Friday, October 17, 2014

Practice EKG Strips 339

Identify the following rhythms.


1.





a. NSR with 4 beat run of VT and a couplet
b. Sinus tachycardia with 4 beat run of VT and a couplet
c. SVT with 4 beat run of VT and a couplet
d. NSR with unifocal PVCs and a couplet

2.






a. NSR with a dropped PAC and a ventricular escape beat
b. Sinus bradycardia with sinus arrest and a ventricular escape beat
c. Sinus rhythm with a dropped PAC and a junctional escape beat
d. Sinus arrhythmia with a unifocal PVC

3.







a. Normal sinus rhythm with short run of VT
b. Normal sinus rhythm with short run of MAT
c. Normal sinus rhythm with short run of SVT
d. Normal sinus rhythm with short run of AT


4.







a. 2nd degree heart block with blocked PAC
b. Normal sinus rhythm with a pause
c. 2nd degree heart block type II
d. Sinus arrhythmia

5.







a. AV paced with demand ventricular pacing
b. Atrial paced with demand AV pacing
c. Ventricular paced with demand atrial pacing
d. Biventricular pacing with demand AV pacing




Answers
1.  a. NSR with 4 beat run of VT and a couplet
2.  b. Sinus bradycardia with sinus arrest and a ventricular escape beat
3.  c. Normal sinus rhythm with short run of SVT
4.  a. 2nd degree heart block with blocked PAC.   Notice the change in the height of the T wave on the 1st, 4th, and 7th complexes.  This suggests that there are early nonconducted P waves that are fused with the T waves.  The PR interval gets progressively longer over successive beats as you would expect with a type I block but there is not a dropped beat that is characteristic of a Wenckebach rhythm.  I suspect that the nonconducted PACs cause a compensatory pause in the rhythm which allows the SA node to reset itself before the cycle resumes.
5.  c. Ventricular paced with demand atrial pacing. An atrial pacer spike follows the first and sixth complexes. The fifth complex looks like a fusion complex between a paced beat and a PVC.  There is 100% ventricular pacing but there is not an atrial pacer spike for all the QRS complexes so that is the one that is in the demand mode.






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