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.


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