Practice EKG Rhythm Strips 135
Identify the following rhythms.
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Answers
1.
The rhythm is irregular. There is complete AV dissociation present. The atrial rate is 68/min. The ventricular rate is 37/min. The P waves are upright but not associated with the QRS complexes. This is not a type I block because the PR interval is not getting progressively longer. This is not a type II block because there is not a consistent PR interval associated with the QRS complexes. This is a complete heart block because there is no synchronization between the atrium and the ventricles. If you measure the P-P intervals you will find that there are P waves which are buried within the QRS complexes or T waves. The QRS complex is wide suggesting a ventricular escape mechanism. PR: --- QRS: .12 sec, QT: .48 sec.
2.
The rhythm is irregular. The rate is 50/min. There are fibrillatory waves in between the QRS complexes. No P waves are noted. PR: ---, QRS: .12 sec, QT: .42 sec. With this rate consider evaluating the patient's medications: Digoxin, beta blockers, calcium channel blockers, antiarrhythmics. Monitor electrolytes and evaluate for ischemia. If the bradycardia is symptomatic, consider external pacing.
3.
The rhythm is irregular. The rate is 50/min. There are flutter waves between each QRS complex. No ectopic beats are noted. PR: --- QRS: .08 sec, QT: .28 sec.
4.
The rhythm is regular. The calculated rate is 51/min. No upright P waves are present. But there are some retrograde P waves that follow the QRS complex. When the P waves follow the QRS complexes then atrial depolarization follows the ventricular depolarization. PR: ---, QRS: .12 sec. QT: .56 sec. (I used the V1 lead to measure the QT interval) The QT interval is prolonged.
5.
The rhythm is regular. The rate is 41/min. The P waves are upright and precede each QRS complex. No ectopic beats are noted. PR: 18 sec, QRS: .08 sec, QT: .40 sec.
1.
2.
3.
4.
5.
Answers
1.
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| Complete heart block |
The rhythm is irregular. There is complete AV dissociation present. The atrial rate is 68/min. The ventricular rate is 37/min. The P waves are upright but not associated with the QRS complexes. This is not a type I block because the PR interval is not getting progressively longer. This is not a type II block because there is not a consistent PR interval associated with the QRS complexes. This is a complete heart block because there is no synchronization between the atrium and the ventricles. If you measure the P-P intervals you will find that there are P waves which are buried within the QRS complexes or T waves. The QRS complex is wide suggesting a ventricular escape mechanism. PR: --- QRS: .12 sec, QT: .48 sec.
2.
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| Atrial fibrillation with slow ventricular response |
The rhythm is irregular. The rate is 50/min. There are fibrillatory waves in between the QRS complexes. No P waves are noted. PR: ---, QRS: .12 sec, QT: .42 sec. With this rate consider evaluating the patient's medications: Digoxin, beta blockers, calcium channel blockers, antiarrhythmics. Monitor electrolytes and evaluate for ischemia. If the bradycardia is symptomatic, consider external pacing.
3.
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| Atrial flutter with variable block |
The rhythm is irregular. The rate is 50/min. There are flutter waves between each QRS complex. No ectopic beats are noted. PR: --- QRS: .08 sec, QT: .28 sec.
4.
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| Junctional rhythm |
The rhythm is regular. The calculated rate is 51/min. No upright P waves are present. But there are some retrograde P waves that follow the QRS complex. When the P waves follow the QRS complexes then atrial depolarization follows the ventricular depolarization. PR: ---, QRS: .12 sec. QT: .56 sec. (I used the V1 lead to measure the QT interval) The QT interval is prolonged.
5.
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| Sinus bradycardia |
The rhythm is regular. The rate is 41/min. The P waves are upright and precede each QRS complex. No ectopic beats are noted. PR: 18 sec, QRS: .08 sec, QT: .40 sec.
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