Friday, August 31, 2012

EKG Rhythm Strip Quiz 45

Identify the following rhythms.
1.










a. Agonal rhythm
b. Ventricular standstill
c. 3rd degree heart block
d. Junctional rhythm


2.
a. Demand atrial paced with PACs
b. Asynchronous ventricular pacing with PJCs
c. Demand AV paced with multifocal PVCs
d. Demand biventricular pacing with unifocal PVCs

3.


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


4.
a. Normal sinus rhythm with PACs and PVCs
b. Sinus tachycardia with occasional PVCs and PJCs
c. Sinus bradycardia with PACs and PJCs
d. Sinus rhythm with multifocal premature junctional contractions

5.





a. Sinus bradycardia with junctional ectopic beats
b. Normal sinus rhythm with runs of ventricular tachycardia
c. Sinus tachycardia with frequent unifocal PVCs
d. Sinus rhythm with multifocal PACs

6.









a. Sinus bradycardia with trigeminal PACs
b. Normal sinus rhythm with bigeminal PVCs
c. Sinus tachycardia with frequent multiform PVCs
d. Sinus arrhythmia with an occasional PVC

7.


a.  Normal sinus rhythm
b.  Sinus arrhythmia
c.  Atrial fibrillation
d.  Accelerated junctional rhythm


8.

a. Complete heart block
b. Ventricular fibrillation
c. Agonal rhythm
d. Atrial fibrillation


9.










a. Bradycardia with sinus arrhythmia
b. Idioventricular rhythm
c. Complete heart block
d. Junctional rhythm


10.









a. Sinus bradycardia
b. Normal sinus rhythm with an occasional PAC
c. Sinus arrhythmia
d. Sinus tachycardia



Answers
1.
 a. Agonal rhythm

2.

d. Demand biventricular pacing with unifocal PVCs.  It is difficult to determine what the underlying rhythm is though it may be either a sinus with a 1st degree block or an atrial flutter.  Biventricular pacer spikes appear on the paced beats as well as some demand atrial pacer spikes.

3.
 a. Atrial flutter

4.



a. Normal sinus rhythm with PACs and PVCs   The unifocal PVCs are easy to pick out.   The 9th and 11th complexes are PACs    There appears to be two aberrantly conducted complexes present, one before and one after the 2nd PVC.  The first aberrantly conducted beat lands on the upstroke of the P wave.   The second fusion beat looks like it may have a retrograde P wave present on that appears near the junction of the S wave and the T wave.


5.









b. Normal sinus rhythm with runs of ventricular tachycardia.    This arterial blood pressure tracing provides some insight into the hemodynamics behind ventricular tachycardia.   Notice on the arterial pressure tracing that there is a slight delay in the pressure waveform and the cardiac QRS complex.   This represents the time that it takes the pressure wave to travel from the heart to arterial line transducer in either the radial or femoral artery.   The graph numbers on the left side represent the arterial pressure (mm Hg).  During the sinus beats, the patient's arterial pressure is running around 110/60.  However, during periods of ventricular tachycardia, his arterial systolic pressures fall into the 60-70s are not detectable.

6.






b. Normal sinus rhythm with bigeminal PVCs

7.









b. Sinus arrhythmia.   The R-R interval varies from beat to beat.

8.

b. Ventricular fibrillation

9.

c. Complete heart block.  There is no association between the P waves and the QRS complexes.  If you measure the P-P interval you will find that a P wave is hidden within the 1st, 4th, and 7th QRS complexes.

10.





a. Sinus bradycardia



Reviewed  6/3/14, 3/6/16

Thursday, August 30, 2012

EKG Rhythm Strip Quiz 44

Identify the following rhythms.

1.
a. Sinus tachycardia with supraventricular ectopy
b. Normal sinus rhythm with occasional PVCs
c. Sinus rhythm with trigeminal PACs
d. Sinus rhythm with premature junctional contractions

2.
a. Complete heart block
b. Junctional rhythm with sinus arrest
c. Idioventricular rhythm
d. Atrial fibrillation with slow ventricular response

3.
a. Bradycardia with a PVC
b. Idioventricular rhythm
c. Complete heart block
d. Junctional rhythm

4.
a. Normal sinus rhythm
b. Atrial fibrillation with slow ventricular response
c. Accelerated junctional rhythm
d. Sinus bradycardia

5.
a. Complete heart block
b. Junctional rhythm with sinus arrest
c. Agonal rhythm
d. Atrial fibrillation with slow ventricular response


6.
a. Normal sinus rhythm with 1st degree block
b. Sinus bradycardia
c. Atrial flutter with variable rate
d. 2nd degree heart block type II

7.

