Thursday, January 31, 2013

Practice EKG Rhythm Strips 99

Identify the following rhythms.

1.


2.


3.


4.


5.










Answers


1.
Junctional rhythm










The rhythm is slightly irregular with a rate of 55/min.   The P waves are negative and precede the QRS complex.   No ectopic beats are noted.   PR:  .12 sec,  QRS:  .08 sec,  QT:  .44 sec.


2.
Normal sinus rhythm










The rhythm is regular.   The rate is 79/min.   There are uniform, upright P waves that are associated with the QRS complexes. The P waves are tall suggesting right atrial enlargement.   No ectopic beats are seen.  PR:  .16 sec,  QRS:  .12 sec,  QT:  .44 sec.


3.
Sinus arrhythmia









The rhythm is irregular.   The PR interval between the 2nd and 3rd complex is .44 sec and the PR interval between the 9th and 10th complex is .84 sec.   No ectopic beats are seen.  PR:  .12 sec  QRS:  .08 sec,  QT:  .36 sec.


4.
Sinus bradycardia









The rhythm is regular with a ventricular rate of 48/min.   The P waves are associated with a QRS complex and are positive.   No ectopic beats are present.   PR:  .12 sec,  QRS:  .08 sec,  QT:  .36 sec.


5.
Sinus tachycardia













The rhythm is regular and the rate is 125/min.  The P waves are uniform, upright, and precede the QRS complex.   No ectopic beats are seen.  There is inversion of the T wave.   PR:  .12 sec,  QRS:  .08 sec.  QT:  .36 sec.

Wednesday, January 30, 2013

Practice ECG Rhythm Strips 98

Identify the following rhythms.

1.

2.







3.







4.








5.






Answers

1.
NSR with unifocal PVCs (bigeminy)








The rhythm is irregular with multiple ectopic beats.   The rate is 96/min.  The P waves are positive and are associated with a QRS complex.  Unifocal PVCs occur every other beat.  There are P waves before the 3rd and 4th PVC.   The remaining PVC have a slurred upstroke on the R wave suggesting that they are fused with a P wave, this is especially evident on the 6th PVC.  There is down slopping of the ST segment with a negative T wave.  PR:  .12 sec,  QRS:  .08 sec,  QT:  . 36 sec.


2.
NSR with unifocal PVCs (trigeminy)








The rhythm is irregular due to the ectopic beats.  The rate is 72/min.  There are positive P waves that are associated with a QRS complex.  Unifocal PVCs are seen every 3rd beat in a trigeminal pattern.  A compensatory pause follows the PVC.  The T wave is negative.  PR:  .20 sec,  QRS:  .10 sec,  QT:  .40 sec.


3.
NSR with unifocal PVCs (quadrigeminy)








The rhythm is irregular with a rate of 78/min.  The P waves are spit but upright and precede the QRS complex.  There are unifocal PVCs every 4th beat.  PR:  .20 sec,  QRS:  .08 sec,  QT:  .40 sec.


4.
Sinus tachycardia with unifocal PVCs (pentageminy)









The rhythm is irregular with a rate of 102.  Upright P waves have a corresponding QRS complex.  There are unifocal PVCs every 5th beat.  A compensatory pause follows each PVC.  PR:  .12 sec,  QRS:  .08 sec,  QT:  .36 sec.


5.
NSR 1st degree block with unifocal PVCs (hexigeminy)










The rhythm is irregular with a rate of 96/min.   The P waves are uniform, positive, and are associated with a QRS complex.  The PR interval is prolonged.   Unifocal PVCs are seen every 6th beat.   PR:  .22 sec,  QRS;  .08 sec,  QT:  .40 sec.







Tuesday, January 29, 2013

Practice EKG Rhythm Strips 97

Identify the following rhythms.

1.

2.












3.

4.

5.














Answers.

1.
1st degree block


2.
NSR with bigeminy

3.
Sinus arrhythmia

4.
Junctional rhythm










5.
Atrial fibrillation with rapid ventricular response

Monday, January 28, 2013

Practice ECG Rhythm Strips 96

Identify the following rhythms.

1.





2.

3.

4.


5.







Answers

1.
Bradycardia with 1st degree AV block










The rhythm is regular with a rate of 57/min.   The P waves are upright and precede each QRS complex.  The PR interval is prolonged.  No ectopic beats are present.   PR:  .24 sec,  QRS:  .12 sec,  QT:  .40 sec.


2.
Demand AV pacing











The rhythm is regular with a rate of 75/min.  The P waves are upright and associated with a QRS complex.   With the exception of the 2nd and 9th P waves, there are atrial pacer spikes before each P wave.  No ectopic beats are noted.  There are ventricular pacer spikes before each QRS complex.   PR:  .16 sec,  QRS:  .16 sec,  QT:  .44 sec.


3.
NSR with ventricular bigeminy











The rhythm is irregular due to the PVCs.   The P waves have a corresponding QRS complex and are uniform and upright.   There are unifocal PVCs every other beat in a bigeminal pattern.  A compensatory pause follows each PVC.  PR:  .16 sec,  QRS:  .12 sec,  QT:  .36 sec.


4.
NSR with PACs











The rhythm is regular due to the atrial ectopic beats.   The rate is 90/min.   The P waves precede a QRS complex but display some differences in morphology.   Premature atrial complexes are seen on the 2nd, 7th, 9th, and 10th complexes.   PR:  .20 sec,  QRS:  .08 sec,  QT:  .32 sec


5.
Ventricular tachycardia














The rhythm is regular with wide, monomorphic QRS complexes.  The rate is 166/min.  No P waves are present.





Saturday, January 26, 2013

Practice EKG Rhythm Strips 95

Identify the following rhythms.

1.






2.





3.

4.





5.











Answers


1.
Agonal rhythm











The rate is 20/min.   No P waves are seen.   The QRS complexes are wide with some ST elevation.  P:   ---,   QRS:  .16 sec,  QT:  .48 sec.


2.
SVT with aberrancy changing to NSR








Notice that there is a right bundle branch block present in the patient's underlying rhythm.   When the rate speeds up the wide QRS complex gives the impression that the patient has ventricular tachycardia


3.
Demand atrial pacing with some dropped beats










The rhythm is irregular.   The rate is 60/min.  The P waves are upright and precede each QRS complex.  There is an atrial pacer spike before the 2nd and 6th complexes.  There is a dropped P wave after the 1st, 5th, and 8th complexes.  Ventricular pacer spikes precede each QRS complex.
PR:  .10 sec,  QRS:  16 sec,  QT:  .44 sec.


4.
NSR with unifocal PVCs (pentageminy)









The rhythm is irregular due to the PVCs.  The rate is 100/min. The P waves are upright and are associated with a QRS complex.   Unifocal PVCs are seen every 5th beat.   PR:  .16 sec,  QRS:  .08 sec,  QT:  .40 sec.


5.
NSR with junctional trigeminy













The rhythm is irregular with junctional ectopic beats.   The rate is 90/min.  The P waves have a corresponding QRS complex.   There are negative P waves every third beat in a trigeminal pattern. PR:  .12 sec,  QRS: .08 sec,  QT:  .36 sec.