Tuesday, July 31, 2012

EKG Rhythm Strip Quiz 38

Identify the following rhythms.

1.
a. Sinus tachycardia
b. Atrial flutter with rapid ventricular response
c. Junctional tachycardia
d. Supraventricular tachycardia

2.
a. Sinus tachycardia
b. Atrial flutter with rapid ventricular response
c. Junctional tachycardia
d. Supraventricular tachycardia

3.







a.  Sinus rhythm with an occasional PAC
b.  Normal sinus rhythm with a couplet of PVCs
c.  Sinus rhythm with frequent multifocal PACs
d.  Sinus rhythm with premature junctional contractions

4.
a. Sinus bradycardia with atrial ectopy
b.  Normal sinus rhythm with an occasional PVCs
c.  Sinus tachycardia with frequent multifocal PACs
d.  Sinus rhythm with premature junctional contractions

5.






a. Normal sinus rhythm
b.  Sinus bradycardia
c.  Sinus tachycardia
d.  1st degree AV block

6.
a.  Atrial paced
b.  Ventricular paced
c.  AV pacing
d.  Biventricular pacing 

7.
a. Supraventricular tachycardia with PACs
b.  Multifocal atrial tachycardia
c.  Atrial fibrillation with uniform PVCs
d. Paroxysmal sinus tachycardia

8.
a. Atrial flutter with variable rate
b.  2nd degree heart block type II
c.  Atrial fibrillation with slow ventricular response
d. Sinus tachycardia with sinus pauses

9.
a. Normal sinus rhythm
b.  Sinus bradycardia
c.  Atrial fibrillation
d.  Junctional rhythm

10.






a. Normal sinus rhythm
b.  Sinus bradycardia
c.  Sinus tachycardia
d.  1st degree AV block

Answers
1.
d. Supraventricular tachycardia. No P waves are present. The rate is 150 bpm.

2.
c. Junctional tachycardia. There are inverted P waves before each QRS complex. The rate is 115. Based upon the character of the P waves and the rate this makes this rhythm a junctional tachycardia.

3.
a. Sinus rhythm with an occasional PAC. The 1st and 12th complexes are may be some aberrantly conducted PACs . They are wide like PVCs but there is a P wave before them.  The 4th complex is a PAC.

4.
b. Normal sinus rhythm with an occasional PVC

5.
b. Sinus bradycardia

6.
c. AV pacing. Dual pacer spikes are present

7.




c. Atrial fibrillation with uniform PVCs. The underlying rhythm is irregular with an absence of P waves and there are unifocal PVCs present.

8.

a. Atrial flutter with variable rate. The flutter waves are present in a 5:1 to a 3:1 ratio.

9.

a. Normal sinus rhythm.   There is low voltage in this lead and this can make interpreting the rhythm difficult.

10.




d. 1st degree AV block. The PR interval is 0.28 seconds. The QRS complex is also wide at .12 seconds.


Reviewed 6/4/13

Monday, July 30, 2012

EKG Rhythm Strip Quiz 37

Identify the following rhythms

1.





a.  Normal sinus rhythm
b.  Sinus bradycardia
c.  Sinus tachycardia
d.  1st degree AV block


2.







a. Complete heart block
b.  Accelerated idioventricular rhythm
c.  Junctional rhythm
d.  Atrial fibrillation with slow ventricular response


3.






a. Accelerated idioventricular
b. 3rd degree AV block
c.  Atrial fibrillation
d. Ventricular tachycardia


4.






a. Normal sinus rhythm
b.  Sinus bradycardia
c.  Sinus tachycardia
d.  Junctional rhythm


5.







a.  Normal sinus rhythm with 1st degree block
b.  Sinus bradycardia
c.  Sinus tachycardia
d.  2nd degree heart block type II


6.







a.  Sinus bradycardia with atrial ectopy
b.  Normal sinus rhythm with bigeminal PVCs
c.  Sinus tachycardia with frequent multifocal PVCs
d.  Sinus rhythm with premature junctional contractions


7.






a. Bradycardia with 1st degree AV block
b.  Idioventricular rhythm
c.  Accelerated junctional rhythm
d.  Atrial fibrillation with slow ventricular response


8.





a. Sinus bradycardia
b. Junctional rhythm
c.  Agonal rhythm
d.  Atrial fibrillation with slow ventricular response


9.







a.  Atrial paced
b.  Ventricular paced
c.  AV pacing
d.  Biventricular pacing 


10.






a.  Sinus tachycardia with atrial ectopy
b.  Normal sinus rhythm with occasional PACs
c.  Sinus rhythm with trigeminal PJCs
d.  Sinus rhythm with premature junctional contractions


Answers


1.




d. 1st degree AV block. The PR interval is 0.26 seconds

2.




b. Accelerated idioventricular rhythm. This rhythm has all the characteristics of a ventricular paced rhythm (wide, negative, QRS complex with a positive ST segment) except that I do not see any pacer spikes.

