Friday, November 30, 2012

EKG Rhythm Strips 79

Identify the following rhythms.

1.










2.










3.







4.











5.










Answers


1.
Atrial fibrillation with bigeminy










The rhythm is is irregular with a rate of 100/min.   The P waves are absent and there are fibrillatory/flutter waves between the QRS complexes.  A unifocal PVC is seen every other beat.   A compensatory pause follows the PVC.  PR:  ---,  QRS:  .08 sec,  QT:  .32 sec.


2.
Normal Sinus Rhythm with Unifocal PVCs










The ectopic beats give this strip an irregular rhythm.   The rate is 70/min (Count the R waves in a 6 second strip and multiply by 10.)  The P waves are uniform, upright, and are associated with a QRS complex.  The ST segment is down slopping. Two unifocal PVCs are seen and they are followed by a compensatory pause.  PR: .16 sec,  QRS:  .12 sec,  QT:  .28 sec.


3.
Ventricular paced with unifocal PVCs








The rhythm is irregular with a rate of 80/min.  The P waves are absent and some fibillatory waves are seen between the QRS complexes.  Three unifocal PVCs are seen every fifth beat.   They are followed by a compensatory pause.   Ventricular pacer spikes are seen before the QRS complexes.  The T wave is inverted and the QT interval is prolonged.   PR:  ---,  QRS:  .16 sec,  QT:  .52 sec.


4.
Normal sinus rhythm Quadrageminal PVCs











The rhythm is irregular due to the PVCs.    The rate is 100/min.   The P waves are positive and are merged with T waves of the preceding complex.  Interpolated unifocal PVCs are seen every 4th beat.  The ST segment is elevated in the VI lead with some reciprocal depression in lead II.   PR:  .20 sec,  QRS:  .16 sec,  QT:  .44 sec


5.
Trigeminy











The rhythm strip is irregular with a rate of 80/min.  There are small upright P waves and they are associated with a QRS complex.  Unifocal PVCs are seen in a trigeminal pattern. The QRS complex in the bottom V1 lead has an RSr morphology suggesting a RBBB.  A compensatory pause follows each PVC.   PR.  12 sec,  QRS:  .16 sec,  QT:  .44 sec.


Reviewed 3/9/16

Thursday, November 29, 2012

ECG Rhythm Strips 78

Identify the following rhythms

1.










2.










3.










4.










5.










Answers


1.
2nd Degree Heart Block Type I










The rhythm is irregular with a rate of 40/min.   The P waves are upright and uniform but there are some dropped P waves following the 2nd, 4th, and 6th complexes.   There is progressive prolongation of the PR interval.  No ectopic beats are noted.  PR:  .28 sec and .34 sec,  QRS:  .12 sec,  QRS:  .52 sec


2.
Accelerated Junctional Rhythm with Unifocal PVCs










The rhythm is irregular due to the ectopic beats.   The rate is 100/min.   There are negative P waves seen before their associated QRS complexes.  Two unifocal PVCs are present and are followed by a compensatory pause.  The QRS complex in the V1 lead has an rSR configuration suggesting a right bundle branch block (RBBB).  PR:  .16 sec,  QRS:  .12 sec,  QT:  .36 sec.


3.
Normal sinus rhythm with bigeminy










The rhythm is irregular because of the frequent PVCs.   The rate is 90/min.   The P waves are upright and are associated with a QRS complex.  The P waves are tall suggesting right atrial enlargement.  Unifocal PVCs are seen in a bigeminal pattern.   A compensatory pause follows the PVCs.  PR:  .16 sec,  QRS:  .12 sec.  QT:  .36 sec.


4.
Normal Sinus Rhythm










The rhythm is regular with a rate of 83/min.   The P waves are upright and have a corresponding QRS complex.   No ectopic beats are noted.  PR:  .12 sec,  QRS:  .12 sec,  QT:  .44 sec.


5.
Ventricular Paced












The rhythm is regular with a rate of 71/min.   There are some small flutter waves between the QRS complexes.  No ectopic beats are noted.  Ventricular pacer spikes are seen before each QRS complex.  PR;  ---,  QRS:  .16 sec,  QT:  .44 sec


Reviewed 3/9/16

Wednesday, November 28, 2012

EKG Rhythm Strips 77

Identify the following rhythms.

1.

2.

3.

4.

5.






Answers

1.
1st Degree Block







The rhythm is regular with a rate of 86/min.   The are positive P waves before each QRS complex. The PR interval is prolonged.  No ectopic beats are noted.   PR:  .32 sec,  QRS:  .08 sec,  QT:  .40 sec.


2.
Accelerated Idioventricular Rhythm








The rhythm is regular with a rate of 63/min.   No P waves or ectopic beats are noted.   The QRS is wide suggesting a ventricular ectopic rhythm.   PR:  ---,  QRS:  .16 sec,  QT:  .44 sec


3.
Accelerated Junctional Rhythm








The rhythm is regular with a rate of 75/min.   There are negative P waves before each QRS complex.  No ectopic beats are noted.   PR:  .20 sec,  QRS:  .08 sec,  QT:  .32 sec.


