EKG

Lessons. Practice Strips and Drills

EKG Definition

An EKG, also called an ECG or electrocardiogram, is a recording of the heart's electrical activity. It is a quick and painless procedure. EKGs captures a tracing of cardiac electrical impulse as it moves from the atrium to the ventricles. These electrical impulses cause the heart to contract and pump blood. EKGs are interpreted by medical professionals to understand the following:

  • Heart rate
  • Heartbeat regularity
  • Strength and timing of the electrical signals
  • Any possible abnormal conditions

EKG Training Introduction

Use our lessons, drills and quizzes to improve your EKG knowledge and skills.

EKG Interpretation - Introduction

This introductory course reviews the main features of electrocardiogram strips. A method for analyzing an electrocardiogram is presented. This method includes assessment of rhythm, calculating heart rate, observing P-wave forms, measurement of wave intervals and segments and the evaluation of other relevant waves. In addition, our drills allow students to practice electrocardiogram identification.

EKG Basics

EKG Practice Drills

The EKG practice drills provide a fast and interactive method for learning EKGs. Users are asked to identify the arrhythmia category. Immediate feedback is available after answering a multiple choice question.

EKG Practice Drills

ECG Quiz

Our quiz presents twenty tracings for interpretation. A graded quiz provides detailed feedback. Quiz ekg tracings are randomly selected from our database of 375 tracing, so the quiz can be repeated many times.

ECG Quiz

EKG Reference Guide

Our EKG Reference Guide provides information on over forty different types of arrhythmias. For each type there are patient tracings and simulated electrocardiograms. We also provide an annotated tracing with a summary of the key features and values. Interactive digital calipers can be used for measuring key features on each tracing.

EKG Reference Guide

ECG Interpretation Tutor

Try the ECG interpretation with immediate coaching.

ECG Rhythm Interpretation Tutor

12 Lead EKG


12 lead ekg tracing

A slide presentation on 12 lead EKG, written by Dr. Michael Mazzini, M.D., Boston University.

12 Lead EKG Lecture

Practice 12 lead EKG interpretation with immediate feedback.

12 Lead Tutor

ECG Monitor Quiz (beta version)

Our Monitor Quiz is similar to the standard Quiz, but with a twist. Instead of static tracings, the ECGs are presented using a simulated patient monitor. After the twenty tracings are evaluated, we present a graded report along with static images of each tracing. Your score is compared to a mean score for all recent website visitors. Don't worry, your score is kept private.

ECG Monitor Quiz

Spanish Edition

In cooperation with Project Semilla, we have recently launched Spanish Editions of several of our ECG training modules.

Guía de referencia de los ritmos cardíacos

Paciente Virtual Prueba con Monitor

Ejercicios de práctica de ritmos cardíacos

Conceptos Básicos ECG

French, German & Spanish EKG Training

Quick Links

Abnormal EKG Types

A summary of each of the most common EKG types is provided below.

Accelerated Idioventricular Rhythm
Accelerated Idioventricular Rhythm EKG Strip

The EKG rhythm will appear regular. The heart rate is 50-120 bpm, which is faster than a ventricular rhythm but slower than ventricular tachycardia. The P wave is absent and PR interval is not measurable. The QRS complex will typically be wide (>0.10 sec) and bizarre looking.

Accelerated Junctional Rhythm
Accelerated Junctional Rhythm ekg strip

The EKG rhythm will appear regular with heart rate that is normal (60-100 bpm). The P wave is present before, during (hidden) or after QRS. If visible it is inverted. The PR interval is not measurable. The QRS complex will typically be normal (0.06-0.10 sec).

Asystole
Asystole EKG strip

Cardiac electrical activity is absent. No EKG rhythm can be observed. The P wave and QRS complex are not visible. Confirm using multiple leads.

Atrial Fibrillation
Atrial Fibrillation EKG strip

The EKG rhythm will appear irregular. Heart rate is very fast: over 350 bpm for atrial, but ventricular rate may be slow, normal or fast. The P wave features are absent - erratic waves are present. The PR interval is absent. The QRS complex will typically be normal but may be widened if there are conduction delays.

Atrial Flutter
Atrial Flutter EKG strip

The atrial heart rate is rapid (250-350 bpm), but ventricular rate is often slower. EKG rhythm will appear more regular thank atrial fibrillar. P wave and PR interval are not observable, but saw-toothed flutter waves are present.The QRS complex will typically be normal (0.06-0.10 sec).

Bundle Branch Block
Bundle Branch Block EKg strip

The EKG rhythm P wave features should appear normal and the PR interval is normal (0.12-0.20 sec). The QRS complex will typically be wide (>0.12 sec).

First Degree Heart Block
First Degree Heart Block EKG strip

The P wave will be normal while the PR interval is prolonged (>0.20 sec). The QRS complex will typically be normal (0.06-0.10 sec).A first degree av block occurs when electrical impulses moving through the atrioventricular (AV) node are delayed (but not blocked). The adjective first degree indicates slowed conduction without missed beats.

