Monday, June 30, 2014

Basic EKG Rhythm Test 20

Identify the following rhythms.


01.







a. First Degree block
b. Second degree block type I
c. Second degree block type II
d. Third degree block

02.






a. Atrial paced
b. Biventricular paced
c. Dual paced
d. Ventricular paced

03.






a. Sinus bradycardia
b. Junctional rhythm
c. Idioventricular rhythm
d. Agonal rhythm

04.







a. Atrial flutter
b. Atrial fibrillation
c. 2nd degree heart block type II
d. NSR with PACs

05.













a. Atrial paced with a multifocal couplet
b. Biventricular paced with a multifocal couplet
c. Dual paced with a multifocal couplet
d. Ventricular paced with a multifocal couplet

06.






a. Polymorphic ventricular tachycardia
b. Ventricular fibrillation
c. Torsades de pointes
d. Atrial fibrillation

07.







a. NSR with a pause
b. Sinus arrhythmia
c. Wandering atrial pacemaker
d. Atrial fibrillation

08.






a. NSR with bigeminal PVCs
b. NSR with unifocal PVCs
c. NSR with multifocal PVCs
d. Sinus rhythm with couplets

09.







a. Sinus bradycardia
b. Junctional rhythm
c. Idioventricular rhythm
d. Agonal rhythm

10.






a. Complete heart block
b. Junctional rhythm
c. Idioventricular rhythm
d. Agonal rhythm

11.













a. First degree heart block
b. Wenckebach
c. Mobitz II
d. Third degree heart block

12.






a. Monomorphic ventricular tachycardia changing to normal sinus rhythm
b. Supraventricular tachycardia changing to fine normal sinus rhythm
c. Sinus tachycardia changing to normal sinus rhythm
d. Polymorphic ventricular tachycardia changing to normal sinus rhythm

13.






a. Accelerated idioventricular rhythm
b. Accelerated junctional rhythm
c. Sinus rhythm
d. Atrial fibrillation

14.











a. Demand biventricular paced
b. Demand AV paced
c. Demand ventricular paced
d. Demand atrial paced

15.









a. Atrial fibrillation
b. First degree block
c. Sinus bradycardia
d. Normal sinus rhythm

16.






a. NSR with multifocal PVCs
b. NSR with unifocal PVCs
c. NSR with ventricular escape beats
d. NSR with PACs

17.












a. Accelerated idioventricular rhythm
b. Junctional tachycardia
c. Supraventricular tachycardia
d. Ventricular tachycardia

18.







a. Atrial paced
b. Biventricular paced
c. Dual paced
d. Ventricular paced

19.







a. Wandering atrial pacemaker
b. Atrial fibrillation with rapid ventricular response
c. Supraventricular tachycardia
d. Multifocal atrial tachycardia

20.






a. Polymorphic ventricular tachycardia
b. Ventricular fibrillation
c. Torsades de pointes
d. Atrial fibrillation

21.












a. Atrial paced
b. Biventricular paced
c. Dual paced
d. Ventricular paced

22.






a. First degree heart block
b. Wenckebach
c. Mobitz II
d. Third degree heart block

23.







a. Sinus arrhythmia
b. Second degree heart block type II
c. Complete heart block
d. Idioventricular rhythm

24.






a. NSR with triplets of PVCs
b. NSR with multifocal PVCs
c. NSR with couplets of PVCs
d. NSR with trigeminal PVCs

25.







