: a broad and irregular peak, a sharp peak, and a dip. The strip also shows a sharp peak corresponding to the QRS complex and a broad and subtle peak, corresponding to the T wave.

The strip shows three morphologies for P waves: a broad and irregular peak, a sharp peak, and a dip. The strip also shows a short and sharp peak corresponding to the R wave, a sharp dip corresponding to the S wave, and a broad and curved peak, corresponding to the T wave.

The strip shows sharp peaks of the R waves, sharp dips of the S waves, and short and curved peaks of the T waves occurring at irregular intervals. The interval of the ST segment varies. A short R-R interval occurs after a longer one due to aberrantly conducted premature complex. The flat regions between the long R-R intervals show very mild fluctuations.

The strip shows a curved peak of the P wave, a small and sharper peak of the R wave, a small dip of the S wave, and a wide and broad peak of the T wave. An arrow points toward a premature complex with thinner and taller peak of the R wave and thinner dip of the S wave.

The strip shows a fluctuating peak of the P wave, a tall and narrow peak of the QRS complex, and a wide and curved peak of the T wave. The first PJC is the third complex and shows a shorter QRS complex and a scooped ST segment. The second PJC is the seventh complex and is similar to the normal ones.

The strip shows a short peak of the P wave, a tall and narrow peak of the QRS complex, and a broad peak of the T wave. The complexes occur at high frequency and with varying baseline. An arrow points toward a PJC with missing P wave, wider R wave, and an irregularly shaped dip.

The strip shows a short peak of the P wave, a tall and narrow peak of the R wave, a sharp and narrow dip of the S wave, and a broad peak of the T wave. A notch is located in the region where the S waves rise to the T waves. The aberrant PJCs consist of wide and sharp dip, which first rises steeply to the baseline and then gradually, followed by an irregularly shaped curved and wide peak.

The strip shows a small and curved peak of the P wave, a sharp peak of the QRS complex, and a curved and wide peak of the T wave. The fifth complex occurs after a long pause and is the junctional rhythm. The P wave occurs right before the complex and is inverted.

The strip shows a small and curved peak of the P wave, a dip of the QRS complex, and a wide and curved peak of the T wave. The PR intervals in seconds are 0.26, 0.46, and slightly greater than 0.46. The amount of change between the first and second interval is 0.20 seconds and between the second and third interval is unclear. The P wave is buried in the T wave of the third complex, pointed by an arrow.

The strip shows a small and curved peak of the P wave, a narrow peak of the R wave, a narrow dip of the S wave, and a broad wave of the T wave. The fourth P wave is nonconducted. The PR intervals are constant before the dropped beat. The first PR interval after the pause is shorter. The intervals then continue to be constant.

The strip shows a small and curved peak of the P wave, a fluctuating dip of the QRS complex, and a small dip of the T wave. A PVC occurs as a tall and sharp peak with wide and curved dip and does not cause the change in the rate of P-P interval.

The normal complex consists of a curved peak of the P wave, a sharp peak of the QRS complex, and a curved dip of the T wave. PVCs occur as sharp dips with fluctuating upstroke, followed by a curved dip. They occur every second complex.

The normal complex consists of a curved peak of the P wave, a sharp peak of the R wave, a sharp dip of the S wave, and wide and curved peak of the T wave. PVCs occur as wide and sharp peaks followed by wide and curved dips, with P waves buried in the downstroke. They occur every third complex.

The normal complex consists of a small and curved peak of the P wave, a narrow peak of the QRS complex, and a wide and imperceptible peak of the T wave. PVCs occur as a dip followed by a bi-humped peak, one which corresponds to the fused P wave. They occur every fourth complex.

The normal complex consists of a small and curved peak of the P wave, a sharp peak of the QRS complex, and a curved dip of the T wave. Unifocal couplet occurs as sharp dip followed by wide and curved peaks.

The normal complex consists of a small and curved peak of the P wave, a sharp and fluctuating dip of the QRS complex, and a fluctuating region. Unifocal couplet and PVC occur as sharp dip followed by wide and curved peaks.

The normal complex consists of a small and curved peak of the P wave, a sharp dip of the QRS complex, with a notch in the downstroke, and a curved dip of the T wave. PVCs occur as a sharp peak followed by a wide and curved dip of varying heights and as bi-humped peak.

