This document provides an overview of basic dysrhythmia interpretation and ECG analysis. It defines key aspects of the ECG waveform including the P wave, PR interval, and QRS complex. It describes methods for calculating heart rate and outlines the characteristics of normal sinus rhythm as well as various arrhythmias including atrial fibrillation, atrial flutter, atrial tachycardia, premature ventricular contractions, ventricular tachycardia, ventricular fibrillation, and different types of AV blocks. The document emphasizes the importance of consistently analyzing the ECG for rate, rhythm, P wave properties, and interval durations.

1. Basic Dysrhythmia
Interpretation
Presented by :
Rina Hadi Abdullah Lestari
CRN/ACLS Instructor/Nursing Director Secretary

2. Heart

4. Recording of the ECG

5. • P wave represents atrial activation (0.08 - 0.10s)
• PR interval is the time from onset of atrial activation to
onset of ventricular activation. (0.12 - 0.20s)
• QRS complex represents ventricular activation (0.06 -
0.10s)
• QT interval is the duration of ventricular activation and
recovery (≤ 0.44 s)

6. Calculating Heart Rate
Several method can be used including:
• 6-second interval X 10 method
• 300,150,100,75,60,50 Method
• 1500 method
• Rate calculator

21. Lets Have A Deal …!!!!
• Normal P, normal P-R, normal QRS, normal
P:QRS ratio = Sinus ……
• Problem in the P wave = Atrial ………
• Problem in the QRS = Ventricular ………
• More P waves than QRS = 2nd or 3rd Degree AV
Block.
• Fibrillation = always irregular

22. ECG - Analysis
• Use a consistent method to analyze an ECG
– Rate
– Rhythm
– Assess P wave
– Assess P wave to QRS ratio 1=1
– Interval duration

23. Sinus Rhythm
1- Sinus Rhythm ( the only normal one )
• Rate 60-100 bpm
• Regular
• Normal identical P waves
• P-R interval Normal
• Each P followed by a QRS
• Normal QRS
Normal QRS
PR interval

24. Normal Sinus Rhythm

25. 2-Sinus Tachycardia
• Same as SR but the rate is > 100
• Regular
• Normal identical P waves
• P-R interval Normal
• Each P followed by a QRS

26. 3- Sinus Bradycardia
• Same as SR but the rate is < 60
• Regular
• Normal identical P waves
• P-R interval Normal
• Each P followed by a QRS

27. Sinus Bradycardia

28. Atrial Arhythmias
• General Characteristics
1. Abnormal P wave.
2. Multiple Foci.
3. Regular or Irregular
4. Fast most of the time

29. 1- Atrial Fibrillation
• Always irregular
• No P wave ( can not be determined )
• Normal QRS
Unequal R-R = irregular

30. Atrial Fibrilation

31. 2- Atrial Flutter
• Mostly regular, but it can be irregular
• No P wave but saw-toothed wave ( F wave )
• Normal QRS
ٍSaw toothed
Normal QRS

32. Atrial Flutter

33. 3- Atrial Tachycardia
• Some times it is called Supraventricular
Tachycardia ( SVT ).
• Very fast rate > 150 bpm.
• Narrow QRS.
• No P wave.(Shaped like an umbrella )
No P wave
Narrow QRS
Very fast

34. Atrial Tachycardia

35. Ventricular Rhythms
• General characteristics
1. Wide QRS.
2. NO P wave
3. Mostly very fast
4. Could be Lethal

36. Idioventricular Rhythms
• Regular
• No P wave
• Wide QRS
• Rate 20-40
No P wave

37. • Premature = comes early with bizarre shape.
• Most of the time accompany sinus rhythm.
1- Premature Ventricular
Contraction ( PVC )
PVCs
( early, wide and bizarre)

38. PVCs … continued
2- unifocal vs. multifocal
Unifocal
multifocal

39. PVCs … continued
3- Couplets
4. Bigeminy
Couplets
Every other beat is PVC

40. PVCs…Continued
5- Trigeminy
every second beat is PVC
Every second beat is PVC

41. 6- Ventricular Tachycardia
( V-tach.)
• A whole strip with PVCs. (Wide QRS)
• Rate :Rate
• No P waves.
• If there is no pulse, it is lethal
• Always check the Pulse and BP

42. Monomorphyc VT
• The appearance of all the beats match each
other in each lead of a surface ECG

43. Polymorphic VT
Torsade de pointes ( twisting of the point)
has beat-to-beat variations in morphology

44. 7- Ventricular Fibrillation
• No P waves, No QRS, only electrical
activity present.
• Lethal, always check Pulse and BP

45. AV Blocks
• Prolonged P-R interval or more P waves
than QRS
• Block means DELAY.

46. 1- 1st Degree AV Block
• It looks like the sinus rhythm but with prolonged
P-R interval..
• Normal and identical P waves. Each P is
Followed by a QRS
• Normal QRS.
• P-R interval is > 0.20 sec.
Prolonged P-R interval

47. 2- 2nd Degree AV Block
a- Mobitz I
• Normal QRS.
• Identical P waves.
• P-R interval progressively prolongs until there
is P not followed by a QRS
P without QRS

48. • Identical P waves, Not every P is followed by a QRS.
• When there is a QRS, it has to be preceded by a P
wave
• Atrial rate is regular.
• Check BP immediately.
2nd Degree AV Block
a- Mobitz II
Identical P waves
Every QRS preceded by a P waves

49. • No relationship between P waves and QRS
complexes
• Check the BP immediately
3rd Degree AV Block
( Complete Heart Block )

50. Pulseless Electrical Activity

51. No electrical Activity
( Asystole ) or Ventricular Standstill
No QRS, no electrical activity, P waves may
present

53. Artifact
Artifact occurs when something causes a disruption in
monitoring.
Some common causes are:
• AC interference
• Muscle tremors
• Respiratory artifact-wandering baseline
• Loose electrode
• Broken lead wire

54. Instant Feedback 
1.Sinus tachycardia is a normal response to
pain.
True
False
2. Sinus bradycardia is always abnormal
and must be treated.
True
False

55. 3.
Instant Feedback 
The hallmark sign of atrial fibrillation is:
a. An irregulary rhythm
b. A sawtooth pattern
4. In atrial flutter, instead of P waves there is
commonly a "sawtooth" pattern seen.
a. True
b. False
5.Treatment is usually required if there are more
than six PVCs per minute.
a. True
b. False

56. Instant Feedback 
6.In first degree AV block, the P-R interval is:
a. Greater than 0.20 seconds
b. Between 0.12 and 0.18 seconds
7. In a third degree heart block, the P waves are
"married" to the QRS complexes.
a. True
b. False

57. Instant feedback
• 8. who am i??
• 9. give me a name please 

58. Last