Friday, June 13, 2014

Practice Rhythm Strips 295

Identify the following rhythms

1.











a. NSR with unifocal PVCs
b. NSR with a multifocal couplet
c  NSR with bigeminal PVCs
d. NSR with multiform PVCs

2.


a.  First degree block with unifocal PVCs
b.  Second degree block type I with unifocal PVCs
c.  Second degree block type II with unifocal PVCs
d. Third degree block with unifocal PVCs

3.












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

4.






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


5.






a.  NSR with bigeminal PVCs
b.  Idioventricular with bigeminal PVCs
c.  Agonal rhythm with bigeminal PVCs
d. Ventricular paced with bigeminal PVCs


Answers

1. b. NSR with a multifocal couplet.  The rhythm is irregular with a rate of 80/min. There are upright P waves that are paired with a QRS complex. The QRS complexes are narrow. A multifocal couplet follows the 3rd complex. PR: .16 sec, QRS: 08 sec, QT: .40 sec. Interpretation: Sinus arrhythmia with a multifocal couplet.
2. d. Third degree block with unifocal PVCs.  There is some kind of funky AV dissociation going on plus a couple of unifocal PVCs thrown in for good measure. The heart rate of 70/min is much faster than what you would expect from a 3rd degree block of ventricular origin, the inherent ventricular rate is 20-40. The QRS complexes are narrow and the P waves are upright. The narrow QRS complexes point towards an accelerated junctional mechanism underlying the rhythm. If you measure out the P-P intervals they are fairly regular. The P wave of the first complex is buried within the QRS complex. On the 2nd complex you can see how the P wave distorts the shape of the initial upstroke of the QRS complex. The P wave of the 5th complex follows the QRS complex.
3. b.  NSR with PACs.  The rhythm is irregular with a heart rate of 80/min. The P waves are uniform, positive and associated with a QRS complex. The QRS complexes are narrow. PACs are seen every other beat. The P waves of the PACs are seen best in lead V1. The 7th complex is an atrial paced beat. Interpretation: NSR with demand atrial pacing and bigeminal PACs.
4. a.  NSR with PJCs.  The rhythm is irregular with a heart rate of 50/min. The P waves are seen but the PR interval is prolonged. The QRS complexes are narrow. A PJC is seen, the 2nd and 4th complexes. PR: .24 sec, QT: .08 sec, QT: .48 sec. Interpretation: Sinus bradycardia with PJCs.
5. d. Ventricular paced with bigeminal PVCs.   I invite any discussion about this strip. The complexes that follow the paced beats could be either PVCs or something intrinsic. They follow the paced beats rather early and give the impression of being unifocal PVCs. However, if you measure the R-R interval of these ventricular beats they are regular and have a rate of 35/min, within the norm of what you would expect with idioventricular rhythm. 

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