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Latest Update (2026/2027)
Question:
Atrial Flutter -has a "saw tooth or
picket fence" atrial pattern (no P
waves, F-waves in stead that may be
in a ratio) between the QRS
complexes.
Atrial Fibrillation-Has "chaotic" atrial
electrical activity (no P waves, f-
waves instead) with irregular R-R
intervals.
PJCs cause the rhythm to be
irregular. The P wave is inverted if it
can be seen. It may occur before,
during or after the QRS. The P wave
will not be seen due to its low
voltage.
Junctional Rhythm may have an
inverted or absent P wave. The P
wave may occur before, during or
after the QRS complex. The rate for
this rhythm is 40-60 bpm.
Accelerated Junctional Rhythm may
have an inverted or absent P wave.
The P wave may occur before, during
or after the QRS complex. The rate
for this rhythm is 60-100 bpm.
Junctional Tachycardia Rhythm may
have an inverted or absent P wave.
, The P wave may occur before, during
or after the QRS complex. The rate
for this rhythm is 100-180 bpm
Supraventricular Tachycardia
presents with a "normal-narrow"
appearing QRS complex and a rate
of greater than 150 bpm. Remember
for heart rates approaching 150 or
higher, it will be very likely that the P
wave will be buried. Be prepared to
increase the paper speed for this
rhythm.
First Degree AV Block, the PR
interval is constant and measures
greater than 0.20 second.
Second Degree AV Blocok Mobitz I
(Wenkebach) has a cyclical
prolonging PR interval until the QRS
is dropped. Then the cycle begins
again. ***Remember the clue
"lengthen, lengthen drop
Wenkebach.
Second Degree (AV) Block has a
constant PR interval with blocked
QRS complexes
Second Degree (AV) Block has a
constant PR interval with blocked
QRS complex (2)
Third Degree (Complete) Heart
Block, the P-P and R-R intervals are
regular (constant) but firing at
different rates.
T wave inversion, or negatively
deflected T wave indicates ischemia
and is usually seen with ST segment
elevation.