4.
Atrial Fibrillation with Demand Ventricular Pacing









The rhythm is irregular.   The rate is 72/min.   The P waves are absent.   Some fibrillatory activity is present between the QRS complexes.   No ectopic beats are present.   The 4th, 5th, 6th, 8th, and 9th complexes are ventricular paced beats.   PR:  ---,  QRS:  .12 sec,  QT:  .36 sec.


5.
Sinus Tachycardia with a PJC








The rhythm is slightly irregular.   The rate is 108/min.   The P waves are tall, upright, and preceded the QRS complexes.  The tall P waves suggest right atrial enlargement.  There is a premature beat, the 7th complex.  Small 2mm Q waves are present.  The P wave is may be buried buried  T wave of the previous complex as the T wave appears broader than those of the other complexes.   However,  one could reasonably conclude that this premature beat is a junctional beat because of the negative down stroke that follows the T wave.   I opt for a junctional origin because of the deep negative down stroke.  We can take the middle ground and call this a premature supraventricular complex.  PR:  .16 sec,  QRS:  .08 sec,  QT:  .36 sec.


Reviewed 3/9/16

Tuesday, November 27, 2012

ECG Rhythm Strips 76

Identify the following rhythms.

1.










2.










3.










4.










5.










Answers


1.
2nd Degree AV Block Type I










The rhythm is irregular with some dropped beats.   The rate is 60/min.   The P waves are upright and uniform but there are dropped P waves after the 4th and 7th complexes.  There is progressive lengthening of the PR interval.   No ectopic beats are noted.  PR: .20/.26/.32/.36 sec,  QRS:  .12 sec,  QT:  .48 sec.  This patient would sometime alternate between 3 beat cycles and 4 beat cycles of this rhythm.


2.
2nd Degree AV Block Type II










The rhythm is is irregular with some dropped complexes.  The rate is 50/min.   The P waves are upright but there are some that are not associated with a QRS complex.   The PR interval is the same on the conducted beats.  No ectopic beats are present.  There is ST elevation in the V1 lead with some reciprocal ST depression in lead II.  PR:  .16 sec,  QRS:  .16 sec,  QT:  .36 sec.


3.
Biventricular Paced

The rhythm is regular with a rate of 70/min.  There are very small flutter flutter waves between each complex.   No ectopic beats are seen.  Biventricular pacer spikes are seen.  PR:  ---,  QRS:  .16 sec,  QT:  .48 sec.


4.
Sinus bradycardia 
 The rhythm is regular with a ventricular rate of 40/min.   The P waves are positive and have a corresponding QRS complex.  There is ST segment depression with inversion of the T wave in lead II.  PR:  .16 sec,  QRS:  .16 sec,  QT:  .48 sec.


5.
Sinus Tachycardia with Unifocal PVCs














The rhythm is irregular due to the ventricular ectopic beats.   The rate is 110/min.  The P waves are wide, upright and are associated with a QRS complex.  The are two unifocal PVCs present.  The ST segment is up slopping in lead II with 2mm ST elevation in the V1 lead.  PR:  .14 sec,  QRS:  .08 sec,  QT:  .34 sec.


Reviewed 3/8/16

Monday, November 26, 2012

EKG Rhythm Strips 75

Identify the following rhythms.

1.










2.

3.










4.










5.











Answers


1.
2nd Degree Heart Block Type I










The rhythm is irregular with a rate of 50/min.   The P waves are upright and uniform but there are some dropped P waves after the 2nd and 4th complexes.   The PR interval gets progressively longer.   No ectopic beats are noted.   PR:  .22/.24 sec (3rd & 4th complexes),  QRS:  .08 sec,  QT:  .40 sec.   This patient had an underlying 1st degree block but often she would transition in to a Mobitz I block of varying cycles of 3-5 grouped beats.


2.
Sinus bradycardia with biventricular pacing










The rhythm is regular with a rate of 55/min.   The P waves are upright and have a corresponding QRS complex.   The wide P waves suggest a left atrial enlargement.   There are both single and double pacer spikes seen before the QRS complexes.  I am not sure if the monitor is sensing each pacer spike correctly.  The pacer spike on the first complex is wide but it is a biventricular spike.  The second complex shows only one pacer spike.  PR:  .16 sec,  QRS:  .16 sec,  QRS:  .56 sec.


3.
Bradycardia with sinus arrhythmia











The rhythm is irregular with a rate of 40/min.   The P waves are small and upright.   No ectopic beats are seen.  The R-R interval between the 1st and 2nd complex is 1.72 sec and the R-R interval between the 3rd and 4th complex is 1.16 sec.   No ectopic beats are present.  PR:  .12 sec,  QRS:  .08 sec,  QT:  .44 sec.


4.
Normal Sinus Rhythm with a PVC











The rhythm is irregular due the PVC.   The rate is 60/min.   The P waves are small, upright, and are associated with a QRS complex.   A single PVC is present.   There is ST depression in lead II and 3mm ST elevation in lead V1 (measure 0.4 sec after the J point).   PR:  .12 sec,  QRS:  .12 sec,  QT:  .44 sec.


5.
Atrial Bigeminy














The rhythm is irregular with bigeminal atrial ectopic complexes.   The rate is 80/min.   The P waves are associated with a QRS complex.   The P wave of the PACs has a morphology that differs from the sinus P waves.  PR:  .16 sec,  QRS:  .08 sec,  QT;  .44 sec.


Reviewed 3/8/16