The strip shows three fusion complexes and a captured beat. The fusion complex consists of a tall and narrow peak and a wide and curved dip. The captured beat consists of a wide and curved peak of the P wave, a small and sharp peak of the QRS complex, and a wide and curved peak of the T wave. P-P intervals are constant throughout. An arrow points toward the fusion of a P wave with a T wave.

The strip shows four fusion complexes and a captured beat. The fusion complex consists of a small and curved peak of the P wave, a narrow peak of the QRS complex, and a curved dip of the T wave. The captured beat consists of a small and curved peak of the P wave, a narrow peak of the QRS complex, and a curved peak of the T wave. P-P intervals are constant throughout.

The strip shows a small and curved peak of the P wave, a narrow, tall, and sharp peak of the QRS complex, and a curved dip of the T wave. A PVC, with a wide peak and dip, leads to sustained ventricular tachycardia, which consists of a sharp dip and a curved peak. There is notching in the downstroke of the dip and in the upstroke of the peak.

The strip shows tachycardia consisting of a sharp dip and a curved peak. There is notching in the downstroke of the dip and in the upstroke of the peak. Fusion beats consist of a bihumped dip or a small peak or a taller and fluctuating peak or a dip with notching.

The strip shows a sharp dip of the QRS complex and a curved dip of the T wave. In some complexes, a small peak of the P wave occurs before the QRS complex. In other complexes, a small and wide peak of the P wave occurs right after the T wave. The P waves are labeled with dots.

The strip shows a bi-humped peak of the P wave, a sharp peak of the QRS complex, and a wide and curved peak of the T wave. The PR intervals in seconds are 0.26, 0.38, and 0.46. There is a dropped beat after the third complex.

The strip shows a curved peak of the P wave, a fluctuating dip of the QRS complex, and a wide and curved peak of the T wave. The PR intervals are constant at 0.26 seconds. The third and the fifth complexes are dropped.

The strip shows complexes with two sets of patterns. The first pattern shows a small and curved peak of the P wave, a sharp peak of the R wave, a sharp dip of the S wave, and a curved peak of the T wave. The second pattern shows a tall peak of the QRS complex, leading to a small dip of the P wave, pointed by an arrow, and a wider dip of the T wave.

The strip shows two groups, A and B. Both groups show a curved dip of the QRS complex. In B, the T wave is a curved peak, while in A it is flat. Some waves are fused, marked with the letter F. The last two complexes, marked with a star, show tall and small peaks.

The strip shows a small and curved peak of the P wave and a small peak and a wide and sharp dip of the QRS complex. Some QRS complexes are double-notched, pointed by arrows. Some P waves are represented as a spike.

The strip shows a curved peak of the P wave, a sharper peak of the QRS complex, a curved peak of the T wave, and a curved peak of the P wave. The P waves are marked with dots. For every succeeding complex, the P wave before the QRS complex comes closer to the latter and the P wave after the T waves moves further away. In the fourth complex, the second P wave is inverted, pointed by an arrow. In the succeeding complexes, inverted P waves occur after the QRS complex.

The strip shows an indiscernible and curved peak of the P wave, a narrow peak of the R wave, a sharp dip of the S wave, and a wide and curved peak of the T wave. The PR intervals in seconds are 0.22, 0.31, and 0.36. The R-R intervals in seconds are 0.88 and 0.84. The fourth beat is dropped.

The strip initially shows a small and curved peak of the P wave, a sharp peak of the QRS complex, and wide and curved peak of the T wave. In the third complex, the T wave fuses with the succeeding P wave, marked with a star, causing the QRS complex to be taller and wider, leading to a curved dip of the T wave. In the second set, the second complex shows a dip, pointed by an arrow. After another fusion of the T wave with P waves, pointed by a star, the third set begins.

The strip shows a small and curved peak of the P wave, a peak of the QRS complex, a wide dip of the T wave, and three small and curved peaks of the P waves. The P waves are marked with dots. The period of the first PR interval is 0.23 seconds and period of the second is 0.18 seconds.

The strip shows a small peak of the P wave and a sharp and narrow peak of the QRS complex, which leads to small and curved peak of the T wave. The QT interval is 0.28 seconds. After the fourth complex, oscillating waves occur whose amplitude first increases and then decreases in each set.

The strip shows three groupings. In each grouping, there is a missed beat after the second complex. The complexes show a curved peak of the P wave, a tall and sharp peak of the QRS complex, and a bi-humped peak of the T wave. The period of the first PR interval is 0.27 seconds and the period of the second is 0.42 seconds.