Idioventricular Rhythm
Idioventricular Rhythm EKG strip

The EKG rhythm will appear regular with a very slow heart rate(20-40 bpm). The P wave will be absent and the PR interval is not measurable. The QRS complex will typically be wide (>0.10 sec) and a bizarre appearance.

Junctional Escape Rhythm
Junctional Escape Rhythm EKG strip

The EKG rhythm will appear regular. Hheart rate that is slow (40-60 bpm). The P wave will be present before, during (hidden) or after QRS, if visible it is inverted. The PR interval is not measurable. The QRS complex will typically be normal (0.06-0.10 sec).

Junctional Tachycardia
Junctional Tachycardia EKG strip

The EKG rhythm will appear regular with a fast heart rate (100-180 bpm). The P wave can appear before, during (hidden) or after QRS, if visible it is inverted. Observe that the PR interval is absent or short. The QRS complex will typically be normal (0.06-0.10 sec).

Multifocal Atrial Tachycardia
Multifocal Atrial Tachycardia EKG strip

The EKG rhythm will appear irregular with a fast heart rate (> 100 bpm). The P wave features often change shape and size from beat to beat with at least three differing forms. Observe that the PR interval is variable. The QRS complex will typically be normal (0.06-0.10 sec). In addition, the T wave can be distorted.

Normal Sinus Rhythm
Normal Sinus Rhythm EKG strip

The EKG rhythm will appear regular with a normal (60-100 bpm) heart rate. The P wave appears normal and precedes each QRS). Observe that the PR interval is normal (0.12-0.20 sec). The QRS complex will typically be normal (0.06-0.10 sec).

Pacemaker Failure to Capture
Pacemaker Failure to Capture EKG strip

The EKG rhythm will appear irregular with heart rate that is slow or normal. Observe that the pacemaker spikes are not followed by p waves or qrs complexes.

Pacemaker Failure to Pace
Pacemaker Failure to Pace EKG strip

The EKG rhythm will appear irregular and pacemaker spikes do not appear.

Pacemaker Single Chamber Atrial

The EKG rhythm will appear regular with heart rate that is normal. The P wave and PR interval will both appear normal. The QRS complex is also normal. Pacemaker spikes will precede the P wave.

Premature Atrial Complex
Premature Atrial Complex EKG strip

The EKG rhythm will appear irregular with heart rate that is usually normal but depends on underlying rhythm. The P wave will appear premature, positive and a shape that is abnormal. Observe that the PR interval is normal or longer. The QRS complex will typically be 0.10 sec or less.

Premature Junctional Complex
Premature Junctional Complex EKG strip

The EKG rhythm will appear regular with premature beats with heart rate that is the underlying rate. The P wave is present before, during (hidden) or after QRS. If the P wave is visible it is inverted. Observe that the PR interval is absent or short. The QRS complex will typically be normal (0.06-0.10 sec).

Premature Ventricular Complex
Premature Ventricular Complex EKG strip

The EKG rhythm will appear irregular with heart rate that is the underlying rate. The P wave features absent. Observe that the PR interval is not measurable. The QRS complex will typically be wide (> 0.10 sec) with a bizarre appearance.

Premature Ventricular Complex Bigeminy
Premature Ventricular Complex Bigeminy EKG strip

The EKG rhythm will appear irregular with an absent P wave and the PR interval is not measurable. The QRS complex will typically be wide (> 0.10 sec) with a bizarre appearance. The PVC appears on every second beat.

Premature Ventricular Complex Quadrigeminy
Premature Ventricular Complex Quadrigeminy EKG strip

The EKG rhythm will appear irregular. The P wave is absent and the PR interval is not measurable. The QRS complex will typically be wide (> 0.10 sec) and bizarre in appearance. The PVC appears every fourth beat.

Premature Ventricular Complex Trigeminy
Premature Ventricular Complex Trigeminy EKG strip

The EKG rhythm will appear irregular. The P wave is absent and the PR interval is not measurable. The QRS complex will typically be wide (> 0.10 sec) with a bizarre appearance. The PVC appears every third beat.

Second Degree Heart Block Type I
Second Degree Heart Block Type I EKG strip

The EKG rhythm will appear irregular but with progressively longer pr interval lengthening. The P wave is normal. Observe that the PR interval becomes progressively longer until a QRS complex is missed, then cycle repeats. The QRS complex will typically be normal (0.06-0.10 sec).

Second Degree Heart Block Type II
Second Degree Heart Block Type II EKG strip

The EKG rhythm will appear regular (atrial) and irregular (ventricular) with heart rate that is characterized by atrial rate that is usually faster than ventricular rate (usually slow). The P wave has a normal form, but more P waves than QRS complexes. The PR interval is normal or prolonged. The QRS complex will typically be normal or wide.

Sinoatrial Block
Sinoatrial Block EKG strip

The EKG rhythm will appear irregular when SA block occurs with a normal or slow heart rate. The P wave will be normal and the PR interval will be normal (0.12-0.20 sec). The QRS complex will typically be normal (0.06-0.10 sec).The pause time is an integer multiple of the p-p interval.