  3.





c. Atrial fibrillation. The rhythm is irregular and without P waves.

  4.




a. Normal sinus rhythm. There is also some ST segment depression.

5.




b. Sinus bradycardia

6.




b. Normal sinus rhythm with bigeminal PVCs. The strip terminates with a multifocal couplet

7.




c. Accelerated junctional rhythm. There is a downward sloping ST segment. May be significant for ischemia.

  8.





c. Agonal rhythm. An agonal rhythm is slower ( < 20 bpm) and less organized than an idioventricular rhythm. The waveform looks more like a sinusoidal wave.

9.




a. Atrial paced. Atrial pacer spikes precede each P wave.

10




c. Sinus rhythm with trigeminal PJCs.   No P waves are associated with the ectopic beats.   The QRS complex is narrow with some slurring of the S wave, similar to the sinus beats.


Reviewed 6/4/13

Saturday, July 28, 2012

EKG Rhythm Strip Quiz 36

Identify the following rhythms.

1.
a.  Bradycardia with 1st degree AV block
b.  Idioventricular rhythm
c.  Accelerated junctional rhythm
d.  Atrial fibrillation with slow ventricular response

2.

a. 3rd degree heart block
b.  Atrial flutter with slow ventricular response
c.  Bradycardia with sinus arrhythmia
d.  2nd degree heart block type II


3.

a. Atrial paced with unifocal PVCs

b.  Ventricular paced with atrial ectopic beats
c.  AV pacing with multiform PVCs 
d.  Biventricular pacing with PJCs


4.
a. Sinus bradycardia with atrial ectopy
b.  Atrial fibrillation with multifocal PACs
c.  Sinus arrhythmia with frequent multifocal PACs
d.  Sinus flutter with bigeminal PVCs

5.
a. Sinus rhythm with atrial ectopic beats
b.  Normal sinus rhythm with a couplets of PVCs
c.  Sinus rhythm with frequent unifocal PVCs
d.  Sinus rhythm with premature junctional contractions

6.







a. Normal sinus rhythm
b.  Sinus bradycardia
c.  Sinus tachycardia
d.  1st degree AV block


7.
a. Sinus tachycardia with unifocal ventricular ectopy
b.  Atrial fibrillation with multifocal PVCs
c.  Sinus arrhythmia with frequent multifocal PACs
d.  Sinus flutter with bigeminal PVCs

8.
a. Sinus tachycardia
b. Atrial flutter with rapid ventricular response
c. Junctional tachycardia
d. Supraventricular tachycardia

9.

a. Sinus arrhythmia
b.  Atrial fibrillation
c. Torsades de pointe
d.  Ventricular fibrillation

10.







a.  Atrial paced
b.  Ventricular paced
c.  AV pacing
d.  Biventricular pacing



Answers

1.
c. Accelerated junctional rhythm. No P waves are present. The rate is 83. Based upon this information the rhythm fits the characteristics of an accelerated junctional rhythm

2.
a. 3rd degree heart block. There is no relationship between the P waves and the QRS complexes. The P-P rhythm is regular and the R-R rhythm are both regular but at different rates.

3.
c. AV pacing with multiform PVCs. The 6th and 8th complex (the first and 2nd PVC) appear to be a fusion complexes. This occurs when a PVC and a pacing stimulus occur simultaneously.

4.
d. Sinus flutter with bigeminal PVCs.   There is some baseline changes that make interpreting this strip somewhat difficult.   Between the 2nd and 3rd complexes there are some flutter waves.  The flutter waves are not as apparent between the 3rd and 4th complexes but reoccur elsewhere.  The PVCs are unifocal in nature and occur every other beat.

5.
c. Sinus rhythm with frequent unifocal PVCs

6.
a. Normal sinus rhythm. Though not as dramatic as a lethal rhythm, a little normalcy in life is always good.

7.
b. Atrial fibrillation with multifocal PVCs. The rhythm is irregular. The are no identifiable P waves present. The QRS complex is very wide with and RSR appearance. Probably a LBBB since it is positive monphasic wave in lead II. The ejection fraction on this patient cannot be very good.

8.
c. Junctional tachycardia. The P waves are absent.

9.





d.  Ventricular fibrillation.   The patient is pulseless and apenic.   CPR- defibrillation 200 J biphasic (360J monophasic)- CPR- Epinephrine (or Vasopressin)- Analyze rhythm- Defibrillation 300 J biphasic (360 monophasic)...


10.




b.  Ventricular paced.  A small pacer spike is noted before each QRS complex.



Reviewed 6/4/13