The strip shows two sets of complexes. In the first set, the complexes show a sharp peak of the QRS complex with falls with fluctuations and leads to a dip. An arrow points toward the slurred rise of the QRS complex. The second set shows complexes labeled C and F, consisting of sharp peaks occurring after curved peaks.

The strip shows that QRS complexes occur alternately. The complexes with QRS complexes show a small and curved peak of the P wave, a narrow and sharp peak of the QRS complex, and a wide and curved peak of the T wave. Two consecutive P-P intervals have the same period.

The strip shows groups of two complexes. Each complex shows a sharp peak of the R wave, a sharp dip of the S wave, and a wide and curved peak of the T wave. In the first complex, the P wave is upright and in the second complex, the P wave is inverted.

The strip from lead 2 shows a sharp peak of the QRS complex, a small dip of the pseudo S wave, and a wide and curved peak of the T wave. The strip from lead V2 shows a sharp dip of the R wave, a sharp peak of the S wave, and a wide and curved dip of the T wave. In lead V1, the P waves are discernible as small and curved peaks, while in lead 2 they are indiscernible, with mild fluctuations in its place.

The strip from lead 2 shows a sharp peak of the R wave and a sharp dip of the S wave. The strip from lead V1 shows a sharp peak of the QRS complex. P waves are on either side of the complexes. In lead 2, P waves on both sides have a bi-humped peak. In lead V1, the P wave before the QRS complex has a bi-humped peak and the P wave after the complex is a small and curved peak.

The strip shows a small bi-humped peak of the P wave, a sharp peak of the R wave, a sharp dip of the S wave, and a wide and curved peak of the T wave. A PAC occurs after the fifth complex, creating a sharp peak of the QRS complex and a depression of the pseudo S wave right after.

The strip shows two sets of waves. In the first set, there is a sharp and wide dip of the QRS complex followed by a wide and sharp peak of the T wave. P waves occur before the complex and are buried in the QRS complex, ST segment, and T waves. In the second set, the waves show a curved peak of the P wave, a tall and sharp peak of the QRS complex, and an indiscernible dip of the T wave.

The strip shows a short and curved peak of the P wave, a short and sharp peak of the R wave, a sharp dip of the S wave, and wide and curved peak of the T wave. The period of PR intervals in seconds are 0.22, 0.17, 0.20, 0.18, 0.17, 0.22, and 0.14. The period of R-R intervals in seconds are 0.80, 1.04, 0.95, 0.96, 0.90, and 0.86.

The strip from lead 2 shows a small and sharp peak of the P wave, small and sharp dip of the QRS complex, and a small and curved peak of the T wave. The strip from lead V1 shows a small and curved peak of the P wave, a tall and wide peak of the QRS complex, and a wide and curved dip of the T wave.

The ventricular escape rhythm consists of bi-humped QRS complexes and followed by a wide and curved peak. The NSR consists of small and curved peaks of the P waves. These combine to form the waveform of ventriculophasic AV dissociation, with some buried P waves.

The strip from lead 2 shows a small dip of the P or F wave, a tall and narrow peak of the QRS complex, and small and curved dip. The strip from lead V1 shows a small peak of the P or F wave, a narrow dip of the QRS complex, and small and curved peak.

The strip shows a small and curved peak of the P wave, a sharp and narrow peak of the QRS complex, a wide and curved peak of the T wave, and a curved peak of another P wave. The P-P intervals in seconds are 0.82, 0.96, 0.84, 0.90, 0.78, and 0.87. The height of the fourth QRS complex is shorter and is pointed by an arrow.

The strip shows a curved peak and a sharp and narrow dip. An inverted P wave, pointed by blue arrow, occurs after the third complex, immediately followed by a peak, pointed by a red arrow. Some P waves are buried in QRS complexes pointed by green arrows.

The strip shows that in complexes 1, 3, 5, and 7, there is a small and curved peak of the P wave and bi-humped dip of the QRS complex. The PR interval is 0.16 seconds. Complexes 2, 4, 6, and 10 show a curved peak and dip and are pointed by red arrows. Complexes 8 and 9 consist of long bi-humped dips.

The strip shows a small and curved peak of the P wave and a dip of the QRS complex. During the first event, pointed by a red arrow, the P wave occurs after the QRS complex and a beat is missed. During the second event, pointed by a brown arrow, the P wave is inverted. During the third event, pointed by a yellow arrow, there is a sharp peak in which the P wave is buried, followed by a curved dip.

