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Robert · Accepted Answer

Let us consider this to be a 10sec rhythm strip.  
Rhythm: is regular.  
If RR interval is constant, then the rhythm is regular.  
Rate: Between two dark vertical lines, distance is 5mm. There are 3.8 vertical boxes between 
two R-R intervals.  
5mm = 0.2 sec. 
So, 0.2*3.8 mm = 0.76 seconds 
This implies (60/0.76=) 78.94 beats per min. 
Ventricular rate = number of QRS complexes in one minute = 8*6 = 48 bpm 
Atrial rate= number of P waves in one minute = 8*6 = 48 bpm
P waves are present. Please note that there is one P wave for every QRS. So, ventricular and 
atrial rates are same.
P wave is not normal or irregular. P wave is enlarged. This means that atria are also enlarged. 
Left atrial enlargement is evident.  
It is not followed by QRS complex immediately.  
QRS configuration: Q is the first negative deflection after P wave. Here it is not so. Before Q 
there is another negative deflection.  
R is the positive deflection. It is present here. 
S is the negative deflection after R wave. It is also present and shown in the diagram above.
PR interval: 2 large boxes. 
One large box is 0.2 sec, so, two large boxes will be 0.4 seconds.  
Normal PR interval is 0.12 to 0.20s. So, this PR interval is prolonged.
QRS complexes: Present and Regular
QRS duration: 70% of 0.2 seconds = 0.14 seconds 
Normal QRS is 0.08 to 0.12 seconds. 
So, QRS interval is slightly prolonged.
Other comments: T and U waveforms are totally missing. T is the first upward deflection after 
QRS complex. Absent T wave has hardly any clinical significance.   
Strip interpretation: 
Delay in conduction through ventricles and auricles results in prolonged QRS and PR complex. 
Prolonged QRS also indicates drug toxicity and electrolyte imbalance. This patient may be 
having slight electrolyte balance. Regular exercise is recommended. Stress test should be 
conducted.
EKG 2:
 
Rhythm: is irregularly irregular or totally irregular.  
Rate:  
Ventricular rate = number of QRS complexes in one minute = 13*6 = 78 bpm 
Atrial rate= number of P waves in one minute.  
Please note that P waves are not identifiable. This indicates sinus arrhythmia.
P waves are present.

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