BASIC ARRHYTHMIA Exam SCRIPT 2026/2027
QUESTIONS WITH ANSWERS RATED A+
• 1 small box ECG paper -✓✓ is equal 0.04 seconds
• PR interval should be less than -✓✓ 0.20 seconds ( 5 small boxes)
• QRS complex should be less than -✓✓ 0.12 seconds ( 3 small boxes)
• sinoatrial (SA) node pacing rate is -✓✓ 60-100 beats per minute
• AV junction pacing rate -✓✓ 40-60 beats per minute
• Ventricular pacing rate -✓✓ 20-40 beats per minute
• Premature Atrial Contraction (PAC) -✓✓ caused by an ectopic focus in the atria that
stimulates an atrial response that comes early
You need to identify underlying rhythm!
• Premature Junctional Contraction (PJC) -✓✓ ectopic beat caused by stimulus from AV
junction that comes early. P waves is either absent, or negative, may follow QRS. QRS
is less than 0.12 sec
You need to identify underlying rhythm!
• Premature Ventricular Contraction (PVC) -✓✓ ectopic beat, early contraction of the
ventricles. QRS is wide and bizarre
You need to identify underlying rhythm!
• Atrial fibrillation (afib) -✓✓ rapid, random, ineffective contractions of the atrium
Irregular rhythm
P waves are missing, atria fibrillating
QRS is less than 0.12 seconds
• Atrial Flutter -✓✓ Rate:Atrial 250-350
P: Irregular or absent, often "saw tooth"
QRS: Normal
Rhythm: Regular (usually)
• Controlled Atrial Fibrillation -✓✓ average ventricular rate (number of QRS complexes)
is less than 100 beats per minute
• Ventricular rate -✓✓ calculated by number of QRS complexes in 1 minute
, • Uncontrolled Atrial Fibrillation -✓✓ Ventricular rate is more than 100 beats per minute
• Junctional Rhythm -✓✓ 40-60 beats per minute
Regular!
- P wave often inverted/missing/follow QRS
- narrow QRS (not wide like ventricular)
• Accelerated Junctional Rhythm -✓✓ regular rhythm, rate 60-100, p waves inverted or
occur before during or after QRS, PRI measured if p before QRS <0.12
• Junctional Tachycardia -✓✓ Rate: over 100
Regularity: regular
P-wave: inverted, absent, or occur after the QRS-complex
PR-interval: short or absent
QRS complex is less than 0.12 seconds
• First degree heart block -✓✓ AV block in which the atrial electrical impulses are
delayed while being conducted to the ventricles - PR interval is longer than 0.20
seconds (4 small boxes)
P wave is present for each QRS. No dropped beats
You need to identify underlying rhythm!
• Second Degree Heart Block Type II -✓✓ Rhythm: Regular (atrial) and irregular
(ventricular)
P Wave: Normal form, but more P waves than QRS complexes:
PR Interval: constant
QRS: Normal or wide
• Second Degree Heart Block Type 1 -✓✓ (Wenckebach's Phenomenon) PR interval
progressively lengthens until one (+) QRS is dropped.
Analogy: An old man goes to work. On his first day, he gets everything done on time.
On his second day, he gets all his work done, but a little late. On his third day, he gets
all his work done but its even later. On the fourth day, he is too tired and doesn't go into
work.
• Third Degree Heart Block (Complete Heart Block) -✓✓ more p waves than QRS;
(Complete heart block) No artial impulses are conducted through the AV node. Heart
has regular atrial activity and regular ventricular activity, but the activities are not
coordinated with each other. R-R always regular
• Asystole -✓✓ absence of contractions of the heart (both atria and ventricles) - flat line
• Ventricular Standstill -✓✓ No ventricular contraction, only P waves are seen
• Idioventricular Rhythm (IVR) -✓✓ Ventricles are pacing the heart
QUESTIONS WITH ANSWERS RATED A+
• 1 small box ECG paper -✓✓ is equal 0.04 seconds
• PR interval should be less than -✓✓ 0.20 seconds ( 5 small boxes)
• QRS complex should be less than -✓✓ 0.12 seconds ( 3 small boxes)
• sinoatrial (SA) node pacing rate is -✓✓ 60-100 beats per minute
• AV junction pacing rate -✓✓ 40-60 beats per minute
• Ventricular pacing rate -✓✓ 20-40 beats per minute
• Premature Atrial Contraction (PAC) -✓✓ caused by an ectopic focus in the atria that
stimulates an atrial response that comes early
You need to identify underlying rhythm!
• Premature Junctional Contraction (PJC) -✓✓ ectopic beat caused by stimulus from AV
junction that comes early. P waves is either absent, or negative, may follow QRS. QRS
is less than 0.12 sec
You need to identify underlying rhythm!
• Premature Ventricular Contraction (PVC) -✓✓ ectopic beat, early contraction of the
ventricles. QRS is wide and bizarre
You need to identify underlying rhythm!
• Atrial fibrillation (afib) -✓✓ rapid, random, ineffective contractions of the atrium
Irregular rhythm
P waves are missing, atria fibrillating
QRS is less than 0.12 seconds
• Atrial Flutter -✓✓ Rate:Atrial 250-350
P: Irregular or absent, often "saw tooth"
QRS: Normal
Rhythm: Regular (usually)
• Controlled Atrial Fibrillation -✓✓ average ventricular rate (number of QRS complexes)
is less than 100 beats per minute
• Ventricular rate -✓✓ calculated by number of QRS complexes in 1 minute
, • Uncontrolled Atrial Fibrillation -✓✓ Ventricular rate is more than 100 beats per minute
• Junctional Rhythm -✓✓ 40-60 beats per minute
Regular!
- P wave often inverted/missing/follow QRS
- narrow QRS (not wide like ventricular)
• Accelerated Junctional Rhythm -✓✓ regular rhythm, rate 60-100, p waves inverted or
occur before during or after QRS, PRI measured if p before QRS <0.12
• Junctional Tachycardia -✓✓ Rate: over 100
Regularity: regular
P-wave: inverted, absent, or occur after the QRS-complex
PR-interval: short or absent
QRS complex is less than 0.12 seconds
• First degree heart block -✓✓ AV block in which the atrial electrical impulses are
delayed while being conducted to the ventricles - PR interval is longer than 0.20
seconds (4 small boxes)
P wave is present for each QRS. No dropped beats
You need to identify underlying rhythm!
• Second Degree Heart Block Type II -✓✓ Rhythm: Regular (atrial) and irregular
(ventricular)
P Wave: Normal form, but more P waves than QRS complexes:
PR Interval: constant
QRS: Normal or wide
• Second Degree Heart Block Type 1 -✓✓ (Wenckebach's Phenomenon) PR interval
progressively lengthens until one (+) QRS is dropped.
Analogy: An old man goes to work. On his first day, he gets everything done on time.
On his second day, he gets all his work done, but a little late. On his third day, he gets
all his work done but its even later. On the fourth day, he is too tired and doesn't go into
work.
• Third Degree Heart Block (Complete Heart Block) -✓✓ more p waves than QRS;
(Complete heart block) No artial impulses are conducted through the AV node. Heart
has regular atrial activity and regular ventricular activity, but the activities are not
coordinated with each other. R-R always regular
• Asystole -✓✓ absence of contractions of the heart (both atria and ventricles) - flat line
• Ventricular Standstill -✓✓ No ventricular contraction, only P waves are seen
• Idioventricular Rhythm (IVR) -✓✓ Ventricles are pacing the heart
