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Identify the following sinus rhythms 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. Answers: 1. Sinus Arrhythmia Sinus Arrhythmia.   The rhythm is irregular.  There is one upright P wave for each QRS complex. The rate is between 60-100.  The rhythm is determined by measureing the distance between the adjacent R waves, called the R-R interval.  If the rhythm is regular, the R-R interval should be the same.  With sinus arrhythmia, the difference between the shortest and longest R-R interval is over 0.12. sec. and the PR interval should be the same.  Some normal rhythmic variation occurs with respirations.  The heart rate speeds up slightly with inspiration and decelerates with expiration. 2. Normal Sinus Rhythm Normal Sinus Rhythm.  The rhythm is regular.  There is one upright P wave with each QRS complex.  the PR interval is < 0.12 sec.  There are no ectopic beats.  The rate is 79.  A PR interval

1. 2. 3. 4. 5. 6. 7. 8. 9. 10. Answers 1. Junctional rhythm Junctional rhythm.  The rhythm is regular.  There are P waves but they are inverted and the QRS complexes are narrow (< .12 sec).  What is the rate?   This is the factor for determining which junctional rhythm you are looking at.  Junctional rhythms arise from around the AV junction.  The inherent rate of AV junctional area is 40-60 and the rhythm is called a junctional rhythm.  When the rate is between 60-100 it is called an accelerated junctional rhythm and it is called junctional tachycardia when the rate exceeds 100 beats per minute.  The characteristics of a junctional rhythm is that the rhythm is regular.  The P wave may be absent or be present but inverted and precede or follow the QRS complex.  The QRS complexes are usually narrow.  2. Junctional Tachycardia Junctional Tachycardia.  The rhythm is regular.

01. 02. 03. 04. 05. 06. 07. 08. 09. 10. Answers 01. Sinus Rhythm With 1st Degree AV Block Sinus Rhythm With 1st Degree AV Block.  This block is characterized by a PR interval that is greater than .20 sec.  The rhythm is usually regular.  There is one P wave for each QRS complex (no dropped beats).  What is the actual PR interval in this strip?  02. 3rd Degree Heart Block 3rd Degree Heart Block  or Complete Heart Block is identified by P waves and QRS complexes that do not occur together.  Recall that in a sinus rhythm there should be one P wave for each QRS complex and that the PR interval should be < .20 seconds.   In most cases, structually there is a block below the level of the AV node so this prevents electrical impulses by the SA node from reaching the ventricles. Thus, an escape mechanism comes into play and the ventricular rate will be dependent upon a junctional focus