Practice EKG Rhythm Strips 198

Identify the following rhythms.


1.


2.


3.

4.












5.













Answers


1.
Agonal rhythm













The rhythm is irregular.  The rate is 20/min.  No atrial activity is present.   The QRS complex is wide, bizzare looking, and slow.

2.
Biventricular paced













The rhythm is regular with a heart rate of 94/min.   The P waves are uniform, upright, and precede the QRS complexes.   There are biventricular pacer spikes seen before each QRS complex.  No ectopic beats are noted.  PR:  .12 sec,  QRS: .12 sec,  QT:  .40 sec.

3.
Atrial fibrillation with slow ventricular response













The rhythm is irregular with a ventricular rate of 30/min.   The R-R interval between the 1st and 2nd complexes is 1.68 sec and the R-R interval between the 2nd and 3rd complex is 1.52 sec.  No P waves are present but there looks like some small flutter waves present in the V1 lead, though this could be some artifact.   No PVCs, PACs or PJCs are seen.   PR:  ---,  QRS:  .08 sec,  QT:  .48 sec.  Because of the irregular rhythm and absent of P waves this rhythm looks more like an atrial fibrillation with slow ventricular response.   If the rhythm were more regular I would call it a junctional rhythm.   For this slow rhythm, of course, check the patient for hemodynamic instability.

4.
NSR with 5 beat run of VT











The rhythm is irregular with a run of ventricular tachycardia.   The underlying rhythm is sinus in origin.  The P waves are upright and precede the QRS complexes.  The PR interval is fixed.  A 5 beat run of ventricular tachycardia follows the 3rd are wave.   It appears that the run begins on the later half of the T wave of the 3rd complex so we have VT with R-on-T.    A fusion beat follows the run of VT then sinus rhythm resumes.   PR:  .20 sec,  QRS:  .10 sec,  QT:  .32 sec.

5.
Sinus bradycardia with a PAC

The rhythm is irregular with a rate of 50/min.   The P waves are upright not are not all uniform.   A  PAC follows the 3rd complex.  The P wave (seen better in the V1 lead) has a different morphology and PR interval than the P waves of sinus origin.  PR:  .22 sec,  QRS:  .08 sec,  QT:  .44 sec.


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