Narrow-Complex Rhythm Practice
Consolidation cards for identifying supraventricular rhythms using the 5-question algorithm.
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Questions Covered in This Set
10 cards to master
What are the 5 questions in the narrow-complex algorithm?
1) Rate? 2) Regular? 3) P waves? 4) PR interval? 5) QRS narrow (<120 ms)?
Two ways to calculate rate
300 ÷ number of large boxes between R waves, or count QRS complexes in a 6-second strip × 10.
Rate 62, regular, upright uniform P before every QRS, PR 160, QRS 90
Normal sinus rhythm.
Rate 44, regular, upright P, PR 180, QRS 88 in an asymptomatic marathon runner
Sinus bradycardia — a rate description, often benign in athletes or on beta-blockers.
Rate 130, regular, identical upright P waves partly buried in T waves, gradual onset, fever 39 °C
Sinus tachycardia — treat the underlying cause, not the rate.
Rate 180, metronome-regular, no visible P waves, pseudo-S notch after QRS, abrupt onset
SVT (AVNRT); vagal maneuvers or adenosine are diagnostic and often therapeutic.
Rate 90, irregularly irregular, no P waves, fine wavering baseline
Atrial fibrillation with controlled ventricular response — the classic triad.
Atrial rate 300 with sawtooth in II, III, aVF; ventricular rate 150 and regular
Atrial flutter with 2:1 conduction; 4:1 conduction gives ~75.
Early beat with differently shaped P, narrow QRS, non-compensatory pause
Premature atrial complex (PAC).
How do you name a rhythm properly?
Rate + rhythm origin + regularity, e.g. 'sinus tachycardia at 118' or 'AF with controlled ventricular response.'
