Tuesday, June 17, 2014

Practice Rhythm Strips 297

Identify the following rhythms.

1.










a. I am calling it junctional rhythm
b. No wait. It is complete heart block
c. It looks like accelerated idioventricular to me
d. It probably is sinus bradycardia

2.











a. It has to be normal sinus rhythm
b. 1st degree block, for sure
c. I'm thinking sinus arrhythmia
d. Sinus bradycardia without a doubt


3.













a. Could be junctional tachycardia with inverted T waves
b. Might be sinus tachycardia with inverted T waves
c. What about atrial tachycardia with inverted T waves
d. Definitely supraventricular tachycardia with inverted T waves

4.











a. I choose atrial paced
b. Let it be AV paced
c. No, it is biventricular paced
d. Ventricular paced, final answer


5.






a. I choose normal sinus rhythm with pauses
b. Give me idioventricular rhythm or give me death
c. Sinus bradycardia is the one for me
d. I will take junctional rhythms for 500 Alex




Answers

1. c. It looks like accelerated idioventricular to me.  The rhythm is slightly irregular with a rate of 60. No P waves are seen. The QRS complexes are wide suggesting a ventricular rhythm. No ectopic beats are noted. There is some ST depression present. PR:---, QRS: .16 sec, QT: .48 sec. Interpretation: Accelerated idioventricular rhythm
2. c. I'm thinking sinus arrhythmia.  The rhythm is irregular with a heart rate of 80/min. The P waves have a corresponding QRS complex. The QRS complexes are narrow. No ectopic beats are seen. The R-R interval between the 1st and 2nd complex is .60 sec and the R-R interval between the 4th and 5th complex is .72 sec. PR: .16 sec, QRS: .08 sec, QT: .36 sec. Interpretation: Sinus arrhythmia
3. b. Might be sinus tachycardia with inverted T waves. The rhythm is regular. The heart rate is fast, 125/min. The P waves are upright and have a corresponding QRS complex. The QRS complexes are narrow. There is down slopping of the ST segment with inversion of the T wave. You would suspect inferior ischemia since lead III is an inferior lead. Look for corresponding changes in lead II and aVF. No ectopic beats are noted. PR: .16 sec. QRS: .08 sec, QT: .28 sec. Interpretation: Sinus tachycardia.
4. b. Let it be AV paced.  The rhythm is regular with a rate of 60/min. There are small, low voltage P waves that are preceded by an atrial pacer spike as well as QRS complexes that are preceded by a single pacer spike. The PR interval is prolonged, .28 sec. The QRS complexes are wide which is typical for a paced beat. Typically you see a negative QRS complex followed by a P wave of opposite polarity. Because the impulse travels outside the usually electrical pathways the QRS complex is wider. The PR interval is programed to be prolonged as this delays the onset of a pacemaker induced cardiomyopathy.
5. d. I will take junctional rhythms for 500 Alex.   The rhythm is regular with a rate of 40 min. No P waves are seen and the QRS complexes are narrow. These are characteristics of a junctional rhythm. No ectopic beats are seen. PR: ---, QRS: .08 sec, QT: . 52 sec. Interpretation: Junctional rhythm.




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