EKG Rhythm Strip Quiz 47

Identify the following rhythms.
1.

a. Normal sinus rhythm with monomorphic PVCs
b. Sinus arrhythmia with uniform PVCs
c. Atrial fibrillation with multiform  PVCs
d. Ventricular tachycardia with unifocal PVCs

2.

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


3.

a. Sinus rhythm with frequent PJCs
b. Sinus arrhythmia with PACs
c. Sinus rhythm with junctional escape beats
d. Sinus rhythm with multifocal PVCs


4.

a. Sinus rhythm with an occasional PJC
b. 2nd degree heart block type I
c. Sinus rhythm with junctional escape beats
d. Sinus rhythm with sinus pauses and an occasional PVC


5.

a.  Normal sinus rhythm with an occasional PVC

b.  Sinus arrhythmia with an occasional PVC

c.  Atrial fibrillation with an occasional PVC

d.  Wandering atrial pacemaker with an occasional PVC

6.

a. Sinus tachycardia

b. Atrial flutter with rapid ventricular response

c. Junctional tachycardia

d. Supraventricular tachycardia

7.

a. Junctional rhythm with unifocal PVCs
b. Sinus arrhythmia with multifocal PVCs
c. Idioventricular rhythm
d. Atrial fibrillation with bigeminy

8.

a. Sinus rhythm with multifocal PVCs

b. Normal sinus rhythm with polymorphic PVCs

c. Sinus rhythm with frequent unifocal PVCs

d. Sinus rhythm with monagomous PVCs

9.

a. Sinus rhythm with bigeminal PVCs

b. Normal sinus rhythm with trigeminal PVCs

c. Sinus rhythm with frequent hexigeminalPVCs

d. Sinus rhythm with quadrigeminal PVCs

10.

a. Polymorphic ventricular fibrillation
b. Polymorphic ventricular tachycardia
c. Monomorphic ventricular tachycardia
d. Monomorphic ventricular fibrillation

Answers

1.

c. Atrial fibrillation with multiform PVCs.   The two middle PVCs form a multifocal couplet.   The RSR pattern of the QRS complexes in V1 are consistent with a right bundle branch block

2.

a. Atrial paced

3.

d. Sinus rhythm with multifocal PVCs.  Together the two PVCs form a multifocal couplet.

4.

d. Sinus rhythm with sinus pauses and an occasional PVC.   The rhythm is irregular with a compensatory pause after the initial PVC at the beginning of the strip and a sinus pause at the end of the strip.  If you look at the QRS complex following the sinus pause, you will note a difference in the shape of the P wave.  This complex is possibly an atrial escape beat.

5.

d.  Wandering atrial pacemaker with an occasional PVC.  In V1 the morphology of the P waves as well as the PR interval appears to change.  In lead II you can see where the P wave is in some cases buried within the T wave of the preceding complex.

6.

d. Supraventricular tachycardia.   The rate is about 150.   The rhythm is regular.  There are no identifiable P waves present.  The QRS is narrow.

7.

d. Atrial fibrillation with bigeminy.  A compensatory pause follows each PVC complex.

8.

c. Sinus rhythm with frequent unifocal PVCs.  A PVC occurs every 6th beat, hexigeminy.  There is some down slopping of the ST segment.  Sorry about the use of monogamous PVCs.   I am running out of quiz answers.

9.

b. Normal sinus rhythm with trigeminal PVCs

10.

b. Polymorphic ventricular tachycardia.   Very close to being a torsades de pointe rhythm.   The axis of the QRS does not appear to shift, especially in the first part of the strip and the QRS complex size does not begin small, increase in size, then decrease in size.   This rhythm occurred during a code and the patient was treated with some magnesium.  I plan to post some of the strips related to the code in a few next week.


Reviewed  6/4/13, 3/6/16