Sinus Arrest
Sinus Arrhythmia EKG strip

The EKG rhythm will appear irregular due to a pause with heart rate that is normal to slow. The P wave is normal. The PR interval is normal (0.12-0.20 sec). The QRS complex will typically be normal (0.06-0.10 sec). Pause time is not an integer multiple of the p-p interval.

Sinus Arrhythmia

The EKG rhythm will appear irregular, varying with respiration with heart rate that is normal (60-100 bpm) and rate may increase during inspiration. The P wave is normal and the PR interval is also normal (0.12-0.20 sec). The QRS complex will typically be normal (0.06-0.10 sec). Heart rate frequently increases with inspiration, decreasing with expiration.

Sinus Bradycardia
Sinus Bradycardia EKG strip

The EKG rhythm will appear regular with a slow heart rate (< 60 bpm). The P wave and the PR interval are normal. The QRS complex will typically be normal (0.06-0.10 sec).

Sinus Tachycardia
Sinus Tachycardia EKG strip

The EKG rhythm will appear regular with a fast heart rate (> 100 bpm). The P wave normal but may merge with T wave at very fast rates. Observe that the PR interval is>normal (0.12-0.20 sec). The QRS complex will typically be normal (0.06-0.10 sec). The QT interval shortens with increasing heart rate.

Supraventricular Tachycardia
Supraventricular Tachycardia EKG strip

The EKG rhythm will appear regular and heart rate that will be fast (150-250 bpm). The P wave will be merged with T wave. The PR interval is normal (0.12 sec) but can be difficult to measure. The QRS complex will typically be normal (.10 sec).

Third Degree Heart Block
Third Degree Heart Block EKG strip

The EKG rhythm will appear regular, but atrial and ventricular rhythms are independent. Heart rate is characterized by atrial rate usually normal but that is faster than the ventricular rate. The P wave will have normal shape and size but may appear within QRS complexes. The PR interval is absent: the atria and ventricles beat independently. The QRS complex will typically be normal, but wide if junctional escape focus.

Ventricular Fibrillation

The EKG rhythm will appear highly irregular with an unmeasurable heart rate. The P wave is absent, the PR interval is not measurable and no QRS complex. The EKG tracings is a wavy line.

Ventricular Tachycardia
Ventricular Tachycardia EKG strip

The EKG rhythm will appear regular with heart rate that is fast (100-250 bpm). The P wave is absent and the PR interval is not measurable. The QRS complex will typically be wide (>0.10 sec) with a bizarre appearance.

Ventricular Tachycardia Monomorphic
Ventricular Tachycardia Monomorphic EKG strip

The EKG rhythm will appear regular with a fast (100-250 bpm) heart rate. The P wave is absent and the PR interval is not measurable. The QRS complex will typically be wide (>0.10 sec) and bizarre looking.

Ventricular Tachycardia Polymorphic
Ventricular Tachycardia Polymorphic EKG strip

The EKG rhythm will appear regular or irregular with heart rate that is fast (100-300 bpm). The P wave is absent and the PR interval is not measurable. The QRS complex will typically be normal or wide (>0.10 sec) with a bizarre shape.

Ventricular Tachycardia Torsade de Pointes
Ventricular Tachycardia Torsade de Pointes EKG strip

The EKG rhythm will appear irregular with heart rate that is fast (200-250 bpm). The P wave is absent and the PR interval is not measurable. The QRS complex will typically be wide (>0.10 sec). Its shape is characterized by a gradual change in the EKG amplitude and a twisting of the QRS complexes around a line.

Wandering Atrial Pacemaker
Wandering Atrial Pacemaker ekg strip

The EKG rhythm will appear may be irregular with a normal heart rate. The P wave can be observed changing shape and size from beat to beat (at least three diffferent forms). The PR interval is variable in length. The QRS complex will typically be normal (0.06-0.10 sec) and the T wave normal. If heart rate exceeds 100 bpm, then rhythm may be multifocal atrial tachycardia (MAT).

Wolff-Parkinson-White Syndrome
Wolff-Parkinson-White Syndrome ekg strip

The EKG rhythm will appear regular unless atrial fibrillation present. Heart rate is normal (60-100 bpm). The P wave is normal. Observe that the PR interval is can be short (<0.12 sec). The QRS complex will typically be wide (> 0.12 sec). A delta wave (positive or negative) distorts the early part of the QRS complex.



Authors

Our website contributors and authors include:

  • Dr. Jon Keroes
  • Dr. Barbara Erikson
  • David Lieberman
  • Diane Wrigley
  • Dr. Michael Mazzini
  • Tom O'Brien
  • William French
  • The simulation software team at Medical Training and Simulation, LLC






This website is intended for use by medical professionals for educational purposes only. For medical care, contact a healthcare provider. Copyright 2019 © Medical Training and Simulation LLC. All Rights Reserved.

This website is intended for use by medical professionals for educational purposes only. For medical care, contact a healthcare provider. Copyright 2019 © Medical Training and Simulation LLC. All Rights Reserved.