Thursday, June 12, 2014

EKG Rhythm Quiz 245

Identify the following rhythms.

1.






a.  NSR with PACs
b.  NSR with PJCs
c.  NSR with PVCs
d.  Sinus arrhythmia

2.







a. First degree block
b. Second degree block type I
c. Second degree block type II
d. Complete heart block

3.






a. Agonal rhythm
b. Asystole
c. Ventricular standstill
d. Complete heart block

4.













a. Sinus arrhythmia with multifocal PVCss
b. 1st degree block with bigeminal PVCs
c. 2nd degree AV block type I
d. Ventricular trigeminy

5.









a.  Torsades de pointes
b.  Accelerated idioventricular rhythm
c.  Polymorphic ventricular tachycardia
d. Ventricular fibrillation

6.











a.  Atrial flutter
b. Atrial fibrillation
c. Atrial tachycardia
d. Multifocal atrial tachycarda

7.











a.  Sinus rhythm with sinus arrest
b.  Sinus bradycardia with a dropped PAC
c.  2nd degree AV block type II
d.  Idioventricular rhythm

8.











a.  Atrial fibrillation
b. Atrial flutter
c. Multifocal atrial tachycardia
d. Wandering atrial pacemaker

9.














a.  Sinus rhythm with a pause and an atrial escape beat
b.  Sinus rhythm with a pause and a junctional escape beat
c.  Sinus rhythm with a pause and a ventricular escape beat
d.  Sinus rhythm with a compensatory pause

10.








a.  Sinus bradycardia with sinus arrest
b.  Sinus bradycardia with a dropped PAC
c.  Complete heart block
d.  Idioventricular rhythm



Answers
01.  b.  NSR with PJCs.  The rhythm is irregular with a rate of 60/min. Positive and negative P waves are seen. The P waves are paired with a QRS complex. The QRS complexes are narrow. There is some T wave inversion present. PJCs are seen, the 2nd and 5th complexes. Notice the inverted P waves. PR: .16 sec, QRS: .08 sec, QT: .38 sec. Interpretation: NSR with PJCs.
02. c. Second degree block type II. It looks like sinus rhythm but you can see the extra P wave sticking out of the T wave. Other option for those extra P waves might be dropped PACs. Sometimes there are not any real clear answers. The heart just does not play by our rules.
03.  a. Agonal rhythm.  Other options:  FTD (Fixin ta die), Open the window.....and..say a prayer, Celestial discharge, DND (Darn near dead), Circling the drain, Heading toward the Light, Kicking the bucket
04. b. 1st degree block with bigeminal PVCs
05. c.  Polymorphic ventricular tachycardia.  You do not see the QRS axis change that would be expected if this were TDP.  
06. a.  Atrial flutter.  This has a "warty" looking appearance.   The electronic interpretation suggested an ectopic atrial rhythm competing with an underlying ventricular rhythm.
07. b.  Sinus bradycardia with a dropped PAC.  That little hump after the 1st complex may be a nonconducted P wave.
08. c. Multifocal atrial tachycardia.  The rate is over 100 and there are a variety of different looking P waves.  09. a.  Sinus rhythm with a pause and an atrial escape beat.  The morphology of the P wave of the escape beat does not look like those of sinus origin
10. a.  Sinus bradycardia with sinus arrest.    Arrest seems like an understatement.





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