The strip shows a curved peak of the P wave, a sharp peak of the R wave, a sharp peak of the S wave, and a wide and curved peak of the T wave. The periods of the PR interval in seconds are 0.24, 0.32, 0.36, missed beat, 0.24, 0.34, 0.35, and 0.37.

The strip shows waves with wandering baseline. It also shows a small and curved peak of the P wave, a tall and sharp peak of the QRS complex, and a wide and curved peak of the T wave. There is a gap between the second and the third complexes. The waves occur at varying frequencies.

The strip shows a curved and subtle peak of the P wave, a sharp peak of the QRS complex, and a wide and curved peak of the T wave. The R-R intervals are as follows: 1.10 seconds, 1.10 seconds, 1.06 seconds, 1.00 seconds, 0.94 seconds, and 0.96 seconds.

The strip shows small and curved complexes: a curved peak of the P wave, a curved peak of the R wave, a curved dip of the S wave, and a curved peak of the T wave. The PR interval is 0.24 seconds and the QRS width is 0.18 seconds.

The strip shows a tall peak of the QRS complex and a wide, short, and curved peak of the T wave. The P waves show varying morphologies: fluctuating with a curved peak, broad with a curved peak, small with a sharp peak, and taller with a curved peak. An arrow points toward a fused P wave and T wave, forming a curved peak.

The strip shows complexes grouped in three. Each consists of a small and curved peak of the P wave, a tall and sharp peak of the QRS complex, and a curved peak of the T wave. The third complex in each group occurs immediately after the second.

The complexes of the sinus or ectopic atrial rhythm show a small bi-humped peak of the P wave, a sharp and narrow peak of the QRS complex, and a wide and curved peak of the T wave. The R-R interval is labeled 1. Then, a premature atrial complex with a negligible P wave occurs, which leads to focal atrial tachycardia. The complexes show a curved peak of the P wave, a sharp and narrow peak of the QRS complex, and a wide and curved peak of the T wave. The R-R interval, labeled 2, is shorter than the interval labeled 1.

The strip shows a wandering baseline, a sharp peak of the R wave, a small and sharp dip of the S wave, a depressed ST segment, and a wide and curved peak of the T wave. The P wave has varying morphologies: a small and curved peak, a tall and curved peak, a sharp peak, and a bi-humped peak.

The strip shows a sharp peak of the QRS complex. Every other complex is long and every other complex is short. There are alternating long and short R-R intervals. Dropped beats of varying intervals occur before a QRS complex.

The strip shows a small and curved peak of the P wave, a small and sharp peak of the QRS complex, and a wide and indiscernible peak of the T wave. The complexes occur at irregular intervals. The last P wave is shaper due to a bump in the baseline. The P waves are marked with dots.

The strip shows a small peak of the P wave, a sharp and narrow peak of the R wave, a sharp dip of the S wave, and a small peak of the buried P wave. The distance between the P waves is the presumed P-P interval. The distance between the P wave and the following buried P wave is the actual P-P interval, which is half of the presumed P-P interval.

The strip a small and curved peak of the P wave, a dip of the QRS complex, and a curved peak of the T wave. Every third complex shows a tall and curved peak of the QRS complex and a wide and curved dip of the T wave.

The strip shows that in the first four complexes, a short and curved peak continues as a tall and sharp peak, which then falls to a curved dip. From the fifth complex, there is a small and curved peak, a taller and sharp peak, a taller, wider, and curved peak, a taller sharp peak, and a short and curved dip.

Initially, the period of the QT interval is 0.41 seconds. The strip shows a curved peak of the P wave, a sharp peak of the R wave, a sharp dip of the S wave, and a curved and subtle dip of the T wave. After the occurrence of PVC, the waves are erratic with high amplitudes.

The strip shows 11 complexes. In complexes 1, 5, 7, and 10, there is a short and curved peak of the P wave and a double-notched dip of the QRS complex. In complexes 2, 6, and 11, there is a sharp peak of a P wave fused with the sharp dip of the QRS complex, pointed by an arrow. In complexes 4, 8, and 9, there is a double-notched dip of the QRS complex and a curved peak of the T wave.

The strip shows small and sharp dips of the QRS complexes occurring at irregular intervals along a fluctuating baseline. Arrows point toward a curved peak after a complex and a curved dip of the complex.