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