EKG Rhythm Strip Quiz 50

Identify the following rhythms.

1.






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


2.







a.  Normal sinus rhythm with sinus pauses
b.  Sinus rhythm changing to a junctional rhythm
c.  Sinus arrhythmia with PJCs
d.  Sinus bradycardia with atrial escape beats


3.






a.  Normal sinus rhythm with multifocal PVCs
b.  Sinus arrhythmia with multifocal PVCs
c.  Atrial tachycardia with multifocal PVCs
d.  Atrial fibrillation with multifocal PVCs 


4.







a.  Sinus rhythm with 1st degree block and an occasional PJC
b.  Sinus arrhythmia with 1st degree block and an occasional PJC
c.  Sinus rhythm with 1st degree block and an occasional PAC
d.  Sinus rhythm with 1st degree block and an occasional PVC


5.







a.  Sinus bradycardia with atrial ectopic beats
b.  Normal sinus rhythm with some trigeminal PVCs
c.  Sinus tachycardia with frequent unifocal PVCs
d.  Sinus rhythm with multifocal PJCs


6.










a.  Atrial paced with multifocal PVCs
b.  Ventricular paced with unifocal PACs
c.  AV pacing with unifocal PJCs
d.  Biventricular pacing with unifocal PVCs

7.







a.  Asystole
b.  Ventricular fibrillation
c.  Atrial fibrillation
d.  Ventricular standstill


8.







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


9.










a.  Sinus bradycardia with trigeminal PVCs
b.  Normal sinus rhythm with  trigeminal PVCs
c.  Sinus tachycardia with frequent bigeminalPVCs
d.  Sinus rhythm with quadrigeminal PVCs


10.






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


Answers

1.





b.  2nd degree heart block type I.   You can usually identify the rhythm by the grouped beats.   It can occur in cycles of 2- 4 beats.   The second set of grouped beats has an R-R interval that is longer than the first set of grouped beats and there is also a slight variation in the PR intervals between the two sets of grouped beats.

2.






b.  Sinus rhythm changing to a junctional rhythm


3.





d.  Atrial fibrillation with multifocal PVCs.   This rhythm does not fit neatly into the atrial fibrillation or atrial flutter category.   If you were thinking atrial flutter with variable rate then you would also be correct.  The two ectopic complexes that follow the 2nd PVC are narrow and probably represent some kind aberrantly conducted beats.


4.
c.  Sinus rhythm with 1st degree block and an occasional PAC.


5.





b.  Normal sinus rhythm with some trigeminal PVCs.   The first PVC has a P wave and represents a fusion beat.  The SA node fired creating the P wave, then before the impulse reaches the ventricles, an ectopic site within the ventricle fires.   Notice that this does not change the character of the arterial blood pressure tracing as compared to the other PVCs.   Because of the atrial depolarization in the first P wave, the atrium fill and empty into the ventricles normally so there is little change in the stroke volume and arterial pressure.   By comparison, the last two PVCs have lost the "atrial kick" or the normal atrial filling pressure and this decreases the stroke volume as evidenced by the decrease in the arterial blood pressure.

6.





a.  Atrial paced with multifocal PVCs

7.






b.  Ventricular fibrillation

8.





a.  Normal sinus rhythm with 1st degree block.  The PR interval is .32 sec.


9.





b.  Normal sinus rhythm with trigeminal PVCs.  A compensatory pause follows each PVC.   The bottom waveform is an arterial pressure reading.  You can see a slight drop in the arterial pressure with each PVC.


10.





c.  Demand AV pacing with multifocal PVCs.


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

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