Tuesday, April 30, 2013

Basic EKG Rhythm Test 07

Identify the following rhythms.

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Answers


1.    Junctional tachycardia
2.    Accelerated junctional rhythm
3.    Atrial paced
4.    Normal sinus rhythm with PACs
5.    Sinus rhythm changing to ventricular tachycardia
6.    Supraventricular tachycardia
7.    Ventricular tachycardia changing to ventricular fibrillation
8.    2nd degree heart block type I
9.    Atrial fibrillation with multifocal PVCs
10.  Idioventricular rhythm
11.  Normal sinus rhythm with a multifocal couplet
12.  Polymorphic ventricular tachycardia
13.  Ventricular fibrillation
14.  2nd degree heart block type II
15.  Agonal rhythm
16.  3rd degree heart block
17.  Normal sinus rhythm with multifocal PVCs
18.  Normal sinus rhythm with unifocal PVCs (quadrigeminy)
19.  Torsades de pointe
20.  Accelerated junctional rhythm
21.  Atrial flutter
22.  Junctional rhythm
23.  Normal sinus rhythm with sinus pauses
24.  Bradycardia with sinus arrhythmia
25.  Monomorphic ventricular tachycardia



Monday, April 29, 2013

Practice EKG Rhythm Strips 126

Identify the following rhythms.

1.


2.


3.


4.


5.















Answers

1.
Normal sinus rhythm with a PVC













The underlying rhythm is regular.   The calculated rate is 65.   There are upright P waves that precede the QRS complexes.   There is a single ectopic PVC.   PR:  .20 sec.   QRS:  .10 sec.  QT:  .40 sec
2.
Normal sinus rhythm with a PJC













The underlying rhythm is regular.   The calculated rate is 62.    There are upright P waves before each sinus QRS complex.   A single PJC is noted, the 3rd complex.   The P wave of this complex is retrograde in origin.   PR:  12 sec,  QRS:  .08 sec,  QT:  .44 sec.

3.
Normal sinus rhythm 1st degree block with a pause













The rhythm is irregular due to the pause.   The rate is 80 per minute (10 sec strip rule).   There are upright P waves before each QRS complex.  Notice that the P waves are wide, about .12 sec.  There may be some underlying left atrial enlargement.   No ectopy is noted.  There is .8 sec pause after the 3rd complex.  The pause is less than two cardiac cycles so that is why it is termed a pause and not an arrest.   PR: .24  sec,  QRS:  .08 sec,  QT:  .44 sec.
4.
Normal sinus rhythm 1st degree block with junctional escape beats











The rhythm is irregular.   The rate is 50/minute.   The 1st, 2nd, and 5th complexes have upright P waves.   The 3rd and 4th complexes do not have P waves.   The R-R interval between the 2nd and 3rd complex is longer than the complexes of sinus origin,  this suggests an escape mechanism rather than a premature beat.   The same delay is noted between the 3rd and 4th complexes.   The 5th complex is sinus in origin.   PR:  .24,  QRS:  .12 sec,  QT:  .48 sec

5.
Normal sinus rhythm with prominent U waves and  a PAC














The rhythm is irregular owing to the presence of a PAC, 3rd complex.   Otherwise the underlying rhythm is regular.   The calculated rate is 44.   There are upright P waves before each QRS complex.   A single PAC is noted.  The 3 complex has a P wave that is of slightly different morphology than the P waves of sinus origin.   There are U waves that follow each T waves.  PR:  12 sec,  QRS:  .08 sec,   QT:  .44 sec.


Saturday, April 27, 2013

Practice EKG Rhythm Strips 125

Identify the following rhythms.

1.














2.


3.


4.


5.














Answers

1.
 Agonal rhythm.   The QRS complex is wide and bizzare looking owing to it's ventricular origin.   The rate is less than 20 minute so this qualifies this rhythm as an agonal rhythm.


2.
Atrial paced.  The P waves that follow the atrial paced spike are not very prominent.   There is a significant delay between the atrial spike and the QRS complex.  This is supposed to help reduce the development of a pacemaker induced hypertrophy.   Otherwise, the rhythm is regular.   The rate is 75.  There are upright P waves that are atrial paced in origin.   No ectopy is noted.   PR:  32 sec.   QRS:  .08 sec,   QT:  .32 sec.


3.
Junctional rhythm.  .   Those T waves are tall so I wonder if there was a problem with hyperkalemia.  The rhythm is regular.   The rate is 60.   There are no P waves before each QRS complex.  No ectopic beats are noted.   PR: ---   QRS:  .12 sec,  QT:   .40 sec

4.
 Atrial bigeminy.   The rhythm is irregular.   The rate is 70.   There are upright P waves before each QRS complex.   There are ectopic beats every other beat.   The P waves on the ectopic beats are of differing morphology than the sinus beats.   The PR interval on the ectopic beats is longer than the sinus beats.   PR:  .16 sec,  QRS:  .08 sec,  QT:  .40 sec.


5.








Polymorphic ventricular tachycardia converting to sinus bradycardia

Friday, April 26, 2013

Practice EKG Rhythm Strips 124

Identify the following rhythms.

1.












2.

3.

4.

5.















Answers
1.
Sinus tachycardia with a wandering baseline













The rhythm looks regular, though this is difficult to tell because of the wandering baseline.   The calculated rate is 150/min.   There are upright P waves before each QRS complex.  The P waves are tall and wide suggesting biatrial enlargement.   No ectopy is noted.   PR:  12 sec.   QRS.  08 sec,   QT:  .28 sec.

2.
Normal sinus rhythm with sinus pause













The rhythm is irregular owing to the pause, otherwise the underlying rhythm is regular.   The calculated rate is 60/minute.   There are upright P waves before each QRS complex.   There is a pause lasts 1.4 sec.  PR:  .20 sec,  QRS:  .08 sec,  QT:  .38 sec.


3.
Sinus arrhythmia













The rhythm is irregular.   Notice how the R-R interval slowly gets longer.   The R-R interval between the 1st and 2nd complex is .6 sec.   The R-R interval between the 7th and 8th complex is .72 sec. The rate is 80.  There are upright P waves before each QRS complex.   No ectopy is noted.   PR:  .20 sec,  QRS:  .08 sec,  QT: .36 sec.


4.
Atrial fibrillation with rapid ventricular response













The rhythm is irregular.   The rate is 130/min.   No P waves are present.  Some fibrillatory waves are seen between some complexes.   No ectopic beats are noted.   PR  ---,   QRS:  .12 sec.  QT:  .36 sec

5.
Normal sinus rhythm









The rhythm is regular.   The calculated rate is 60/min.  There are some small biphasic P waves present before each QRS complex.  No ectopic beats are present.   PR:  .12 sec.  QRS:  .08 sec.  QT:  .38 sec.