EKG Rhythm Strip Quiz 117

Identify the following rhythms.

1.

2.

3.

4.

5.

6.

7.

8.

9.

10.

Answers

1.

2nd degree AV block type I

Rate: Because some beats aren't conducted, the ventricular rate is usually slightly slower than normal. The atrial rate is normal

Rhythm: The R - R interval is irregular

P Wave: Upright and uniform. There are more P waves than QRS complexes

PRI: Interval get progressively longer, until one P wave isn't followed by a QRS complex. There is a pattern to this cycle as it is repeated.

QRS: less than 0.12 seconds

S-T Segment: neither elevated or depressed

T Waves: usually slightly rounded and asymmetrical; T wave is less than half the height of the QRS

2.

Junctional rhythm

Rate: The atrial and ventricular rates are equal; the inherent heart rate of the AV Junction is 40 - 60 beats per minute

Rhythm: The R - R intervals are constant; the rhythm is regular

P Wave: The P wave can come before or after the QRS complex or it can be lost in the QRS complex. If visible, the P wave will be inverted.

PRI: If the P wave precedes the QRS complex, the PRI will be less than 0.12 seconds. If the P wave falls within the QRS complex or following it, the will be no PRI

QRS: less than 0.12 seconds

S-T Segment: neither elevated or depressed

T Waves: usually slightly rounded and asymmetrical; T wave is less than half the height of the QRS

3.

Normal sinus rhythm with a PVC

Rate: The atrial and ventricular rates are equal; the heart rate is usually 60 - 100 beats per minute

Rhythm: The R - R intervals are constant; the rhythm is regular

P Wave: The P waves are uniform. There is one P wave in front of every QRS complex.

PRI: 0.12 - 0.20 seconds and constant.

QRS: less than 0.12 seconds

S-T Segment: neither elevated or depressed

T Waves: usually slightly rounded and asymmetrical; T wave is less than half the height of the QRS

4.

 Ventricular trigeminy with demand ventricular pacing

5.

Sinus tachycardia

Rate: The atrial and ventricular rates are equal; the heart rate is usually between 100 to 160 beats per minute

Rhythm: The R - R intervals are constant; the rhythm is regular

P Wave: The P waves are uniform. There is one P wave in front of every QRS complex.

PRI: 0.12 - 0.20 seconds and constant.

QRS: less than 0.12 second

S-T Segment: neither elevated or depressed

T Waves: usually slightly rounded and asymmetrical; T wave is less than half the height of the QRS

6.

Atrial flutter

Rate: The atrial rate is between 250-350 beats per minute. Ventricular rate will depend on the ratio of impulses conducted to the ventricles

Rhythm: The atrial rhythm is regular. The ventricular rhythm will be regular if the AV node conducts impulses through in a consistent pattern. If the pattern varies, the ventricular rate will be irregular.

P Wave: When the atria flutter, they produce a series of well-defined P waves. When seen together, they resemble a "sawtooth" pattern.

PRI: Because of the flutter waves' proximity to the QRS complex, it is difficult, if not impossible to determine the PRI

QRS: less than 0.12 seconds - can be difficult to measure if any flutter waves are concealed in the QRS complex

S-T Segment: neither elevated or depressed

T Waves: Difficult to see with flutter waves

7.

Junctional tachycardia

Rate: The atrial and ventricular rates are equal. Typically, the rate is between 100 - 150.

Rhythm: The R - R intervals are constant; the rhythm is regular

P Wave: The P wave can come before or after the QRS complex or it can be lost in the QRS complex. If visible, the P wave will be inverted.

PRI: If the P wave precedes the QRS complex, the PRI will be less than 0.12 seconds. If the P wave falls within the QRS complex or following it, the will be no PRI

QRS: less than 0.12 seconds

S-T Segment: neither elevated or depressed

T Waves: usually slightly rounded and asymmetrical; T wave is less than half the height of the QRS

8.

NSR with some electrical interference

9.

Polymorphic ventricular tachycardia

Rate: The atrial rate can't be determined. The ventricular rate is 150 - 250.

Rhythm: The rhythm is usually irregular.

P Wave: Not usually visible.

PRI: There is no PRI, as the focus is ventricular.

QRS: The QRS is wide and bizarre, usually 0.12 or greater. It is sometimes difficult to differentiate between QRS complexes and T waves.  The morphology of the QRS complexes are different
S-T Segment: Difficult, if not impossible to see.

T Waves: Difficult to differentiate T waves from QRS complexes

10.

Monomorphic ventricular tachycardia

Rate: The atrial rate can't be determined. The ventricular rate is 150 - 250. If the rate <150, it is called a slow V tach.

Rhythm:  The rhythm is usually regular.

P Wave:  Not usually visible.

PRI: There is no PRI, as the focus is ventricular.

QRS: The QRS is wide and bizarre, usually 0.12 or greater. It is sometimes difficult to differentiate between QRS complexes and T waves.  The morphology of the QRS complexes are the same
S-T Segment: Difficult, if not impossible to see.

T Waves:  Difficult to differentiate T waves from QRS complexes

Reviewed 6/7/13