a. Atrial fibrillation
b. Sinus arrhythmia
c. Atrial flutter
d. NSR


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Answers

01. d. Third degree block
02. d. Ventricular paced
03. b. Junctional rhythm
04. a. Atrial flutter
05. b. Biventricular paced with a multifocal couplet
06. c. Torsades de pointes
07. a. NSR with a pause
08. a. NSR with bigeminal PVCs
09. a. Sinus bradycardia
10. d. Agonal rhythm
11. c. Mobitz II
12. a. Monomorphic ventricular tachycardia changing to normal sinus rhythm
13. d. Atrial fibrillation
14. c. Demand ventricular paced
15. b. First degree block
16. d. NSR with PACs
17. c. Supraventricular tachycardia
18. c. Dual paced
19. b. Atrial fibrillation with rapid ventricular response
20. b. Ventricular fibrillation
21. a. Atrial paced
22. b. Wenckebach
23. d. Idioventricular rhythm
24. c. NSR with couplets of PVCs
25. b. Sinus arrhythmia

Friday, June 27, 2014

Practice Rhythm Strips 306

Identify the following rhythms.

1.







a. Asystole
b. Ventricular paced
c. Atrial paced
d. Biventricular paced

2.






a. NSR with couplets
b. NSR with ventricular bigeminy
c. NSR with uniform PVCs
d. NSR with unifocal PACs

3.







a. Accelerated idioventricular rhythm
b. Accelerated junctional rhythm
c. Complete heart block
d. Agonal rhythm


4.













a. 1st degree block with a triplet of PVCs
b. Sinus rhythm with triplet of PVCs
c. Sinus bradycardia with triplet of PVCs
d. Sinus rhythm with trigeminal PVCs


5.







a. Sinus bradycardia with a pause
b. Sinus arrhythmia
c. Complete heart block
d. 2nd degree AV block type II


Answers

1. a. Asystole.   Asystole with a functioning single chamber pacemaker.
2. b. NSR with ventricular bigeminy.  The rhythm is irregular because of the PVCs. The heart rate is 90/min. The P waves look the same and are paired with a QRS complex. The QRS complexes are narrow. Unifocal PVCs are seen in a bigeminal pattern. PR: .12 QRS: .08 sec, QT: .36 sec. Interpretation: NSR with ventricular bigeminy or bigeminal PVCs
3. a. Accelerated idioventricular rhythm.  This rhythm is regular. The heart rate is 50/min. No P waves are seen. The QRS complex is wide so this screams that it is a ventricular rhythm. No ectopic beats are seen. PR: ---, QRS: .16 sec, QT: .44 sec. Interpretation: Accelerated Idioventricular rhythm.
4. d. Sinus rhythm with trigeminal PVCs.  The rhythm is irregular due to the PVCs. The rate is 68/min. The P waves are uniform, upright, and are paired with a QRS complex. Three consecutive PVCs follow the 2nd complex. This is followed by a short compensatory pause then sinus rhythm resumes. PR: .16 sec, QRS: .08 sec, QT: .40 sec. Interpretation: Sinus rhythm with triplet of PVCs
5. a. Sinus bradycardia with a pause.  Yikers! This looks serious. The rhythm is irregular due to the pause. The heart rate is 30/min. The P waves are associated with a QRS complex. There is a 2.2 sec pause following the 1st beat. No ectopic beats are seen. PR: .16 sec, QRS: .10 sec, QT: .44 sec.


Thursday, June 26, 2014

Practice Rhythm Strips 305

Identify the following rhythms.

1.







a. Junctional rhythm
b. Sinus bradycardia
c. Complete heart block
d. Idioventricular rhythm


2.







What is the rhythm?
 a. Ventricular tachycardia
 b. Multifocal atrial tachycardia
 c. Sinus tachycardia
 d. Supraventricular tachycardia


3.






a. Complete heart block
b. Junctional rhythm
c. Idioventricular rhythm
d. Ventricular paced


4.






a. 2nd degree AV block type II
b. Atrial flutter
c. Sinus tachycardia
d. 2nd degree AV block type I


5.






a. NSR with sinus arrest
b. Complete heart block
c. Junctional rhythm
d. Sinus bradycardia


