Saturday, August 31, 2013

Basic EKG Rhythm Test 11

Identify the following rhythms.

1.











2.














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5.














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10.


11.


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25.













26.













27.













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Answers


1.    Idioventricular rhythm
2.    2nd degree heart block type II
3.    Junctional tachycardia
4.    2nd degree heart block type I
5.    Agonal rhythm
6.    1st degree heart block
7.    Asystole with pacer spikes
8.    Atrial fibrillation
9.    Atrial flutter
10.  AV paced
11.  3rd degree heart block
12.  Idioventricular rhythm
13.  Junctional rhythm
14.  Accelerated junctional rhythm
15.  NSR with triplets of PVCs
16.  NSR with bigeminal PACs
17.  NSR with multifocal bigeminal PVCs
18.  NSR with trigeminal PVCs
19.  Sinus bradycardia
20.  Sinus bradycardia with a PJC
21.  Sinus tachycardia
22.  Supraventricular tachycardia
23.  Torsades de pointe
24.  Failure to capture
25.  P wave asystole
26.  Ventricular tachycardia changing to ventricular fibrillation
27.  Sinus bradycardia with sinus arrest


Friday, August 30, 2013

Practice EKG Rhythm Strips 188

Identify the following rhythms.


1.


2.



3.


4.


5.














Answers


1.
2nd degree AV block type I












The rhythm is irregular with a heart rate of 50/min.   The P waves are upright.   There is a nonconducted P wave after the 1st and 3rd complexes.  The PR interval gets progressively longer then this followed by a nonconducted P wave.   No ectopic beats are present.  PR:  .12/.24/.32 sec, QRS:  .08 sec,  QT:  .40 sec.


2.
Idioventricular rhythm










The rhythm is irregular with a rate of 30/min.  No P waves are present.  The QRS complex is very wide.  The rhythm is a ventricular escape rhythm usually seen in a dying heart.  It certainly looks agonal but based on the rate it is still called an idioventricular rhythm.


3.
3rd degree heart block












The rhythm is regular with a ventricular rate of 40/min and an atrial rate of 90/min.   The P waves are dissociated from the QRS complexes.   No ectopic beats are noted.   PR:  ---,  QRS:  .16 sec,  QT:  .40 sec.


4.
Atrial fibrillation












The rhythm is irregular with a rate of 60/min.  The P waves are not seen.  There appears to be some fibrillatory activity between the QRS complexes.  No ectopic beats are seen.  PR:  ---,  QRS: .10 sec,  QT:  .48 sec.


5.
The rhythm is regular with a rate of 160/min.  No P waves are seen.   The QRS complex is uniform.   The QRS complex is negative in lead 1 and positive in V1.   With ventricular tachycardia you will have positive concordance in all leads,  that is the QRS complex will be all negative or all positive. So this rhythm may actually be a wide complex tachycardia.  However the two cardinal rules for distinguishing between wide complex tachycardia and ventricular tachycardia are:  Rule No 1:  Wide complex tachycardia is VT until proven otherwise.  Rule No 2:  Always remember rule No 1.    Hopefully someone has gone to assess the patient because the hemodynamic consequences of wide complex tachycardia and ventricular tachycardia is the same.

Ventricular tachycardia

Thursday, August 29, 2013

Practice EKG Rhythm Strips 187

Identify the following rhythms.


1.


2.


3.


4.


5.














Answers


1.
Normal sinus rhythm changing to accelerated junctional rhythm











The rhythm is regular with a rate of 88/min.   There are both upright and negative P waves present.   The P waves of the first four complexes are upright but beginning at the fifth complex the P waves are retrograde.   No ectopic beats are present.   PR:  .12 sec,  QRS:  .08 sec,  QT:  . 36 sec.


2.
Seven beat run of ventricular tachycardia












The rhythm is irregular.   The rate is 120/min.   Upright P waves are seen on the first 4 beats.  The 1st and 3rd beats are sinus beats while the 2nd and 4th beats look like PACs.   This is followed by a 7 beat run of ventricular tachycardia.   PR:  .12 sec,  QRS:  .08 sec,  QT:  .36 sec.


3.
Bigeminal PACs











The rhythm is irregular with frequent PACs.    The rate is 100/min.   There are upright P waves present.   The P waves are associated with a QRS complex.   There are PACs every other beat in a bigeminal pattern.   The morphology of the P waves of the PACs differs from the morphology of the sinus P waves.   PR:  .12 sec,  QRS:  .08 sec,  QT:  .36 sec.


4.












The rhythm is irregular with a rate of 90/min.   The P waves are positive and have a corresponding QRS complex.   There are bigeminal unifocal PVCs present.  A compensatory pause follows each PVC.  PR:  .16 sec,  QRS:  .08 sec,  QT:  .40 sec.


5.
Sinus arrhythmia with 1st degree block 

The rhythm is slightly irregular with a rate of 58/min.  The P waves are upright and associated with a QRS complex.   No ectopic beats are present.  PR:  .22 sec,  QRS:  .08 sec,  QT:  .36 sec.



Wednesday, August 28, 2013

Practice EKG Rhythm Strips 186

Identify the following rhythms.


1.


2.



3.


4.


5.













Answers


1.
2nd degree AV block type I













The rhythm is irregular with a rate of 50/min.  The P-P interval is regular while the R-R interval is irregular.  The P waves are upright and uniform.   There is a nonconducted P wave that follows the 3rd complex.   No ectopic beats are noted.   PR:  .12/.24/.32 sec,  QRS:  .08 sec,  QT:  .40 sec.


2.
Ventricular paced with multifocal couplets










The rhythm is irregular due to the PVCs.   The paced rate is 88/min.   Upright P waves are paired with a QRS complex.   There are two multifocal couplets present.  PR:  .20 sec,  QRS:  .16 sec,  QT:  .40 sec.


3.
3rd degree heart block












The rhythm is regular with a ventricular rate of 30/min and an atrial rate of 90/min.  The P waves are upright and uniform but are unassociated with a QRS complex.   PR:  ---,  QRS:  .16 sec,  QT: .40 sec.


4.
Idioventricular rhythm












The rhythm is regular with a rate of 40/min.   No P waves are present.   No ectopic beats are seen. The QRS is wide indicating that the rhythm is of ventricular origin.   PR:  ---,  QRS:  .16 sec,  QT; .40 sec.


5.
Ventricular tachycardia


The rhythm is regular with a rate of 167/min.   No P waves are seen.   The QRS complex is uniform and monomorphic.