5 Steps to Rhythm Strip Interpretation

Brief A&P:

 SA node; AV Junction; Bundle of His; Perkinje Fibers; Automaticity; Depolarization; Repolarization;

Cardiac Output;
 It is important to think of arrhythmias in terms of – can a patient tolerate that rhythm and how it is
affecting cardiac output or perfusion?

The 5 Steps

1. What is the Rate?

2. What is the Rhythm? Is it regular? If not, regularly or irregularly?
3. Is there a P for every QRS? Upright? Look the same?
4. P-R interval?
5. Do all the QRS complexes look the same? QRS length?

Defines the graphic representation of the electrical activity of the heart only; NOT the action of the
heart…….You can have electrical activity without contractility. CHECK THE PATIENT!!!!

Where its coming from:

– Sinus; SA node – normally 60 - 100bpm
– Atrial; SA node fails, impulse comes from the atria (the AV node) 40 - 60bpm
– Ventricular; SA node or AV junction fails, ventricles will shoulder responsibility of pacing the heart. Up to
40bpm

Sinus Rhythms

 Normal Sinus Rhythm (NSR) – rate of 60 – 100bpm

 Sinus Bradycardia (SB) - rate < 60bpm
 Sinus Tachycardia (ST) – rate > 100bpm

Atrial Rhythms – SA node fails to generate the rhythm or is overridden. Generally not considered life
threatening unless too slow or too fast. Think about it! What’s happening when it’s too fast?

 Atrial Flutter (A Flutter)

 Atrial Fibrillation (AFib)
 Supraventricular Tachycardia (SVT)
Ventricular Rhythms – SA node or AV node Fail or is overridden by ventrical. !!!!SERIOUS!!!!, Can be
lethal. Check Patient.

 Premature Ventricular Complex (PVC) – not so much..

 Ventricular Tachycardia (VT)
 Ventricular Fibrillation/Torsades (VF)
 Asystole
 Pulseless Electrical Activity (PEA): The absence of a palpable pulse and myocardial muscle activity
with the presence of organized electrical activity (excluding VT and VF) on cardiac monitor. It is
not an actual rhythm, it represents a clinical condition wherein the patient is clinically dead,
despite the fact that some type of organized rhythm appears on the monitor.

Types of Heart Blocks

 First Degree AV Block
 Second-Degree AV Block (Mobitz Type I) or Wenckebach
 Second-Degree AV Block (Mobitz Type II)
 Third Degree AV Block (Complete)

Rate Ruler : I use this. You don’t have to, but if you want to let me know! An easier and quicker way to
estimate the heart rate. As seen in the diagram below, when QRS complexes are 1 box apart the rate is
300 bpm. 2 boxes apart...150 bpm, etc. So if you memorize these simple numbers you can estimate the
heart rate at a glance!