The following guidelines were adhered to during the annotation of ECGs for the ECG Quiz. Please ensure you follow these same principles when selecting your diagnoses.

Be sure to read how Differential Diagnoses and Multiple Interpretations are handled in the ECG Quiz.

Bradycardia

A rhythm that is ≤ 60 beats/min for 3 or more consecutive RR intervals.

Tachycardia

A rhythm that is ≥ 100 beats/min for 3 or more consecutive RR intervals.

Sinus Arrest

Sinus node inactivity that lasts 3 seconds or more.

Ventricular Asystole

Ventricular inactivity that last 3 seconds or more.

First Degree AV Block

A PR interval ≥ 200 milliseconds.

Bigeminy, Trigeminy, and Quadrigeminy

Include when 3 or more cycles of the pattern are present in the ECG.

Premature Complexes (Atrial, Junctional, and Ventricular)

Include the diagnosis when one or more of these complexes is present and not included in another diagnosis.

Here are a couple of illustrative examples:

• A Ventricular Tachycardia is present and no other instances of Ventricular Premature Complexes are present in the ECG
  • Do not include Ventricular Premature Complexes.
• A Ventricular Bigeminy rhythm transitions into a Normal Sinus Rhythm that includes one or more Ventricular Premature Complexes not in a pattern
  • Include Ventricular Premature Complexes.

Sinus Rhythm

Sinus Rhythm is defined as a supercategory that includes Normal Sinus Rhythm, Sinus Tachycardia, Sinus Bradycardia, and Marked Sinus Bradycardia.

Only use Sinus Rhythm when one of the subcategory rhythms cannot clearly be determined. As such, Sinus Rhythm and Normal Sinus Rhythm are not synonyms.

For example if you enter Sinus Rhythm and the correct rhythm is clearly Normal Sinus Rhythm, you will receive a False Positive for entering Sinus Rhythm and a False Negative for failing to enter Normal Sinus Rhythm. See the Hierarchical Scoring Modifications section in The Scoring System and the Understanding the Results sections for more information on how your results are scored.

Include these diagnoses when the sinus rate is as follows:

• Marked Sinus Bradycardia: The sinus rate is < 40 BPM
• Sinus Bradycardia: The sinus rate is >= 40 BPM and < 60 BPM
• Normal Sinus Rhythm: The sinus rate is >= 60 BPM and < 100 BPM
• Sinus Tachycardia: The sinus rate is >= 100 BPM

Multifocal Atrial Tachycardia and Wandering Atrial Pacemaker

Include these diagnoses if the ECG contains three or more distinct P wave morphologies, the absence of a dominant P wave morphology, and varying P-P intervals.

• Multifocal Atrial Tachycardia if the ventricular rate is >= 100 BPM
• Wandering Atrial Pacemaker if the ventricular rate is < 100 BPM

Junctional Rhythms

Include these diagnoses if the ECG contains three or more junctional beats at the following rates.

• Junctional Bradycardia: The rate is < 40 BPM
• Junctional Rhythm or Junctional Escape Rhythm: The rate is >= 40 BPM and < 60 BPM
• Accelerated Junctional Rhythm: The rate is >= 60 BPM and < 100 BPM
• Junctional Tachycardia: The rate is >= 100 BPM

Permanent Junctional Reciprocating Tachycardia (PJRT)

PJRT is a rare type of supraventricular tachycardia caused by an accessory pathway. It's usually found in children and young adults. The ECG characteristics of PJRT include:

• Inverted P waves: In leads II, III, AVF, and lateral precordial leads
• Long R-P interval: Consistent with slow retrograde conduction
• Shortened P-R interval: During tachycardia, compared to the R-P interval
• Narrow QRS tachycardia: Almost incessant
• An atrioventricular ratio of 1:1: During tachycardia
• NOTE: PJRT can have rates in the normal range (60 BPM to 100 BPM)

Be sure to read how Differential Diagnoses and Multiple Interpretations are handled in the ECG Quiz.

References will be added soon.