Answers
1. b. Sinus bradycardia. The rhythm is regular and the rate is 50/min. The P waves are paired with QRS complexes. The QRS complexes are narrow. No ectopic beats are seen. PR: .16 sec, QRS: .08 sec, QT: .44 sec. Interpretation: Sinus bradycardia
2. d. Supraventricular tachycardia. The rhythm is regular with a rate of 214mn. No P waves are seen. The QRS complexes are narrow so we know the rhythm comes from above the ventricles. No ectopic beats are seen. PR: ---, QRS: .08 sec, QT: .28 sec. Interpretation: Supraventricular tachycardia
3. d. Ventricular paced. The rhythm is regular with a rate of about 70/min. The P waves are paired with a QRS complex and are upright. The are pacer spikes before each QRS complex. No ecoptic beats are seen. PR: .12 sec, QRS: .16 sec, QT: .56 sec. Interpretation: Ventricular paced
4. b. Atrial flutter. The familiar "saw tooth" appearance identifies this rhythm as atrial flutter. The rhythm is regular with a ventricular rate of 70 and an atrial rate of 300/min. The flutter waves are seen in a 3:1 ratio to the QRS complexes. The QRS complexes are narrow and there is a tall T seen. Could be hyperkalemic. It would be a good reason to check a serum K level. PR: ---, QRS: .08 sec, QT: .36 sec. Interpretation: Atrial flutter.
5. c. Junctional rhythm.  This rhythm looks regular. The heart rate is 50/min. No P waves are seen. The QRS complexes are narrow. These are characteristics of a junctional rhythm. PR: ---, QRS: .o8 sec, QT: .44 sec. Interpretation: Junctional rhythm.



Wednesday, June 25, 2014

Practice Rhythm Strips 304

Identify the following rhythms.

1.






a. Ventricular fibrillation
b. Ventricular tachycardia
c. Asystole
d. Ventricular standstill


2.







a. NSR with PACs
b. NSR with some PJCs
c. NSR with a couple of PVC
d. NSR with escape beats


3.






a. 1st degree block
b. Wenckebach
c. Mobitz II
d. Complete heart block


4.








a. Sinus bradycardia with a multifocal couplet
b. NSR with multifocal PVCs
c. Sinus arrhythmia with uniform PVCs
d. Sinus tachycardia with bigeminal PVCs


5.







a. Ventricular standstill
b. Asystole
c. Agonal rhythm
d. Sinus bradycardia



Answers

1. a. Ventricular fibrillation.  Juice 'em up at 200 J.
2. a. NSR with PACs
3. b. Wenckebach.  Those P waves are drifting away from the QRS complexes. The rhythm is irregular with a rate of 50/min. The P waves are positive and uniform. There is progressive elongation of the PR interval over successive beats.  Interpretation:  2nd degree AV Block Type II or just plain Wenckebach
4. b. NSR with multifocal PVCs.
5. a. Ventricular standstill.  The rhythm is regular with an atrial rate of 60. No QRS complexes are seen thus there is no ventricular activity and no cardiac output. Luckily for us the patient is a DNR. Interpretation: Ventricular standstill or P wave asystole.

Tuesday, June 24, 2014

Practice Rhythm Strips 303

Identify the following rhythms.

1.







a. Atrial paced
b. Biventricular paced
c. Dual paced
d. Ventricular paced


2.






a. Normal sinus rhythm with couplets
b. Normal sinus rhythm with multifocal PVCs
c. Normal sinus rhythm with multiform PVCs
d. Normal sinus rhythm with bigeminal PVCs


3.







a. Idioventricular rhythm
b. Sinus bradycardia
c. Junctional rhythm
d. Agonal rhythm


4.







a. Sinus bradycardia with 1st degree block
b. Junctional rhythm with 1st degree block
c. Idioventricular rhythm with 1st degree block
d. 2nd degree AV block type I


5.








a. 1st degree AV block
b. 2nd degree AV block type I
c. 2nd degree AV block type II
d. 3rd degree block


