Basic Arrhythmias

With 12-Lead EKGs

ALGrawany

This page intentionally left blank

Basic Arrhythmias

With 12-Lead EKGs

Ninth Edition

Gail Walraven

Brady is an imprint of PEARSON

ALGrawany

ISBN-10: 0-13-816495-9

ISBN-13: 978-0-13-816495-9

$PrintCode

Library of Congress Cataloging-in-Publication Data

Names: Walraven, Gail, 1949- author.

Title: Basic arrhythmias: With 12-Lead EKGs / Gail Walraven.

Description: Ninth edition. | [Hoboken, NJ] : Pearson, [2024] | Revised

   edition of: Basic arrhythmias / Gail Walraven. Eighth edition. 2016.

Identifiers: LCCN 2023053103 | ISBN 9780138164959 (paperback) | ISBN

   0138164959 (print) | ISBN 9780138164911 (ebook) | ISBN 9780138165079

   (other ebook)

Subjects: LCSH: Arrhythmia--Diagnosis--Programmed instruction. |

   Electrocardiography--Programmed instruction.

Classification: LCC RC685.A65 W33 2024 | DDC 616.1/28--dc23/eng/20231214

LC record available at https://lccn.loc.gov/2023053103

Content Production: Maria Reyes

Product Management: Katrin Beacom, Kevin Wilson

Product Marketing: Brooke Imbornone

Rights and Permissions: Jenell Forschler

Please contact www.AskPearsonSupport.com with any queries on this content.

Please contact us with concerns about any potential bias at https://www.pearson.com/

report-bias.html

You can learn more about Pearson’s commitment to accessibility at https://www.pearson.com/us/

accessibility.html

Chapter Opener Photos: Lucidio Studio Inc/Photographer’s Choice RF/Getty Images

Copyright © 2025, 2017, 2011 by Pearson Education, Inc. or its affiliates. All Rights Reserved. This

digital publication is protected by copyright, and permission should be obtained from the publisher

prior to any prohibited reproduction, storage in a retrieval system, or transmission in any form or

by any means, electronic, mechanical, photocopying, recording, or otherwise except as authorized

for use under the product subscription through which this digital application is accessed. For

information regarding permissions, request forms and the appropriate contacts within the Pearson

Education Global Rights & Permissions department, please visit www.pearsoned.com/permissions/.

Acknowledgments of third-party content appear on the appropriate page within the text.

PEARSON and ALWAYS LEARNING are exclusive trademarks in the U.S. and/or other countries

owned by Pearson Education, Inc. or its affiliates.

Unless otherwise indicated herein, any third-party trademarks that may appear in this work are the

property of their respective owners and any references to third-party trademarks, logos or other trade

dress are for demonstrative or descriptive purposes only. Such references are not intended to imply

any sponsorship, endorsement, authorization, or promotion of Pearson’s products by the owners

of such marks, or any relationship between the owner and Pearson Education, Inc. or its affiliates,

authors, licensees or distributors.

Dedication

To the men in my life:

Bruce, Kellen, Dustin, and Case

ALGrawany

This page intentionally left blank

vii

Contents

Preface ix

Navigating Through the Text xi

Learning Objectives xiii

1 Electrophysiology 1

Self-Instructional Unit

Electrical vs. Mechanical Function 1

Impulse Formation 3

Polarization and Depolarization 4

Conduction System 5

Inherent Rates 6

Irritability and Escape 7

Nervous System Influence 8

KEY POINTS 11

SELF-TEST 11

2 Waves and Measurements 14

Self-Instructional Unit

Introduction 14

Electrodes 15

Rule of Electrical Flow 15

Monitoring Leads 16

Graph Paper 17

Voltage Measurements 18

Time Measurements 19

Cardiac Cycle 19

Waves, Intervals, Segments 21

P Wave and PRI 21

QRS Complex 22

ST Segment and T Wave 24

Measurements 24

Practice 24

Artifact, Interference 24

Refractory Periods 26

KEY POINTS 28

SELF-TEST 28

PRACTICE STRIPS (PART I) 31

PRACTICE STRIPS (PART II) 33

3 Analyzing EKG Rhythm Strips 48

Self-Instructional Unit

Analysis Format 48

Regularity 50

Rate 51

P Waves 53

PR Intervals and QRS Complexes 54

Role of the AV Node 55

Ventricular vs. Supraventricular 55

KEY POINTS 57

SELF-TEST 57

PRACTICE STRIPS (PART I) 60

PRACTICE STRIPS (PART II) 64

4 Sinus Rhythms 68

Self-Instructional Unit

Introduction 68

Normal Sinus Rhythm 69

Sinus Bradycardia 71

Sinus Tachycardia 71

Sinus Arrhythmia 73

Review 74

KEY POINTS 76

SELF-TEST 76

PRACTICE STRIPS 78

INTERPRETATION OF CHAPTER 3 RHYTHM STRIPS 93

5 Atrial Rhythms 94

Self-Instructional Unit

Atrial Rhythms 94

Wandering Pacemaker 95

Ectopics 97

Premature Atrial Complex 97

Atrial Tachycardia 99

Atrial Flutter 100

Atrial Fibrillation 102

KEY POINTS 105

SELF-TEST 105

PRACTICE STRIPS 108

6 Junctional Rhythms 137

Self-Instructional Unit

Junctional Pacemaker 137

Junctional P Wave 139

Premature Junctional Complex 141

Junctional Escape Rhythm 143

Junctional Tachycardia 144

Accelerated Junctional Rhythm 145

ALGrawany

viii Contents

Supraventricular Tachycardia 148

KEY POINTS 150

SELF-TEST 150

PRACTICE STRIPS 153

7 Heart Blocks 174

Self-Instructional Unit

Conduction Through the AV Node 174

Heart Blocks 175

First-Degree Heart Block 176

Second-Degree Heart Blocks 178

Type II Second-Degree Heart Block 180

Wenckebach (Type I Second-Degree Heart Block) 182

Third-Degree Heart Block (Complete Heart Block) 185

KEY POINTS 190

SELF-TEST 190

PRACTICE STRIPS 193

8 Ventricular Rhythms 214

Self-Instructional Unit

Ventricular Rhythms 214

Premature Ventricular Complex (PVC) 215

Unifocal vs. Multifocal 219

R on T Phenomenon 220

Runs and Couplets 221

Grouped Beating 222

Ventricular Tachycardia (VT) 224

Ventricular Fibrillation 226

Idioventricular Rhythm 227

Asystole 228

Pulseless Electrical Activity (PEA) 230

KEY POINTS 232

SELF-TEST 233

PRACTICE STRIPS 237

9 Practice Makes Perfect 276

Introduction 276

PRACTICE STRIPS 278

10 Final Challenge 403

Introduction 403

SELF-TEST 404

Appendix A: Cardiac Anatomy and Physiology 454

Appendix B: Pathophysiology and Clinical

Implications of Arrhythmias 462

Appendix C: 12-Lead Electrocardiography 467

Appendix D: Basic 12-Lead Interpretation 480

Appendix E: Pacemakers 534

Glossary 544

Answers Key 551

Index of Practice Strips by Rhythm Names 586

Subject Index 593