Practice EKG Rhythm Strips 163
Identify the following rhythms.
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Answers
1.
The rhythm is irregular due to the pauses. The rate is 40/min. No P waves are identified. The rhythm is ventricular in origin. Idioventricular rhythm is between 20-40 beats per minute. It is characterized by an absent P wave, QRS complex > .12 sec. It may be a regular or an irregular rhythm.
2.
The R-R interval is irregular. The R-R interval between the 1st and 2nd complex is .92 sec and the R-R interval between the 5th and 6th complexes is 1.2 sec. The P waves are small, low voltage. No ectopic beats are present. PR: .12 sec, QRS: .08 sec, QT: .40 sec.
3.
The rhythm is not regular. The rate is 80/min. Up right P waves are present. The PR interval is prolonged. There is a blocked PAC that falls on the T wave of the 5th complex. The P wave arrives early in the cardiac cycle so that is why it is termed a blocked PAC instead of a nonconducted beat. This is followed by a brief pause and an atrial escape beat and then a PVC. The PR interval of the escape beat is shorter than the PR interval of the sinus beats. PR: .24 sec. QRS: .12 sec, QT: .40 sec.
4.
This rhythm is irregular and has a rate of 60/min. The P waves are biphasic, characteristic of biatrial enlargement. There is a 1st degree block. The QRS complex is wide. A dropped PAC follows the 4th complex. Notice that change in the morphology of the P wave. It has an initial negative deflection whereas the sinus beats have an initial positive deflection. A brief pause follows the dropped PAC and two junctional escape beats follow. The escape beats have a similar morphology as the native QRS complexes so I suspect that these are junctional rather than ventricular escape beats. PR; .24 sec, QRS: .12 sec, QT: .40 sec.
5.
A PAC causes the irregularity in this paced rhythm. The rate is 80/min. There are small upright P waves that precede each QRS complexes. The morphology of the P waves change from beat to beat suggesting a wandering atrial pacemaker. The 4th complex arrives much earlier in the cardiac cycle. There slight height change in the T wave of the previous complex suggesting that a P wave is buried within it. A pacer spike initiates the QRS complexes. PR; .12 sec, QRS: .16 sec, QT: .44 sec.
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Answers
1.
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| Idioventricular rhythm |
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| Sinus arrhythmia |
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| 1st degree block with a PVC and a blocked PAC |
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| Normal sinus rhythm with a dropped PAC and junctional escape beats |
This rhythm is irregular and has a rate of 60/min. The P waves are biphasic, characteristic of biatrial enlargement. There is a 1st degree block. The QRS complex is wide. A dropped PAC follows the 4th complex. Notice that change in the morphology of the P wave. It has an initial negative deflection whereas the sinus beats have an initial positive deflection. A brief pause follows the dropped PAC and two junctional escape beats follow. The escape beats have a similar morphology as the native QRS complexes so I suspect that these are junctional rather than ventricular escape beats. PR; .24 sec, QRS: .12 sec, QT: .40 sec.
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| Ventricular paced with a PAC |
A PAC causes the irregularity in this paced rhythm. The rate is 80/min. There are small upright P waves that precede each QRS complexes. The morphology of the P waves change from beat to beat suggesting a wandering atrial pacemaker. The 4th complex arrives much earlier in the cardiac cycle. There slight height change in the T wave of the previous complex suggesting that a P wave is buried within it. A pacer spike initiates the QRS complexes. PR; .12 sec, QRS: .16 sec, QT: .44 sec.
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