EKG Rhythm Strip Quiz 34

Identify the following rhythms.

1.

a.  Sinus bradycardia with atrial ectopy

b.  Normal sinus rhythm with unifocal PVCs

c.  Sinus tachycardia with frequent multifocal PACs

d.  Sinus rhythm with premature junctional contractions

2.

a.  Sinus bradycardia with atrial ectopy

b.  Normal sinus rhythm with unifocal PVCs

c.  Sinus tachycardia with frequent multifocal PACs

d.  Sinus rhythm with premature junctional contractions

3.

a.  Normal sinus rhythm

b.  Sinus bradycardia

c.  Sinus tachycardia

d.  Sinus bradycardia with 1st degree AV block

4.

a.  Sinus tachycardia

b. Atrial flutter with rapid ventricular response

c. Multifocal atrial tachycardia

d. Supraventricular tachycardia

5.

a.   Atrial paced

b.  Ventricular paced

c.  AV pacing

d.  Biventricular pacing 

6.

a.  Normal sinus rhythm with 1st degree block

b.  Sinus bradycardia

c.  Sinus tachycardia

d.  2^nd degree heart block type II

7.

a.  Complete heart block

b. Normal sinus rhythm with 1st degree block
c. Accelerated junctional rhythm
d. Accelerated idioventricular rhythm

8.

a.  Atrial paced

b.  Ventricular paced

c.  AV pacing

d.  Biventricular pacing 

9.

a.  Sinus bradycardia with atrial ectopy
b. Normal sinus rhythm with an occasional PAC

c.  Sinus tachycardia with frequent multifocal PVCs

d.  Sinus rhythm with premature junctional contractions
10.

a.  Normal sinus rhythm

b.  Sinus bradycardia

c.  Sinus tachycardia

d.  1st degree AV block

Answers

1.

d. Sinus rhythm with premature junctional contractions. The inverted P waves before each premature beat are characteristic of PJCs

2.

b. Normal sinus rhythm with unifocal PVCs

3.

d. Sinus bradycardia with 1st degree AV block. The PR interval is .28. The P waves are split. Split P waves are sometimes referred to as P Mitrale and are seen in left atrial enlargement and mitral valve disease.

4.

d. Supraventricular tachycardia.   The rate is around 150.   No P waves are evident.

5.

b. Ventricular paced. Pacer spikes are seen before each QRS complex.

6.

a. Normal sinus rhythm with 1st degree block. The PR interval is 0.28 seconds.

7.

c. Accelerated junctional rhythm. Best guess, accelerated idioventricular rhythm with a prolonged QT interval of 0.60 seconds. The EKG machine called this an "undetermined rhythm." It could be sinus rhythm with a wide QRS complex and a very long 1st degree AV block (0.36 sec). The P wave could be wide due to left atrial enlargement. If this is the case then, as the saying goes (An American saying from the Apollo space program) "Houston we have a problem." It could be an accelerated junctional rhythm with a prolonged QT interval. You would have to know the patient's history to determine if the patient had a pre-existing bundle branch block, in lead II probably a LBBB. The EKG machine may be right and it is an undetermined rhythm. The bottom line, is treat the patient and not the machine. Please feel free to send me your comments.

8.

c. AV pacing. It looks like the underlying rhythm may be an atrial fibrillation. A pacer spike is seen before the P wave and the QRS complex.

9.

b. Normal sinus rhythm with an occasional PAC. The P wave is very small in comparison the the sinus P waves and has a shorter PR interval.

10.

a. Normal sinus rhythm. My favorite rhythm at the end of a long day. Good night!


Reviewed 6/4/13, 3/2/16