Practice EKG Rhythm Strips 188
Identify the following rhythms.
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Answers
1.
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.
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.
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.
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.
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2.
3.
4.
5.
Answers
1.
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| 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.
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| 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.
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| 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.
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| 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.
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| Ventricular tachycardia |
The strip # 4 is called Afib with heart rate of 60/min that looks more like 50/min or less?
ReplyDeleteI arrived at the rate of 60 bpm by counting the number of R waves in a 6 second strip and multiplying that number by 10. I included the last complex even though the ST segment lies outside of the 6 second hash mark.
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