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 Table of Contents
Welcome to An Atlas of Heart Rhythms, copyright © 2000, 2014 by Roy Pittman.
Information about this website may be obtained by contacting the author at:


This atlas is free for you to use, free from advertising, and will stay that way.  I hope it is useful to you.  If you have questions you can ask them by emailing me at the address above.  If you want to express your appreciation, click on the "Donate" button above.  Any amount is welcome.

This atlas began as a collection of illustrations for a lecture on heart rhythms.  I believed that large, clear, attractive illustrations would make learning easier, and have found this to be the case.   Here are close to one hundred of the most illustrative and legible strips I have taken from clinical practice.  Each strip is presented with leading questions, then discussed for the rhythm it illustrates, and for other interesting features it may have.  This case-by-case approach offers the opportunity to start with the very simple and develop into greater depth on each page.  Some very basic knowledge of EKGs is assumed.   This web presentation is not intended as a stand-alone complete text on the subject.   It is intended as a complement to a basic text, with the hope that it will assist the student in taking a firmer grasp of fundamentals, and in reaching further into the depths of detail that the subject possesses.
An explanation or warning is needed here: the conventional wisdom is that monitor strips, while excellent for rhythm analysis, cannot be relied upon for morphology - interpretation of such matters as the details of bundle branch blocks, ischemia, and drug and electrolyte effects.   This conventional wisdom is largely correct, and a 12-lead EKG should be obtained whenever morphological interpretation is needed.  However, in this atlas, strips will be interpreted for morphology.  The opportunities are just too good to pass up.  One further note: in every strip in this atlas where a V lead is seen, it is a V-1.

To use this atlas, select a page from the Table of Contents below.   You may want to start at the beginning of the atlas, or start at the beginning of a subtopic.  Either way, you will be able step forward or back through the pages until you decide to quit.
Be sure to look at the Index.   It is pretty well crossreferenced and by selecting pages and using your browser's "back" button you can look at all the entries on a particular topic.

Table of Contents

 ABCs of EKGs
         EKG paper
         A Normal Beat: its Elements
         Normal Intervals and Durations
         Lead Axis
  Atrial Rhythms and Beats
         Normal Sinus Rhythm
         Sinus Rhythm Variants
         QRS widths
         Right and Left Bundle Branch Blocks
         Sinus Bradycardia
         Sinus Tachycardia
         Sinus Arrhythmia example one
         Sinus Arrhythmia example two
         Sinus Pauses example one
         Sinus Pauses example two
         Premature Atrial Contraction example one
         Premature Atrial Contraction example two
         Atrial Bigeminy
         Wandering Atrial Pacemaker example one
         Multifocal Atrial Tachycardia
        Atrial Fibrillation example one
        Atrial Fibrillation example two
        Atrial Fibrillation example three
         Atrial Flutter example one
        Atrial Flutter example two
        Atrial Flutter example three
         Atrial Flutter example four
         Fib / Flutter example one
         Fib / Flutter example two
         Supraventricular Tachycardia
         Paroxysmal Supraventricular Tachycardia
 Junctional Rhythms and Beats
         Junctional Rhythm example one
         Junctional Rhythm example two
         Accelerated Junctional Rhythm example one
         Accelerated Junctional Rhythm example two
         Junctional Escape Beats example one
         Junctional Escape Beats example two
 Ventricular Rhythms and Beats
         Premature Ventricular Contraction
         Interpolated PVCs
         Multifocal PVCs
         Multifocal Couplet
         PVCs and Fusion Beats
         Ventricular Escape Beat
         Ventricular Bigeminy
         Ventricular Trigeminy
         Ventricular Tachycardia example one
         Ventricular Tachycardia example two
         Ventricular Tachycardia example three
         Ventricular Tachycardia: Torsades des Pointes
         A Four-Beat Run of VT
         Intermittent Bundle Branch Block
         Rate Related Bundle Branch Block example one
         Rate Related Bundle Branch Block example two
         Reperfusion Ectopy
         Idioventricular Rhythm example one
         Idioventricular Rhythm example two
         Accelerated Idioventricular Rhythm
         Agonal Rhythm
         Ventricular Fibrillation example one
         Ventricular Fibrillation example two
 Atrioventricular Blocks
         First Degree Block
         Second Degree Block Type One example one
         Second Degree Block Type One example two
         Second Degree Block Type Two example one
         Second Degree Block Type Two example two
         Second Degree Block Type Two example three
         Wandering Atrial Pacemaker example two
         Second Degree Block two-to-one type
         Third Degree Block example one
         Third Degree Block example two
         Third Degree Block example three
 Electronic Pacing
         A Note about Pacemaker Nomenclature
         Atrial Pacing example one
         Atrial Pacing example two
         Ventricular Pacing example one
         Ventricular Pacing example two
         Ventricular Pacing example three
         Ventricular Pacing example four
         Ventricular Pacing example five
         Dual Chamber Pacing example one
         Dual Chamber Pacing example two
         Dual Chamber Pacing example three
         Check of Underlying Rhythm
         Failure to Capture
         Failure to Sense
         Failure to Capture and Sense example one
         Failure to Capture and Sense example two
         60 Cycle Interference
         Seizure Activity example one
         Seizure Activity example two
         Toothbrushing Rhythm
         Chest Percussion Therapy