a. Normal sinus rhythm
b. Sinus arrhythmia
c. Atrial flutter
d. Junctional tachycardia


8.
a. Atrial flutter with unifocal PVCs
b. Atrial flutter with ventricular escape beats
c. Atrial fibrillation with demand ventricular pacing
d. Atrial fibrillation with brief run of ventricular tachycardia

9.
a. Tachycardia with sinus arrhythmia
b. Normal sinus rhythm with occasional PAC
c. Sinus rhythm with sinus pause
d. Sinus rhythm with premature junctional contractions

10.









a. Sinus bradycardia
b. Normal sinus rhythm with an occasional PAC
c. Sinus arrhythmia
d. Sinus tachycardia

Answers


1.
c. Sinus rhythm with trigeminal PACs.    Atrial ectopic beat every 3rd beat. The morphology of the P wave changes on the ectopic beats. When there are 3 or more P waves of varying morphology then also consider wandering atrial pacemaker.
2.
a. Complete heart block. No relationship between the P waves and the QRS complexes.

3.
b. Idioventricular rhythm. Wide bizzare-looking complex without any P waves. Usually a PEA rhythm. Begin CPR and give vasopressors (epinephrine or vasopressin).

4.
d. Sinus bradycardia. In lead V1 (anterior lead) there is ST elevation with some reciprocal ST depression in lead II (inferior lead)

5.
c. Agonal rhythm. Wide, slow, bizzare shaped QRS complexes with a rate less than 20 are characteristic of an agonal rhythm. There is about a 4.9 second pause between the 2nd and 3rd complexes.

6.
d. 2nd degree heart block type II. There are non-conducted P waves between the QRS complexes. The PR interval is the same on the conducted beats.  A PVC follows the 2nd QRS complex.

7.
c. Atrial flutter

8.
 c. Atrial fibrillation with demand ventricular pacing.    This looks like a mixture between fibrillation and flutter.   Some people call it fib-flutter.

9.
 b. Normal sinus rhythm with occasional PAC.   The 10th complex is the ectopic beat.   If you look close, then you can see a small P wave that notched into the T wave of the preceding complex.

10.





c. Sinus arrhythmia. The R-R interval is irregular.


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

Wednesday, August 29, 2012

EKG Rhythm Strip Quiz 43

Identify the following rhythms

1.
a. 3rd degree heart block
b. Atrial flutter with slow ventricular response
c. Atrial fibrillation
d. 2nd degree heart block type II

2.
a. Atrial paced
b. Ventricular paced
c. AV pacing
d. Biventricular pacing

3.
a. Bradycardia with sinus arrhythmia
b. Idioventricular rhythm
c. Complete heart block
d. Junctional rhythm

4.
a. Sinus bradycardia with atrial ectopic beats
b. Normal sinus rhythm with PACs
c. Sinus tachycardia with frequent unifocal PVCs
d. Sinus rhythm with multifocal PVCs

5.







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

6.


a. Ventricular unigeminy
b. Ventricular bigeminy
c. Ventricular trigeminy
d. Ventricular quadrigeminy

7.


a. Normal sinus rhythm with T wave inversion
b. Atrial fibrillation with slow ventricular response
c. Accelerated junctional rhythm ST elevation
d. Idioventricular rhythm with ST depression

8.


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


9.
a. Sinus arrhythmia
b. Multifocal atrial tachycardia
c. Atrial fibrillation with controlled ventricular response
d. Wandering atrial pacemaker

10









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

Answers

1.
a. 3rd degree heart block.   There is no relationship between the P waves and the QRS complexes.

2.
c. AV pacing.   Demand atrial pacing on the 7th complex.

3.
b. Idioventricular rhythm.   Wide, slow, and bizarre looking QRS complexes characterize this rhythm.

4.
 b. Normal sinus rhythm with PACs.   The early beats will have a P wave that is shaped differently from the sinus beats.   Also notice that in some cases the P waves are buried within the preceding T wave thus changing the shape or height of the P wave.

5.






c. Agonal rhythm.   Wide, slow, and bizzare QRS complexes with an underlying rate of less than 20 beats per minute.   Agonal beats represent the terminal changes of an idioventricular rhythm.  In other words, the patient is dying.

6.








c. Ventricular trigeminy   There is a PVC every 3rd beat.


7.





a. Normal sinus rhythm with T wave inversion (in lead II)    This may represent ischemic changes to the myocardium.


8.





d. 2nd degree heart block type II.    There are P waves with dropped QRS complexes.   The PR interval is consistent on the conducted beats.   Recall, that on a Mobitz I block that the PR interval increases over consecutive beats.


9.









a. Sinus arrhythmia.  The R-R interval is irregular.

10.





a. Atrial flutter with variable rate.



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