Tuesday, June 10, 2014

EKG Rhythm Quiz 243

Identify the following rhythms.

1.






a. Sinus arrhythmia with multiform PVCs
b. NSR with unifocal PVCs
c. NSR with multifocal PVCs
d. NSR with trigeminal PVCs


2.







a. NSR with uniform PVCs
b. NSR with PJCs
c. NSR with multifocal PVCs
d. NSR with PACs

3.






a. NSR with PJCs
b. NSR with unifocal PVCs
c. NSR with multifocal PVCs
d. NSR with frequent PACs

4.






a. NSR with PJCs
b. NSR with unifocal PVCs
c. NSR with PVCs
d. NSR with PACs

5.






a. Atrial flutter with PJCs
b. Atrial flutter with unifocal PVCs
c. Atrial flutter with multifocal PVCs
d. Atrial flutter with uniform PACs

6.













a. Atrial fibrillation with a triplet of PVCs
b. Atrial paced with a triplet of PVCs
c. Ventricular paced with a PVC triplet
d. Sinus rhythm with a PVC triplet

7.





a. Sinus arrhythmia with a multifocal triplet
b. Sinus rhythm with a unifocal couplet
c. Junctional rhythm with a couplet
d. Accelerated junctional rhythm with a couplet

8.






a. Sinus arrhythmia with unifocal PVCs
b. Second degree heart block type II with multifocal PVCs
c. Complete heart block with bigeminal PVCs
d. Idioventricular rhythm with unifocal PVCs

9.









a. Sinus arrhythmia
b. NSR with frequent PACs
c. 2nd degree heart block type II
d. NSR with trigeminal PJCs

10.











a. First degree block with bigeminal PJCs
b. Sinus rhythm with bigeminal PVCs
c. Sinus rhythm with bigeminal PACs
d. Sinus arrhythmia with bigeminal



Answers

1.  b. NSR with unifocal PVCs.  The rhythm is irregular. The rate is 70/min. Upright, uniform P waves are seen in association with a QRS complex. The sinus QRS complexes are narrow. Two unifocal PVCs are seen, the 3rd and 7th complexes. PR: .16 sec, QRS: .08 sec, QT: .40 sec. Interpretation: NSR with unifocal PVCs
2. c. NSR with multifocal PVCs
3. a. NSR with PJCs  The rhythm is irregular with a rate of 60/min. There are both positive and negative P waves present. The QRS complexes are narrow. There are PJC every other beat, junctional bigeminy. PR: .12 sec, QRS: .08 sec, QT: .40 sec. Interpretation: NSR with bigeminal PJCs.
4. d. NSR with PACs.  The rhythm is irregular with a rate of 90/min. The P waves are upright and associated with a QRS complex. The QRS complexes are narrow. PACs are seen in a bigeminal pattern. Some of the P waves of the PACs are fused within the T waves of the previous complexes. PR: .20 sec, QRS: .08 sec
5. c. Atrial flutter with multifocal PVCs.  The rhythm is irregular due to the ventricular ectopy. The heart rate is 80/min. Flutter waves are seen in a 3:1 pattern. The QRS complexes are narrow. Multifocal PVCs are seen, the 5th and 8th complexes. PR: ---, QRS: .08 sec, QT: .36 sec. Interpretation: Atrial flutter with multifocal PVCs
6. d. Sinus rhythm with a PVC triplet.   The underlying rhythm is regular.   The rate is 88 bpm.   Upright P waves precede the QRS complexes.  Three PVCs occur in quick succession, a triplet.  PR: 16 sec, QRS: .08 sec, QT: .28 sec.  Interpretation:  Sinus rhythm with a PVC triple
7. a. Sinus arrhythmia with a multifocal triplet.  The rhythm is irregular with a rate of 65/min.   The P waves are associated with a QRS complex and are upright.  A multifocal triplet follows the 5th complex.  PR:  .16 sec,  QRS: .08 sec, QT: .36 sec.  Interpretation:  Sinus arrhythmia with a multifocal triplet
8.  c. Complete heart block with bigeminal PVCs.   The rhythm is irregular with a ventricular rate of 50 bpm. The P waves are not paired up with the QRS complexes.  The atrial rate is around 94 bpm.  Bigeminal PVCs are seen.  PR:  ---,  QRS:  .16 sec,  QT: .60 sec.  Interpretation:  Complete heart block with bigeminal PVC
9.  d. NSR with trigeminal PJCs.   The rhythm is irregular.   The heart rate is 60 bpm.   There are upright P waves before each sinus beat.   There are inverted P waves seen with the ectopic beats, the 3rd, 6th, ad 9th complexes.  The QRS complexes are narrow.   PR:  12 sec,  QRS:  .08 sec,  QT:  .44 sec.  Interpretation: NSR with trigeminal PJCs
10.  c. Sinus rhythm with bigeminal PACs.   The rhythm is irregular.   The rate is 50 bpm.   Upright P waves are associated with each QRS complex.  There are PACs seen every other beat.  There is a slight variation in the morphology of the ectopic P wave compared to the sinus P wave.   PR:  .20 sec,  QRS:  .12 sec, QT .36 sec.  Interpretation:  Sinus rhythm with bigeminal PAC


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