Answers
1. c. Dual paced. The rhythm is regular. The rate is 70/min. There are atrial pacer spikes seen before the P waves and Biventricular pacer spikes seen before each QRS complex. No ectopic beats are noted. PR: .20 sec, QRS: .16 sec, QT: .48 sec. Interpretation: Dual paced.
2. d. Normal sinus rhythm with bigeminal PVCs. The rhythm is irregular with a rate of 80/min. There are upright P waves associated with a QRS complex. The QRS complexes are wider than normal. There are unifocal PVCs seen every other beat. PR: .16 sec, QRS: .12 sec, QT: .36 sec. Interpretation: NSR with bigeminal PVCs
3. c. Junctional rhythm. The rhythm is regular with a rate of 60/min. No P waves are seen. The QRS complexes are narrow. No ectopic beats are noted. PR: ---, QRS: .08 sec, QT: .40 sec. Interpretation: Junctional rhythm
4. a. Sinus bradycardia with 1st degree block.  The rhythm is regular. The rate is 47/min. The P waves are upright and paired with a QRS complex. The PR interval is prolonged. The QRS complexes are narrow. No ectopic beats are seen. PR: .24 sec, QT: .08 sec, QT: .40 sec. Interpretation: Sinus bradycardia with 1st degree block
5. c. 2nd degree AV block type II.   Look at your PR interval. If it is consistent then it is either a 1st degree or a type II. If it is consistent and there are dropped beats then it is 2nd degree type II. Easy peasy!

Monday, June 23, 2014

Practice Rhythm Strips 302

Identify the following rhythms.

1.







a. Sinus tachycardia
b. Ventricular tachycardia
c Supraventricular tachycardia
d. Multifocal atrial tachycardia


2.








a. Atrial paced
b. AV paced
c. Biventricular paced
d. Ventricular paced

3.







a. 1st degree AV block
b. Idioventricular rhythm
c. Agonal rhythm
d. Complete heart block


4.







a. Torasades de pointe
b. Monomorphic ventricular tachycardia
c. Polymorphic ventricular tachycardia
d. Multifocal atrial tachycardia

5.







a. Normal sinus rhythm with multifocal PVCs
b. Atrial fibrillation with multifocal PVCs
c. Sinus arrhythmia with multifocal PVCs
d. Sinus bradycardia with multifocal PVCs


Answers

1. a. Sinus tachycardia.  There are inverted T waves present. So those deflections before the QRS complexes are probably atrial in origin.  The rhythm is regular with rate of 150/min. There are upright P waves that precede the QRS complexes. The QRS complexes are narrow. There are inverted T waves present suggesting myocardial ischemia. No ectopic beats are noted. PR: .12 sec, QRS: .08 sec, QT: .24 sec. Interpretation: Sinus tachycardia
2. d. Ventricular paced
3. d. Complete heart block
4. a. Torasades de pointe.  The rhythm is irregular with a rate of 200/min. No P waves are seen. The QRS complexes show a variety of morphologic differences which always pointes to a variety of ectopic sites. Notice how the axis of the QRS complex changes from positive to negative and how the amplitude of the QRS complexes begins small and gets large then decreases in size. This is characteristic of Torsades de pointe. Technically it is a polymorphic VT but not all polymorphic VT demonstrates the changes in axis and characteristic changes in the amplitude of the QRS complexes.
5. b. Atrial fibrillation with multifocal PVCs.  The problem with this strip is that there are not enough intrinsic or native beats to make a sound interpretation. The rhythm could also be interpreted as junctional. The PVCs make the rhythm very irregular which is also a characteristic of atrial fibrillation. But the underlying rhythm could be an irregular junctional rhythm because of the PVCs. The fibrillatory activity of this rhythm is not really evident. But sometimes that is the case when the rhythm is very slow. Having seen the strip in it's entirety, I had prior knowledge of the underlying rhythm and made a conclusion based upon that prior knowledge rather that instead a step-wise interpretation of the strip.